Timothy W. Kirk

National Hospice and Palliative Care Organization (NHPCO) Position Statement and Commentary on the Use of Palliative Sedation in Imminently Dying Terminally Ill Patients

This paper was written by Timothy W. Kirk, PhD, and Margaret M. Mahon, PhD, RN, FAAN, on behalf of the Palliative Sedation Task Force of the National Hospice and Palliative Care Organization (NHPCO) Ethics Committee. Members of the Palliative Sedation Task Force were Timothy W. Kirk, PhD (Chair), Kathleen Bliss, MSN, RN, CHA, Pamela Dalinis, MA, BSN, RN, Margaret M. Mahon, PhD, RN, FAAN, Martha McCusker, MD, FACP, W. Brian Guthrie, MD, Marian Silverman, PhD, RN, CHPN, and Joseph Wadas, STL. This paper was approved by the NHPCO Ethics Committee in October 2009 and the NHPCO Board of Directors in December 2009. Creation of this manuscript was not supported by external funding. All members of the NHPCO Ethics Committee are volunteer members. Address correspondence to: Timothy W. Kirk, PhD, Department of History and Philosophy, CUNYdYork College, 94-20 Guy R Brewer Blvd., Jamaica, NY 11451, USA. E-mail: timothy.kirk@york.cuny.edu

Deactivation of automatic implantable cardioverter-defibrillators in hospice and home care patients at the end of life.

For patients at the end of life, active automatic implantable cardioverter-defibrillators (AICDs) may no longer achieve the treatment goals present at the time of implantation. It is possible to deactivate AICDs in patients with terminal and life-limiting diagnoses, thereby preventing the pain and distress of nontherapeutic discharge. This article presents a moral argument for the right of such patients to have their AICDs deactivated. It then explains that hospice and home care agencies have an obligation to address AICD deactivation at a policy level and offers recommendations for doing so.

Engaging Requests for Nondisclosure During Admission to Home Hospice Care

It is not uncommon for hospice admission nurses to receive requests from loved ones to withhold information from patients about their diagnosis or prognosis. Such requests may occur in the context of similar requests having previously been honored by other, nonhospice care teams. This article explores the ethical questions raised by such requests and the motivations behind them. Following, it offers ways to engage requests for nondisclosure that honor ethical obligations to patients and families in a manner consistent with the hospice philosophy of care. The principles of truthfulness, sensitivity, and beneficence are introduced, and a framework using those principles to respond to requests for nondisclosure is proposed.

Intimacy, caring, and an ethics of care.

Intimacy, caring, and an ethics of care I was pleased to read the letter from Mochan (2008) in the July 2008 issue of Nursing Philosophy regarding my 2007 article, ‘Beyond empathy: clinical intimacy in nursing practice’. She raises important questions regarding the possible contributions made by my model of clinical intimacy to a general theory of caring in nursing. Similarly, I read with great interest Betts’ (2008) letter in the October 2008 issue responding to Mochan’s letter and raising concerns about theories of caring being taught absent a grounding in the ethics of care spawned by Gilligan’s (1982) groundbreaking work. In the few paragraphs that follow I offer a brief response to both letters. Mochan raises concerns about reciprocity blurring boundaries in patient–practitioner encounters. As I stress in my article, however, it is complementary behaviours – not reciprocal ones – that are central to my model of clinical intimacy. Indeed, there may be occasions on which reciprocity constitutes a complementary behaviour, but it is by no means a required component in an intimate interaction. My example – perhaps poorly chosen – of the exchange between the psychiatric nurse and patient who attempted suicide is intended to show the effects of complementary behaviours in a way that de-emphasizes reciprocity. Indeed, as I write,