Capacity-oriented accounts of animal ethics have been fairly successful in establishing that the interests of animals ought to be included in moral considerations. Yet, even when individual animals have identical capacities and interests there remains a strong intuition that we have greater moral obligations to some animals, such as pets, than to others, such as animals in the wild. This thesis argues that contemporary relational approaches to animal ethics offer a plausible, more direct means of accounting for this intuition that do current forms of capacity-oriented approaches such as those offered by Peter Singer an Tom Regan. / Graduate

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The media is an important information source regarding psychiatric nursing care. There has been limited English language research that has specifically explored the nurse-patient relationships that were depicted in film between psychiatric nurses and the people for whom they cared. Using an interpretive visual inquiry method, fifteen films were selected and analyzed using a relational ethics framework. The films were: Cosi (Joffe, 1996), Frances (Clifford, 1982), Girl, Interrupted (Mangold, 1999), Gothika (Kassovitz, 2003), Harvey (Koster, 1950), High Anxiety (Brooks, 1977), One Flew Over the Cuckoo’s Nest (Forman, 1975), Persona (Bergman, 1966), Snake Pit (Litvak, 1948), Terminator 2: Judgement Day (Cameron, 1991), The Caretakers (Bartlett, 1963), The Cobweb (Minnelli, 1955), The Jacket (Maybury, 2005), The Sleep Room (Wheeler, 1998), and Titicut Follies (Wiseman, 1967). The roles of the nurses were described using Peplau’s (1952/1988) role descriptions. These included the roles of stranger, resource person, teacher, leader, surrogate, counsellor, consultant, tutor, safety agent, mediator, administrator, recorder, observer, and researcher. Exemplars were drawn from the films to discuss each of the following relational ethics themes: mutual respect, engagement, embodied knowledge, environment, and uncertainty. Two primary discourses were found embedded within the relational ethic themes: otherness and power/control. Within these discourses, sub-discourses relating to stigmatization, prejudice, domination, and marginalization were also found. Nursing must be attentive to the messages contained within the depictions of psychiatric nursing care. Nurses can no longer afford to be silent; as these images have consequences for the patients, their families, and the nurses working in this complex specialty area.

This research explored psychological, social, and relational aspects of caregiving. It examined documented resolution of ethical dilemmas precipitated by veterans' medical crises and involved formal caregivers, informal caregivers, and veteran patients. The unit of analysis was caregiving relationships. The main research question asked, how does case documentation and documented processes of resolving ethical dilemmas in institutional healthcare for veterans reflect relational ethics? Relational ethics was defined as fairness of interpersonal give and take and included efforts to elicit, understand, and honor veteran's values and care preferences. The caregiving context was a Veterans Affairs Medical Center (VAMC). The research population was 25 male veterans whose cases required intervention by the VAMC ethics committee. The research was conducted in three phases using grounded theory methodology. The research purpose, guided by symbolic interaction theory, was to develop substantive theory in relational ethics. Study analyses used Atlas.ti qualitative software. Main study one, Veteran-Formal Caregiver Relations, focused on relational processes internal to the VAMC. It explored how members of professional healthcare disciplines documented ethical caregiving concerns amongst themselves and in interactions with veteran patients. Agency emerged as the core category. Agency meant that veteran patients could make choices and act on those choices in ways that impacted their care. When veterans' agency was compromised, formal caregivers' roles became more salient. The substantive theory was the dynamic process of clarifying agency. Main study two, Formal-Informal Caregiver Relations, focused on interactions between VAMC staff and veterans' significant others. It explored medical center staff communications with informal caregivers regarding veterans' health problems. Documented interactions confirmed the impact of relational ethics. Agendas and advocacy emerged as key categories that determined and respected veterans' relational autonomy. Relational autonomy validated other ethical concerns and resource demands, considered social context, and included obligations as well as entitlements. The substantive theory was the agenda to advocate for relational autonomy. Substantive theories from the two main studies were integrated. Categorical dimensions were combined into substantive theory; that doing the right thing in institutional caregiving for veterans was the dynamic process of clarifying agency with the agenda to advocate for relational autonomy. / Ph. D.

Delirium is a disturbance of consciousness and cognition that affects many terminally ill patients before death. It can manifest as confusion, hallucinations, and restlessness, all of which are known to be distressing to patients, families, and professional caregivers. Underlying the contemporary palliative care movement is a belief in the idea that a good death is possible; that dying can be made better for patients and families through the proper palliation of distressing symptoms and through proper attention to psychological, social, and spiritual issues that affect wellbeing at the end of life. Given that delirium is potentially disruptive to all that the good death assumes, i.e., mental awareness, patient-family communication, peace and comfort, the question was asked: What is the relationship between end-of-life delirium and the good death in hospice care? Ethnographic fieldwork was conducted at a freestanding residential hospice over a period of 15 months in a suburban community in eastern Canada. The research methods included participant observation (320 hours over 80 field visits), interviews with 28 hospice caregivers, and document analysis. The findings of this study provide an in-depth examination of the nature of caregiving relationships with patients and with families in end-of-life care. They illustrate how a commitment toward providing for the good death prevails within the cultural community of hospice, and how the conceptualization, assessment, and management of end-of-life delirium are organized within such a commitment. In this setting, experiences of conscious and cognitive change in dying are woven by hospice caregivers into a coherent system of meaning that is accommodated into prevailing scripts of what it means to die well. At the same time, delirium itself provides a facilitative context whereby processes of supporting families through the patient’s death are enabled. This study highlights the relevance of considering the contextual and cultural features of individual end-of-life care settings that wish to examine, and perhaps improve, the ways in which care of delirious patients and their families is provided.

No description available.

Delirium is a disturbance of consciousness and cognition that affects many terminally ill patients before death. It can manifest as confusion, hallucinations, and restlessness, all of which are known to be distressing to patients, families, and professional caregivers. Underlying the contemporary palliative care movement is a belief in the idea that a good death is possible; that dying can be made better for patients and families through the proper palliation of distressing symptoms and through proper attention to psychological, social, and spiritual issues that affect wellbeing at the end of life. Given that delirium is potentially disruptive to all that the good death assumes, i.e., mental awareness, patient-family communication, peace and comfort, the question was asked: What is the relationship between end-of-life delirium and the good death in hospice care? Ethnographic fieldwork was conducted at a freestanding residential hospice over a period of 15 months in a suburban community in eastern Canada. The research methods included participant observation (320 hours over 80 field visits), interviews with 28 hospice caregivers, and document analysis. The findings of this study provide an in-depth examination of the nature of caregiving relationships with patients and with families in end-of-life care. They illustrate how a commitment toward providing for the good death prevails within the cultural community of hospice, and how the conceptualization, assessment, and management of end-of-life delirium are organized within such a commitment. In this setting, experiences of conscious and cognitive change in dying are woven by hospice caregivers into a coherent system of meaning that is accommodated into prevailing scripts of what it means to die well. At the same time, delirium itself provides a facilitative context whereby processes of supporting families through the patient’s death are enabled. This study highlights the relevance of considering the contextual and cultural features of individual end-of-life care settings that wish to examine, and perhaps improve, the ways in which care of delirious patients and their families is provided.

Delirium is a disturbance of consciousness and cognition that affects many terminally ill patients before death. It can manifest as confusion, hallucinations, and restlessness, all of which are known to be distressing to patients, families, and professional caregivers. Underlying the contemporary palliative care movement is a belief in the idea that a good death is possible; that dying can be made better for patients and families through the proper palliation of distressing symptoms and through proper attention to psychological, social, and spiritual issues that affect wellbeing at the end of life. Given that delirium is potentially disruptive to all that the good death assumes, i.e., mental awareness, patient-family communication, peace and comfort, the question was asked: What is the relationship between end-of-life delirium and the good death in hospice care? Ethnographic fieldwork was conducted at a freestanding residential hospice over a period of 15 months in a suburban community in eastern Canada. The research methods included participant observation (320 hours over 80 field visits), interviews with 28 hospice caregivers, and document analysis. The findings of this study provide an in-depth examination of the nature of caregiving relationships with patients and with families in end-of-life care. They illustrate how a commitment toward providing for the good death prevails within the cultural community of hospice, and how the conceptualization, assessment, and management of end-of-life delirium are organized within such a commitment. In this setting, experiences of conscious and cognitive change in dying are woven by hospice caregivers into a coherent system of meaning that is accommodated into prevailing scripts of what it means to die well. At the same time, delirium itself provides a facilitative context whereby processes of supporting families through the patient’s death are enabled. This study highlights the relevance of considering the contextual and cultural features of individual end-of-life care settings that wish to examine, and perhaps improve, the ways in which care of delirious patients and their families is provided.

No description available.