Joan Liaschenko - Academia.edu (original) (raw)

Papers by Joan Liaschenko

The Journal of Clinical Ethics

Journal of Clinical Ethics, Sep 1, 2017

The controversy over the so-called Ashley Treatment (AT), a series of medical procedures that inh... more The controversy over the so-called Ashley Treatment (AT), a series of medical procedures that inhibited both growth and sexual development in the body of a profoundly intellectually impaired girl, usually centers either on Ashley's rights, including a right to an intact, unaltered body, or on Ashley's parents' rights to make decisions for her. The claim made by her parents, that the procedure would improve their ability to care for her, is often dismissed as inappropriate or, at best, irrelevant. We argue, however, that caregiving is a central issue in the controversy, as Ashley's need for caregiving is a defining characteristic of her life. In this article, we analyze the ethics of the Ashley Treatment within the context of family caregiving. Through the physical and emotional work of caregiving, families participate in the formation and maintenance of personal identity, a process that Hilde Lindemann recently called "holding." We argue that, in an intellectually disabled person such as Ashley, who depends on her family for every aspect of her care, the family's contribution to identity is an essential source of personhood. We believe that the treatment can be justified if it is indeed an instance of appropriate family "holding" for Ashley.

Nursing Ethics, 2010

5 page(s

AACN Advanced Critical Care, 2020

Burnout incurs significant costs to health care organizations and professionals. Mattering, moral... more Burnout incurs significant costs to health care organizations and professionals. Mattering, moral distress, and secondary traumatic stress are personal experiences linked to burnout and are byproducts of the organizations in which we work. This article conceptualizes health care organizations as moral communities—groups of people united by a common moral purpose to promote the well-being of others. We argue that health care organizations have a fundamental obligation to mitigate and prevent the costs of caring (eg, moral distress, secondary traumatic stress) and to foster a sense of mattering. Well-functioning moral communities have strong support systems, inclusivity, fairness, open communication, and collaboration and are able to protect their members. In this article, we address mattering, moral distress, and secondary traumatic stress as they relate to burnout. We conclude that leaders of moral communities are responsible for implementing systemic changes that foster mattering a...

Palliative Medicine, 2019

Background: Adolescent and young adult advance care planning is beneficial in improving communica... more Background: Adolescent and young adult advance care planning is beneficial in improving communication between patients, surrogates, and clinicians. The influences on treatment decisions among adolescents and young adults are underexplored in the literature. Aim: The aim of this study was to explore and better understand the influences on decision-making for adolescent and young adult bone marrow transplant patients about future medical care. Design: Clinical case studies and qualitative inductive content analysis of treatment decisions made during the Respecting Choices® Next Steps Pediatric Advance Care Planning conversation as a component of the Family-Centered Advance Care Planning Intervention. Settings/participants: A total of 10 adolescent and young adult patients (aged 14–27 years) undergoing bone marrow transplant at an academic Midwest children’s hospital were involved in the study. Results: Influences on participants’ decisions were consideration for family, quality of lif...

Journal of Palliative Care, 2019

Understanding Health Inequalities and Justice, 2017

Judgments about risk of harm raise issues of profound moral significance. This chapter criticizes... more Judgments about risk of harm raise issues of profound moral significance. This chapter criticizes prevailing assumptions about risk management in pregnancy. While bioethicists tend to focus on beneficence when analyzing issues of risk, beneficence does not exhaust the moral significance of risk and judgments about risk also raise issues of social justice. The chapter begins by highlighting criteria for adequate understanding of social justice as transcending the distribution of harms and benefits standardly thought to constitute justice. The chapter then considers how culture shapes the normative significance of risk: how we think about risk, what measures we feel justified taking to manage risks, whose interests are promoted by various approaches to risk, whom we hold responsible and for what. Moving beyond criticism, reforms of cultural attitudes toward pregnancy and its management are proposed and recent claims that “fetal origins” research provides a basis for such reform are as...

Nursing ethics, Jan 24, 2016

Explicating nurses' moral identities is important given the powerful influence moral identity... more Explicating nurses' moral identities is important given the powerful influence moral identity has on the capacity to exercise moral agency. The purpose of this study was to explore how nurses narrate their moral identity through their understanding of their work. An additional purpose was to understand how these moral identities are held in the social space that nurses occupy. The Registered Nurse Journal, a bimonthly publication of the Registered Nurses' Association of Ontario, Canada, features a regular column entitled, 'In the End … What Nursing Means to Me …' These short narratives generally include a story of an important moment in the careers of the authors that defined their identities as nurses. All 29 narratives published before June 2015 were analysed using a critical narrative approach, informed by the work of Margaret Urban Walker and Hilde Lindemann, to identify a typology of moral identity. Ethics approval was not required because the narratives are pub...

The Encyclopedia of Adulthood and Aging, 2015

The death with dignity movement is a cultural response to the problems of illness, dying, and dea... more The death with dignity movement is a cultural response to the problems of illness, dying, and death. At the core of the movement is the belief that human dignity and autonomy are honored when people with a terminal illness have control over the circumstances of their death. The movement has a long history but can be traced to the early 1900s, when Ohio became the first US state to propose legislation. The legislation failed but there are now four US states where physician-assisted dying is legal, with another one pending, and seven more with proposed legislation. It is not possible to predict whether the movement will spread or be limited to a few states. Regardless, there are important ethical issues to take into account. Keywords: death with dignity; end of life; euthanasia; physician aid in dying; physician-assisted suicide

Nursing Philosophy, 2015

One of the most significant changes in modern healthcare delivery has been the evolution of the p... more One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care delivery/evidence based practice. Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician-patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner.

Disaster can bring out the best and worst in us as individuals and as a society. If the next pand... more Disaster can bring out the best and worst in us as individuals and as a society. If the next pandemic is as severe as the influenza pandemic of 1918/1919, our already stretched public health and health care systems will be sorely stressed. Hard decisions will have to be made. Our challenge is to rise to the occasion, building on a foundation of careful and inclusive planning. In phase two of the Minnesota Pandemic Ethics Project, ethicists from the Minnesota Center for Health Care Ethics and University of Minnesota Center for Bioethics are engaging the public to respond to and refine an ethical framework for rationing a range of critical health-related resources in a severe influenza pandemic. We will report on what we have learned about HOW to have the conversation as well as what Minnesotans are saying once engaged. This session will present the common and divergent values that we are eliciting from Minnesotans. We cross boundaries of culture, ethnicity, wealth, disability, educat...

International journal of nursing studies, Jan 28, 2015

Specific communication practices used by experienced intensive care nurses who are comfortable wo... more Specific communication practices used by experienced intensive care nurses who are comfortable working with dying patients and their families in ICU to reach consensus on withdrawal of aggressive treatment and shift to palliative care are lacking in the literature. However, there are seven international qualitative studies relevant to this research. Important themes related to communication were composed of four elements: general communication and relationship building, recognizing the need to transition to palliative care, facilitating palliative care, and providing dignified care through to death. To describe the specific communication practices experienced intensive care nurses' comfortable working with dying patients' use with families to negotiate consensus on withdrawal of aggressive treatment and/or shift to palliative are at end of life. A qualitative narrative study. Purposeful sampling was used to recruit nineteen experienced intensive care nurses. A narrative appr...

The American Journal of Bioethics, 2011

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Conte... more Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.

Research and Theory for Nursing Practice, 2008

This article presents an original research method derived from the Thematic Apperception Test use... more This article presents an original research method derived from the Thematic Apperception Test used in clinical psychology to understand human motivation and action. The research method is derived from the theory of projection, which states that humans will perceive stimuli in terms of their own expectations and motives and will credit others with their own attitudes, beliefs, traits, and dispositions. Projective techniques are one of a handful of methods that provide access to this type of knowledge since it resides below the level of consciousness. Use of this type of method in nursing research may be fruitful because of its capacity to make apparent the complex interplay between a clinician's beliefs and the interpretation of meaning that motivates clinical action.

Qualitative Health Research, 2007

In this article, the authors present the central finding of a study aimed at identifying possible... more In this article, the authors present the central finding of a study aimed at identifying possible relationships between the ways in which labor and delivery (L&D) nurses cognitively frame childbirth and cesarean section (CS) rates. They recruited 51 L&D nurses employed at two hospitals in a Midwestern city in the United States to participate in the study, in which they used a projective method to explore nurses' views about the meaning of childbirth and their possible relationship to CS. The authors selected a projective method for this research to identify the preconscious beliefs that inform clinical action. Analysis of the narrative responses to the photograph demonstrated three distinct ways in which participants cognitively framed childbirth and possible ways in which acting in accordance with these belief systems might influence the use of CS.

Obstetrics & Gynecology, 2014

The right of pregnant women to refuse obstetric interventions is an established tenet of obstetri... more The right of pregnant women to refuse obstetric interventions is an established tenet of obstetric ethics. However, that does not mean that fetal considerations are inconsequential. Although respect for negative autonomy is largely a settled issue, what is less clear is the degree to which a pregnant woman's affirmative autonomy (the right to demand) should be controlling. We discuss the ethical basis for deciding when a pregnant woman's affirmative autonomy should be decisive. We focus on the ethical consequences when a fetus is considered a "potential child" because of a woman's decision to continue a pregnancy. Her intention determines the relevance and nature of the interests of the future child. Although fetal interests may temporally approach those of a born child, they are, in all cases, still circumscribed by the de facto circumstance of the potential child, ie, the child cannot be treated without treating the mother. That treatment would implicate the pregnant woman's right to bodily integrity. This right is so fundamental to our conception of autonomy that its trespass should give serious pause to all who respect basic human dignity. Accordingly, the future interests of a child should not constrain a pregnant woman's right of negative autonomy (the right to refuse any intervention intended for the putative benefit of the fetus or herself). However, the interests of the potential child may factor into considerations of affirmative autonomy and, in parallel, on a physician's right to refuse a particular intervention or plan of care.

The Journal of Clinical Ethics

Journal of Clinical Ethics, Sep 1, 2017

The controversy over the so-called Ashley Treatment (AT), a series of medical procedures that inh... more The controversy over the so-called Ashley Treatment (AT), a series of medical procedures that inhibited both growth and sexual development in the body of a profoundly intellectually impaired girl, usually centers either on Ashley's rights, including a right to an intact, unaltered body, or on Ashley's parents' rights to make decisions for her. The claim made by her parents, that the procedure would improve their ability to care for her, is often dismissed as inappropriate or, at best, irrelevant. We argue, however, that caregiving is a central issue in the controversy, as Ashley's need for caregiving is a defining characteristic of her life. In this article, we analyze the ethics of the Ashley Treatment within the context of family caregiving. Through the physical and emotional work of caregiving, families participate in the formation and maintenance of personal identity, a process that Hilde Lindemann recently called "holding." We argue that, in an intellectually disabled person such as Ashley, who depends on her family for every aspect of her care, the family's contribution to identity is an essential source of personhood. We believe that the treatment can be justified if it is indeed an instance of appropriate family "holding" for Ashley.

Nursing Ethics, 2010

5 page(s

AACN Advanced Critical Care, 2020

Burnout incurs significant costs to health care organizations and professionals. Mattering, moral... more Burnout incurs significant costs to health care organizations and professionals. Mattering, moral distress, and secondary traumatic stress are personal experiences linked to burnout and are byproducts of the organizations in which we work. This article conceptualizes health care organizations as moral communities—groups of people united by a common moral purpose to promote the well-being of others. We argue that health care organizations have a fundamental obligation to mitigate and prevent the costs of caring (eg, moral distress, secondary traumatic stress) and to foster a sense of mattering. Well-functioning moral communities have strong support systems, inclusivity, fairness, open communication, and collaboration and are able to protect their members. In this article, we address mattering, moral distress, and secondary traumatic stress as they relate to burnout. We conclude that leaders of moral communities are responsible for implementing systemic changes that foster mattering a...

Palliative Medicine, 2019

Background: Adolescent and young adult advance care planning is beneficial in improving communica... more Background: Adolescent and young adult advance care planning is beneficial in improving communication between patients, surrogates, and clinicians. The influences on treatment decisions among adolescents and young adults are underexplored in the literature. Aim: The aim of this study was to explore and better understand the influences on decision-making for adolescent and young adult bone marrow transplant patients about future medical care. Design: Clinical case studies and qualitative inductive content analysis of treatment decisions made during the Respecting Choices® Next Steps Pediatric Advance Care Planning conversation as a component of the Family-Centered Advance Care Planning Intervention. Settings/participants: A total of 10 adolescent and young adult patients (aged 14–27 years) undergoing bone marrow transplant at an academic Midwest children’s hospital were involved in the study. Results: Influences on participants’ decisions were consideration for family, quality of lif...

Journal of Palliative Care, 2019

Understanding Health Inequalities and Justice, 2017

Judgments about risk of harm raise issues of profound moral significance. This chapter criticizes... more Judgments about risk of harm raise issues of profound moral significance. This chapter criticizes prevailing assumptions about risk management in pregnancy. While bioethicists tend to focus on beneficence when analyzing issues of risk, beneficence does not exhaust the moral significance of risk and judgments about risk also raise issues of social justice. The chapter begins by highlighting criteria for adequate understanding of social justice as transcending the distribution of harms and benefits standardly thought to constitute justice. The chapter then considers how culture shapes the normative significance of risk: how we think about risk, what measures we feel justified taking to manage risks, whose interests are promoted by various approaches to risk, whom we hold responsible and for what. Moving beyond criticism, reforms of cultural attitudes toward pregnancy and its management are proposed and recent claims that “fetal origins” research provides a basis for such reform are as...

Nursing ethics, Jan 24, 2016

Explicating nurses' moral identities is important given the powerful influence moral identity... more Explicating nurses' moral identities is important given the powerful influence moral identity has on the capacity to exercise moral agency. The purpose of this study was to explore how nurses narrate their moral identity through their understanding of their work. An additional purpose was to understand how these moral identities are held in the social space that nurses occupy. The Registered Nurse Journal, a bimonthly publication of the Registered Nurses' Association of Ontario, Canada, features a regular column entitled, 'In the End … What Nursing Means to Me …' These short narratives generally include a story of an important moment in the careers of the authors that defined their identities as nurses. All 29 narratives published before June 2015 were analysed using a critical narrative approach, informed by the work of Margaret Urban Walker and Hilde Lindemann, to identify a typology of moral identity. Ethics approval was not required because the narratives are pub...

The Encyclopedia of Adulthood and Aging, 2015

The death with dignity movement is a cultural response to the problems of illness, dying, and dea... more The death with dignity movement is a cultural response to the problems of illness, dying, and death. At the core of the movement is the belief that human dignity and autonomy are honored when people with a terminal illness have control over the circumstances of their death. The movement has a long history but can be traced to the early 1900s, when Ohio became the first US state to propose legislation. The legislation failed but there are now four US states where physician-assisted dying is legal, with another one pending, and seven more with proposed legislation. It is not possible to predict whether the movement will spread or be limited to a few states. Regardless, there are important ethical issues to take into account. Keywords: death with dignity; end of life; euthanasia; physician aid in dying; physician-assisted suicide

Nursing Philosophy, 2015

One of the most significant changes in modern healthcare delivery has been the evolution of the p... more One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care delivery/evidence based practice. Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician-patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner.

Disaster can bring out the best and worst in us as individuals and as a society. If the next pand... more Disaster can bring out the best and worst in us as individuals and as a society. If the next pandemic is as severe as the influenza pandemic of 1918/1919, our already stretched public health and health care systems will be sorely stressed. Hard decisions will have to be made. Our challenge is to rise to the occasion, building on a foundation of careful and inclusive planning. In phase two of the Minnesota Pandemic Ethics Project, ethicists from the Minnesota Center for Health Care Ethics and University of Minnesota Center for Bioethics are engaging the public to respond to and refine an ethical framework for rationing a range of critical health-related resources in a severe influenza pandemic. We will report on what we have learned about HOW to have the conversation as well as what Minnesotans are saying once engaged. This session will present the common and divergent values that we are eliciting from Minnesotans. We cross boundaries of culture, ethnicity, wealth, disability, educat...

International journal of nursing studies, Jan 28, 2015

Specific communication practices used by experienced intensive care nurses who are comfortable wo... more Specific communication practices used by experienced intensive care nurses who are comfortable working with dying patients and their families in ICU to reach consensus on withdrawal of aggressive treatment and shift to palliative care are lacking in the literature. However, there are seven international qualitative studies relevant to this research. Important themes related to communication were composed of four elements: general communication and relationship building, recognizing the need to transition to palliative care, facilitating palliative care, and providing dignified care through to death. To describe the specific communication practices experienced intensive care nurses' comfortable working with dying patients' use with families to negotiate consensus on withdrawal of aggressive treatment and/or shift to palliative are at end of life. A qualitative narrative study. Purposeful sampling was used to recruit nineteen experienced intensive care nurses. A narrative appr...

The American Journal of Bioethics, 2011

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Conte... more Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.

Research and Theory for Nursing Practice, 2008

This article presents an original research method derived from the Thematic Apperception Test use... more This article presents an original research method derived from the Thematic Apperception Test used in clinical psychology to understand human motivation and action. The research method is derived from the theory of projection, which states that humans will perceive stimuli in terms of their own expectations and motives and will credit others with their own attitudes, beliefs, traits, and dispositions. Projective techniques are one of a handful of methods that provide access to this type of knowledge since it resides below the level of consciousness. Use of this type of method in nursing research may be fruitful because of its capacity to make apparent the complex interplay between a clinician's beliefs and the interpretation of meaning that motivates clinical action.

Qualitative Health Research, 2007

In this article, the authors present the central finding of a study aimed at identifying possible... more In this article, the authors present the central finding of a study aimed at identifying possible relationships between the ways in which labor and delivery (L&D) nurses cognitively frame childbirth and cesarean section (CS) rates. They recruited 51 L&D nurses employed at two hospitals in a Midwestern city in the United States to participate in the study, in which they used a projective method to explore nurses' views about the meaning of childbirth and their possible relationship to CS. The authors selected a projective method for this research to identify the preconscious beliefs that inform clinical action. Analysis of the narrative responses to the photograph demonstrated three distinct ways in which participants cognitively framed childbirth and possible ways in which acting in accordance with these belief systems might influence the use of CS.

Obstetrics & Gynecology, 2014

The right of pregnant women to refuse obstetric interventions is an established tenet of obstetri... more The right of pregnant women to refuse obstetric interventions is an established tenet of obstetric ethics. However, that does not mean that fetal considerations are inconsequential. Although respect for negative autonomy is largely a settled issue, what is less clear is the degree to which a pregnant woman's affirmative autonomy (the right to demand) should be controlling. We discuss the ethical basis for deciding when a pregnant woman's affirmative autonomy should be decisive. We focus on the ethical consequences when a fetus is considered a "potential child" because of a woman's decision to continue a pregnancy. Her intention determines the relevance and nature of the interests of the future child. Although fetal interests may temporally approach those of a born child, they are, in all cases, still circumscribed by the de facto circumstance of the potential child, ie, the child cannot be treated without treating the mother. That treatment would implicate the pregnant woman's right to bodily integrity. This right is so fundamental to our conception of autonomy that its trespass should give serious pause to all who respect basic human dignity. Accordingly, the future interests of a child should not constrain a pregnant woman's right of negative autonomy (the right to refuse any intervention intended for the putative benefit of the fetus or herself). However, the interests of the potential child may factor into considerations of affirmative autonomy and, in parallel, on a physician's right to refuse a particular intervention or plan of care.