When Loved Ones and Patients Don’t Choose Life

By Karen Roush, AJN clinical managing editor

Photo by the author Photo by the author

This isn’t the blog post I started out to write. That was a more personal story about someone close to me, let’s call this person Jess, who died after years of chronic illness worsened by self-neglect—after years of being that person Olsen talks about in this month’s article (free until August 15) on helping patients who don’t help themselves (and in his related blog post from last week).

But as I wrote, I realized that it wasn’t fair, that I was leaving out the complex story behind their persistent unhealthy behaviors, behaviors that eventually led to a lingering, awful death.

And without that background knowledge, it was too easy to be judgmental—as it is sometimes too easy for us as nurses to be judgmental of patients who don’t help themselves, who even seem to be willfully destroying their own health: the obese person who keeps drinking those giant sodas, the smoker who lights up another cigarette. As a nurse it can be very frustrating to care for a patient who ignores health recommendations, to their own detriment. As a family member or friend, it can be heartbreaking and infuriating.

There are limits to what we can do. We cannot force patients to eat well, take necessary medications, quit smoking, modify their alcohol intake, wear their seatbelts . . . the list goes on and on. Yes, we […]

2016-11-21T13:07:02-05:00July 15th, 2013|nursing perspective|4 Comments

Obesity as Disease and the Health Care Culture’s Take on Personal Responsibility and Suffering

Doug OlsenBy Doug Olsen, PhD, RN, associate professor, Michigan State University College of Nursing, and AJN contributing editor. Olsen regularly addresses topics related to nursing ethics. His most recent article for AJN was “Helping Patients Who Don’t Help Themselves” (July issue; free until August 15).

Why does the American Medical Association’s recognition of obesity as a disease (AMA, 2013) stir strong feelings? People are just as heavy as before, their health is suffering as much, and the therapies for obesity remain the same. The main difference is that the label may give clinicians a better rationale to seek reimbursement for obesity-related services, which might help increase treatment rates. No one yet knows if the new label will really have an effect on treatment rates; in any case, this is not what people are concerned about.

The issue is what labeling a health problem with a behavioral component as a “disease” implies about personal responsibility—or what people think it means. How does personal responsibility relate to individual suffering?

The relationship between decision making, suffering, and personal responsibility is at the heart of bioethics as it is practiced in the United States. But bioethics didn’t invent our cultural tendency to connect personal responsibility and sympathetic regard for suffering, and our current approach to the issue was developed […]

2017-04-03T12:12:36-04:00July 11th, 2013|Ethics, patient engagement, Public health|0 Comments
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