دانلود رایگان مقاله انگلیسی رهبری در طب آرام بخش: وجدانی، اخلاقی و آموزشی - اشپرینگر 2018

Abstract

Background: Making particular use of Shale’s analysis, this paper discusses the notion of leadership in the context of palliative medicine. Whilst offering a critical perspective, I build on the philosophy of palliative care offered by Randall and Downie and suggest that the normative structure of this medical speciality has certain distinctive features, particularly when compared to that of medicine more generally. I discuss this in terms of palliative medicine’s distinctive morality or ethos, albeit one that should still be seen in terms of medical morality or the ethos of medicine. Main text: I argue that, in the context of multi-disciplinary teamwork, the particular ethos of palliative medicine means that healthcare professionals who work within this speciality are presented with distinct opportunities for leadership and the dissemination of the moral and ethical norms that guide their practice. I expand on the nature of this opportunity by further engaging with Shale’s work on leadership in medicine, and by more fully articulating the notion of moral ethos in medicine and its relation to the more formal notion of medical ethics. Finally, and with reference to the idea of medical education as both on going and as an apprenticeship, I suggest that moral and ethical leadership in palliative medicine may have an inherently educational quality and a distinctively pedagogical dimension. Conclusions: The nature of palliative medicine is such that it often involves caring for patients who are still receiving treatment from other specialists. Whilst this can create tension, it also provides an opportunity for palliative care professionals to disseminate the philosophy that underpins their practice, and to offer leadership with regard to the moral and ethical challenges that arise in the context of End of Life Care.

Conclusion

Whilst palliative medicine – and palliative care more generally - differs from medical practice it is, nevertheless, part of this broader enterprise. As such we should understand its morality or ethos do be an instantiation or realisation of the ethos of medicine. Adopting this point of view we can appreciate that the values, norms and principles that come to the fore in both palliative medicine and palliative care are not absent from medical practice more generally. It is merely the case that each has a different emphasis. Some of the values, norms and principles that we find in the forefront of curative medical practices do not receive the same emphasis in palliative contexts. There is then, a certain degree of commonality between palliative and curative medicine, as a result there should be room for an appreciation of the shared aspects of their respective ethos. Nevertheless, one should acknowledge that palliative care is a subaltern medical culture. Whilst this may cause it to be somewhat neglected, or to be relegated to ‘Cinderella’ status, this does provide its practitioners with opportunity for moral, ethical and educational leaderships. Particularly in the context of an aging population, and increasing levels of chronic, and often terminal, illnesses amongst that population, it is becoming increasingly clear that what palliative care has to offer is what many patients require. Furthermore, at its best, palliative care can both improve patient’s quality of life and its quantity or length. Whilst any number of editorials and op ed. pieces can state these claims, the best proof is to be found by demonstrating the benefits of palliative care; displaying the contribution palliative care can make to patients is the best route to being involved in the orchestration of treatment more generally. Over the past few decades palliative care has established itself as a legitimate medical speciality. The challenge it now faces is to maintain this status whilst also become embedded in, or available to, medical practice more generally. One route to meeting this challenge is through providing the moral, ethical and educational leadership considered above.