Conflicting Values: A Case Study in Patient Choice and Caregiver Perspectives

Decisions related to births in the "gray zone" of periviability are particularly challenging. Despite published management guidelines, clinicians and families struggle to negotiate care management plans. Stakeholders must reconcile conflicting values in the context of evolving circumstance...

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Bibliographic Details
Published in:Narrative inquiry in bioethics 2015-06, Vol.5 (2), p.167-178
Main Authors: Eves, Margot M, Danziger, Phoebe Day, Farrell, Ruth M, Cole, Cristie M
Format: Article
Language:English
Subjects:
Attitude of Health Personnel
Bioethics
Caregivers - ethics
Caregivers - psychology
Decision Making - ethics
Disabled Persons
Dissent and Disputes
Ethics Consultation
Female
Gestational Age
Humans
Morals
Patient Participation
Patient Selection
Personal Autonomy
Physician-Patient Relations - ethics
Pregnancy
Pregnancy Outcome
Premature Birth
Risk
Stress, Psychological
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Summary:Decisions related to births in the "gray zone" of periviability are particularly challenging. Despite published management guidelines, clinicians and families struggle to negotiate care management plans. Stakeholders must reconcile conflicting values in the context of evolving circumstances with a high degree of uncertainty within a short time period. Even skilled clinicians may struggle to guide the patient in making value-laden decisions without imposing their own values. Exploring the experiences of one pregnant woman and her caregivers, this case study highlights how bias may undermine caregivers' ability to meet their obligation to enhance patient autonomy and the moral distress they may experience when a patient's values do not align with their own. Management strategies to mitigate the potential impact of bias and related moral distress are identified. The authors then describe one management strategy used in this case, facilitated ethics consultation, which is focused on thoughtful consideration of the patient's perspective.
ISSN:2157-1732
2157-1740
2157-1740
DOI:10.1353/nib.2015.0054