Abstract
This thesis investigates “best interests” decisions concerning the care of adults with or approaching end-stage kidney failure. I focus on the ethico-legal dimensions of questions of dialysis provision versus conservative kidney management. Through an empirical bioethics approach, I complement my normative inquiry with qualitative exploration of the views and experiences of three stakeholder groups: nephrologists, renal nurses, and “consultees” (family members).Limited existing literature lacks consensus on how these decisions should be made, but overwhelmingly recognises difficulties in involving various stakeholders and manoeuvring towards an appropriate decision without conflict. There is acknowledgement of the complexity of balancing medical and non-medical factors, with particular reference to what the patient might value. Participants in my own empirical research similarly highlighted areas of conflict in their own experiences. Whilst wanting to respect the patient’s own care preferences, healthcare professionals and consultees alike spoke of a difficulty in accurately identifying such preferences. For professionals, resulting disagreements had the potential to lead them down the “path of least resistance” in trying to maintain relationships with those close to the patient.
Employing a process of reflective equilibrium, I combine my own intuitions with the perspectives identified in the literature and my empirical data to reach a set of coherent positions on how these best interests decisions should be made. I argue that active discussions should begin in advance of any significant care decision arising. These should focus on exploring not only what care options the patient might want, but also how the patient might want any future best interests decision to be approached. Further, these discussions should include the clarification of stakeholder roles in best interests decisions and sensitively set expectations – following which, strong communication should remain consistent. In addition, I highlight where research is needed to supplement my recommendations.
| Date of Award | 5 Dec 2023 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Jonathan C S Ives (Supervisor) & Fergus J Caskey (Supervisor) |
Cite this
- Standard