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- El-Alti, Leila, 1986, et al.
(author)
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Caregiver perspectives on patient capacities and institutional pathways to person centered forensic psychiatric care
- 2022
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:9
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Journal article (peer-reviewed)abstract
- The ethical discourse surrounding patients’ agential capacities, vis-à-vis their active participation in shared decision-making (SDM) in forensic psychiatric (FP) contexts, is an unexplored area of inquiry. The aim of this paper is to explore caregivers’ perceptions of patient agential capacities and institutional pathways and barriers to person centered care (PCC) in the context of FP. Following an exploratory qualitative design, we conducted eight semi-structured interviews with hands-on caregivers at an in-patient FP facility in Sweden. A deductive framework method of analysis was employed, and four themes emerged: “Fundamental Variability in Patient Capacity”, “Patient Participation: Narration or Compliance?”, “Antagonism Rooted in Power Struggles”, and “System Structure Thwarts Patient Release”. While the results generally paint a bleak picture for the possibility of a person-centered FP care, we describe a constrained version of PCC with high-level SDM dynamics which promotes a certain degree of patient empowerment while allowing care strategies, within set restrictions, to promote patient adherence and treatment progress.
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| 2. |
- El-Alti, Leila, 1986
(author)
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Confluence and Divergence of Emancipatory Healthcare Ideals and Psychiatric Contextual Challenges
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Person-centered care (PCC) is generally understood to involve shaping healthcare processes, decisions, and plans according to the individual values, preferences, or goals of each patient. This is in contrast to more traditional approaches which provide care to patients based on standard clinical guidelines. In healthcare and bioethical literature, PCC is often praised as an ideal approach of healthcare provision because it is thought to empower patients and improve their adherence, satisfaction, and overall health outcomes. However, the notion has been defined in different ways, and it is unclear how and whether it can be implemented in all healthcare settings. This dissertation aims to elucidate the concept of PCC and explore the implications of its intersection with psychiatry. The work contextualizes the concept within larger healthcare and social movements, and in that light, analyzes its values, decision-making process, and ambitions. The unique and complex challenges that psychiatric care settings engender are further used to examine how PCC commitments fare when faced with the limitations of mental illness and restrictive conditions of psychiatric facilities.
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| 3. |
- El-Alti, Leila, 1986, et al.
(author)
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Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions?
- 2019
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In: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 27:1, s. 45-59
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Journal article (peer-reviewed)abstract
- In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can be combined or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications.
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| 4. |
- El-Alti, Leila, 1986
(author)
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Shared Decision Making in Psychiatry: Dissolving the Responsibility Problem
- 2023
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In: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 31:2, s. 65-80
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Journal article (peer-reviewed)abstract
- Person centered care (PCC) invites ideas of shared responsibility as a direct result of its shared decision making (SDM) process. The intersection of PCC and psychiatric contexts brings about what I refer to as the responsibility problem, which seemingly arises when SDM is applied in psychiatric settings due to (1) patients' potentially diminished capacities for responsibility, (2) tension prompted by professional reasons for and against sharing responsibility with patients, as well as (3) the responsibility/blame dilemma. This paper aims to do away with the responsibility problem through arguing for a functional approach to mental illness, a blameless responsibility ascription to the person with mental illness, as well as a nuanced understanding of SDM as part of an emancipation-oriented PCC model.
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| 5. |
- Munthe, Christian, 1962, et al.
(author)
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Disputing with patients in person-centered care: Ethical aspects in standard care, pediatrics, psychiatry, and public health
- 2018
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In: Journal of Argumentation in Context. - : John Benjamins Publishing Company. - 2211-4742 .- 2211-4750. ; 7:2, s. 231-244
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Journal article (peer-reviewed)abstract
- This article explores ethical aspects of using open argumentation in person-centered care (PCC), where health professionals (HPs) openly criticize or contradict factual claims, assumptions, preferences, or value commitments of patients. We argue that such disputing may be claimed to have an important place in advanced versions of PCC, but that it actualizes important clinical ethical aspects of doing such disputation well. This may prompt caution in the implementation of PCC, but also inspire educational and organizational reform. We also probe the notion of openly disputing with patients when PCC is applied in less standard settings (where it is nevertheless advocated), using the cases of children, psychiatry, and public health interventions, such as antibiotic stewardship programs, as examples. These contexts offer new reasons for why PCC may or should include open disputing with patients, but also introduce new ethical complications. Some of these may transform either to arguments against PCC implementation in these areas, or to a more open view of the extent a HP may seek to dominate patients in a PCC setting. We are especially skeptical of the meaningfulness of applying advanced PCC in areas of psychiatry with high levels of compulsory elements, such as forensic psychiatric detention.
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| 6. |
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| 7. |
- Munthe, Christian, 1962, et al.
(author)
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Questioning the patient in person centred care: ethical aspects: children, forensic psychiatry, and public health
- 2017
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In: Medical Argumentation and Patient Centred Care, University of Amsterdam, October 26-27, 2017..
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Conference paper (other academic/artistic)abstract
- The paper explores the room, both conceptually and ethically, for questioning, contradicting and adapting positions to patients in three specific areas: care of patients with vulnerable cpapcities for taking responsibility (adolescents and psychiatry), contexts of constrained autonomy (forensic care), and public health (antobiotic resistance stewardship and vaccination). These areas in various ethically relevant ways exhibit non-standard settings, compared to usual assumptions about the nature of patients and institutional contexts made when person centredness and shared decision-making are held out as primarily emancipating concepts. The paper probes to what extent that ethical idea may be maintained also in such non-standard settings.
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