Dunia tanpa sempadan, pengetahuan dan mentality memberikan kesinambungan kepada pengalaman yang menakjubkan dalam dunia pemikiran
World without borders, knowledge and mentality provide continuity to the amazing experience in the world of thought
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Sabtu, 13 April 2024
Legal Evidence for Murabahah (Cost-Plus Sale)
Let's take a look at Islamic finance and banking and how the process works.
Quranic Evidence
Allah permits trade but prohibits riba (interest) and gharar (excessive uncertainty):
"But Allah has permitted trade and forbidden riba."
(Quran, Surah Al-Baqarah 2:275)
This verse establishes the permissibility of buying and selling (trade), which includes Murabahah (a transparent, cost-plus sale).
Hadith Evidence
The Prophet Muhammad (ﷺ) approved of profit-based sales as long as the terms are clear:
"The Muslims must abide by their conditions, except a condition that permits what is forbidden or forbids what is permissible."
(Sunan Ibn Majah, 2351)
This Hadith supports Murabahah because it requires full disclosure of cost and profit, ensuring transparency.
Scholarly Consensus (Ijma’)
Classical scholars like Imam Malik, Imam Shafi’i, and Imam Ahmad recognized Murabahah as a valid sale.
Modern Islamic financial institutions (AAOIFI, Bank Negara Malaysia, etc.) have standardized Murabahah contracts.
Legal Evidence for Sukuk (Islamic Bonds)
Quranic Evidence
Sukuk are based on asset ownership and profit-sharing, which aligns with the Quranic principle of fair trade and risk-sharing:
"And do not consume one another’s wealth unjustly, but only in lawful business by mutual consent."
(Quran, Surah An-Nisa 4:29)
This verse prohibits unjust enrichment and supports Sukuk, where investors share profits from real assets rather than earning interest.
Hadith Evidence
The Prophet (ﷺ) encouraged partnership-based financing (Musharakah), which is a common structure in Sukuk:
"Allah says: 'I am the third partner in a business between two partners, as long as one does not betray the other.'"
(Sunan Abu Dawud, 3383)
This Hadith justifies Sukuk al-Musharakah, where investors and issuers share profits and losses.
Scholarly Consensus (Ijma’)
Contemporary Islamic scholars (such as those in AAOIFI and IFSB) have approved Sukuk as Shariah-compliant.
Both Murabahah and Sukuk are firmly rooted in Quranic principles, Prophetic traditions, and scholarly consensus. They avoid riba and gharar while promoting ethical finance.
References for Shariah Evidence
Quran (Surah Al-Baqarah 2:275, Surah An-Nisa 4:29)
Hadith (Sunan Ibn Majah 2351, Sunan Abu Dawud 3383)
AAOIFI Shariah Standards (https://aaoifi.com)
Islamic Fiqh Academy Resolutions (https://www.fiqhacademy.org.sa)
Further Quranic and Hadith Support for Murabahah
Quranic Basis for Transparency in Trade
Allah commands fairness in business dealings:
"Give full measure and do not cheat, and weigh with an even balance."
(Quran, Surah Ash-Shu’ara 26:181-182)
This reinforces the Murabahah requirement of disclosing cost and profit.
Hadith on Permissibility of Deferred Payment Sales
The Prophet (ﷺ) allowed sales with delayed payment:
"Whoever sells a product on deferred payment should clearly fix the amount and due date."
(Sahih Bukhari, 2086)
This justifies Murabahah’s installment payment structure.
Prohibition of Riba (Interest) in Loans vs. Permissibility of Trade Profit
The Quran distinguishes between halal profit (trade) and haram riba:
"Whatever you pay as riba to increase people’s wealth does not increase with Allah. But whatever you give in charity, seeking Allah’s pleasure, will be multiplied manifold."
(Quran, Surah Ar-Rum 30:39)
Murabahah’s markup is profit from trade, not interest.
Loss Scenario Investors share losses Bondholders still owed principal + interest
3. Controversial Areas & Shariah Compliance
A. Murabahah Markup vs. Interest
Permissible: Profit margin reflects real effort (bank bears ownership risk).
Impermissible: If profit is pegged to LIBOR (resembles riba).
B. Sukuk "Fixed Returns" Debate
Permissible: Projected profit rate (based on historical performance).
Impermissible: Guaranteed returns (like bonds).
Example of Valid Sukuk Profit:
Sukuk al-Ijarah (Lease): Rent linked to market rates (e.g., RM1 million/year from tenants).
4. Visual Summary: How Returns Are Calculated
Murabahah (Deferred Sale)
Sukuk (Profit-Sharing)
plaintext
Copy
Investors fund 60% of project (RM60m)
↓
Project earns RM10m profit/year
↓
Investors get 70% = RM7m (RM116.67/Sukuk)
5. Key Takeaways
Murabahah profit is cost-plus, fixed upfront.
Sukuk returns depend on actual project performance.
Shariah compliance requires:
No interest (riba).
No guaranteed profits (gharar).
Need a numerical exercise? Try calculating returns for a RM1 million Murabahah car financing (15% profit, 3-year term) or a RM200 million infrastructure Sukuk!
Date : 18/11/2023 Volume : (2) 1-4 Subject: Sebuah Jurnal Teori Kaunseling : Mengubah Pemikiran, Emosi dan Tindakan Harian dengan Fokus terhadap Pembangungan Diri, University
of UNITAR
Author : Muhammad Afiq Shahiri
Bin Sapie (MC210915114) Date: 18/10/2023 Volume : (3) 1-4 Subject : A journal of subject
theory of counselling : Applying
individual psychology theory to My daily life, University of UNITAR
Ipoh, Perak
Mengaplikasikan teori psikologi individu dalam kehidupan seharian saya
Adler dikaitkan dengan perkembangan teori psikologi individu, yang memberikan pandangan baru tentang psikologi manusia di samping menyediakan alat berguna untuk pembangunan dan kemajuan peribadi. Teori ini menggalakkan individu untuk menyiasat idea, perasaan, dan tingkah laku mereka sendiri dan memberi penekanan kepada kepentingan memahami orang itu dalam konteks persekitaran sosial mereka. Dengan memasukkan konsep-konsep ini ke dalam aktiviti harian kita, kita boleh membangunkan pemahaman yang lebih mendalam tentang siapa kita dan membuat pelarasan membina yang akan menyumbang kepada peningkatan kesihatan kita. Adalah menjadi harapan saya bahawa dengan mendekati proses penemuan diri dalam rangka teori psikologi individu alfred adler, saya akan dapat memperoleh pemahaman yang lebih mendalam tentang interaksi antara idea, emosi dan tingkah laku saya. Penyiasatan saya dibuat berdasarkan latar belakang tumpuan adler pada pencarian kepentingan dan kepentingan peristiwa awal pada pembentukan personaliti. Matlamat saya menyimpan diari ini adalah untuk menyimpan rekod pengalaman harian saya, menggabungkan konsep dari psikologi individu untuk mendapatkan pengetahuan yang lebih baik tentang siapa saya dan untuk menggalakkan perkembangan peribadi saya sendiri.rujukan.
Memahami maksud menjadi lebih rendah sambil berusaha untuk menjadi penting:
Saya telah menggabungkan konsep teori ini ke dalam idea peribadi saya sendiri tentang teori psikologi individu untuk membantu saya menavigasi melalui tinggi dan rendah yang merupakan sebahagian daripada kehidupan seharian saya. Saya mempraktikkan idea ini dengan menjalankan analisis mendalam tentang pemikiran saya sendiri. Menurut adler, cara kita secara peribadi mentafsir peristiwa mempunyai kesan yang besar terhadap perasaan dan tingkah laku yang kita alami. Saya dapat menghadapi pemikiran negatif saya dan menyusun semula mentaliti saya supaya saya boleh mengembangkan idea yang lebih positif dan membina dengan menyedari corak pemikiran kebiasaan saya dan mencabarnya.
Sebagai contoh, jika saya merasakan bahawa saya sentiasa bimbang tentang keadaan yang berada di luar kawalan saya, saya akan mengingatkan diri saya tentang penekanan adler untuk menumpukan perhatian pada aspek kehidupan yang saya kuasai dan akan cuba mengalihkan perhatian saya ke sana. Ini membantu saya memfokuskan semula perhatian saya untuk mencari penyelesaian kepada masalah dan mengambil usaha proaktif ke arah mencapai objektif saya. Oleh kerana saya sedar tentang kaitan yang wujud antara idea dan perasaan saya, saya dapat mewujudkan sikap yang lebih positif dan lebih berjaya menguruskan tekanan saya. Hari ini, saya memikirkan beberapa contoh dari sejarah saya yang mungkin menjadi faktor dalam pembangunan kompleks rendah diri. Menurut teori psikologi individu, peristiwa formatif mempunyai kesan yang mendalam terhadap persepsi individu tentang siapa mereka. Saya melihat kembali ingatan awal saya dan melihat corak yang mungkin mempunyai peranan dalam membentuk idea saya sekarang. Menyedari asal usul ini adalah langkah pertama dalam memfokus semula usaha saya untuk mencari kepentingan dengan cara yang lebih bermanfaat dan membantu untuk diri saya dan orang lain.
Penilaian cara hidup anda dan perasaan anda:
Saya meneliti rutin dan tingkah laku harian saya berdasarkan tanggapan adler bahawa gaya hidup seseorang adalah cerminan keperibadian mereka, dan saya membuat kesimpulan bahawa saya harus menjalankan penilaian gaya hidup. Adakah keputusan yang saya buat adalah selaras dengan kepentingan yang ingin saya capai? Saya menentukan bidang yang saya perlukan untuk membuat perubahan untuk membentuk cara hidup yang bukan sahaja membantu untuk mencapai objektif utama rekaan saya tetapi juga menggalakkan kesejahteraan keseluruhan saya. Memahami kesan yang dimainkan oleh emosi kita dalam mempengaruhi pilihan yang kita buat adalah satu lagi komponen teori psikologi individu yang saya praktikkan dalam kehidupan seharian saya. Emosi adalah petunjuk penting tentang kehendak dan aspirasi kita, oleh itu adalah penting untuk memberi perhatian kepada mereka. Apabila saya memberi perhatian kepada reaksi emosi saya, saya menjadi lebih berhubung dengan sentimen terdalam saya, dan sebagai hasilnya, saya dapat membuat pertimbangan yang berpendidikan yang berdasarkan keinginan tulen saya dan bukannya bertindak terburu-buru dalam bertindak balas terhadap situasi. Amalan muhasabah diri yang kerap telah mengajar saya untuk menerima malah menghargai perasaan saya serta melihatnya sebagai sumber maklumat yang penting. Saya membuat satu titik untuk tidak mengabaikan atau menekan perasaan saya; sebaliknya, saya memberi kebenaran kepada diri saya untuk merasakannya sepenuhnya dan mengatasinya dengan cara yang seimbang. Oleh kerana itu, saya dapat bertindak balas terhadap kesukaran dan kesenangan hidup seharian dengan cara yang lebih tulen dan membantu.
Gangguan personaliti merupakan satu keadaan mental yang dicirikan oleh corak pemikiran, perasaan, dan tingkah laku yang berbeza daripada norma masyarakat dan kekal dalam jangka masa panjang. Ia boleh menjejaskan fungsi harian dan hubungan interpersonal seseorang individu. Di Malaysia, kesedaran tentang gangguan ini semakin meningkat, namun masih terdapat banyak stigma dan salah faham mengenainya.
Jenis-jenis Gangguan Personaliti
Menurut Manual Diagnostik dan Statistik Gangguan Mental (DSM-5), gangguan personaliti boleh diklasifikasikan kepada beberapa kategori utama:
Gangguan Personaliti Klasifikasi A (Eksentrik atau Aneh):
Paranoid: Mempunyai kepercayaan bahawa orang lain berniat jahat atau tidak boleh dipercayai.
Schizoid: Mengelakkan hubungan sosial dan tidak menunjukkan banyak emosi.
Schizotypal: Memiliki pemikiran atau kelakuan aneh dan percaya pada perkara yang luar biasa.
Gangguan Personaliti Klasifikasi B (Dramatik, Emosional atau Tidak Stabil):
Antisosial: Tidak mengambil kira hak atau perasaan orang lain.
Borderline: Emosi yang tidak stabil, imej diri yang kabur, dan hubungan yang tidak tetap.
Histrionik: Sentiasa mencari perhatian dan cenderung dramatik.
Narsistik: Mempunyai perasaan kepentingan diri yang berlebihan dan memerlukan penghargaan berterusan.
Gangguan Personaliti Klasifikasi C (Cemas atau Takut):
Avoidant: Mengelak daripada situasi sosial kerana rasa takut terhadap kritikan atau penolakan.
Dependent: Bergantung secara berlebihan kepada orang lain untuk membuat keputusan dan memenuhi keperluan diri.
Obsessive-Compulsive: Terlalu fokus kepada kesempurnaan, peraturan, dan kawalan.
Faktor Penyumbang di Malaysia
Terdapat pelbagai faktor yang boleh menyumbang kepada perkembangan gangguan personaliti di kalangan rakyat Malaysia:
Budaya dan Sosial:
Tekanan sosial dan harapan budaya yang tinggi, seperti kepentingan keluarga dan kejayaan akademik, boleh mencetuskan atau memperburuk gangguan personaliti.
Stigma sosial terhadap gangguan mental menyebabkan ramai individu tidak mendapatkan bantuan yang diperlukan.
Ekonomi:
Kesempitan hidup dan tekanan ekonomi boleh mempengaruhi kesejahteraan mental seseorang.
Perubahan pantas dalam ekonomi negara turut memberi kesan kepada kestabilan emosi dan psikologi rakyat.
Keluarga dan Persekitaran:
Pengalaman zaman kanak-kanak yang negatif, seperti penderaan atau pengabaian, boleh menyumbang kepada perkembangan gangguan personaliti.
Dinamika keluarga yang disfungsional juga boleh menjadi faktor risiko.
Genetik dan Biologi:
Faktor genetik mungkin memainkan peranan dalam perkembangan gangguan personaliti, di mana sejarah keluarga dengan gangguan mental boleh meningkatkan risiko.
Prevalensi dan Cabaran dalam Penjagaan
Kajian menunjukkan bahawa gangguan personaliti agak umum di kalangan rakyat Malaysia, namun prevalensinya sering diabaikan atau disalah tafsir sebagai masalah sosial atau moral. National Health and Morbidity Survey (NHMS) pada tahun 2015 mencatatkan bahawa sekitar 29.2% rakyat Malaysia mengalami masalah kesihatan mental, yang termasuk pelbagai jenis gangguan personaliti.
Cabaran utama dalam menangani gangguan personaliti di Malaysia termasuk:
Kekurangan Kesedaran dan Pendidikan:
Masih terdapat banyak salah faham dan kurang pengetahuan tentang gangguan ini.
Usaha pendidikan awam masih kurang, menyebabkan kesedaran masyarakat terhadap isu ini berada pada tahap yang rendah.
Akses kepada Rawatan:
Kekurangan sumber dan kemudahan perubatan untuk rawatan kesihatan mental di kawasan luar bandar.
Kurangnya pakar psikologi dan psikiatri yang terlatih dalam menangani gangguan personaliti.
Stigma dan Diskriminasi:
Individu dengan gangguan personaliti sering berhadapan dengan stigma dan diskriminasi, yang menyukarkan mereka untuk mendapatkan bantuan atau rawatan.
Tanggapan negatif masyarakat terhadap gangguan mental menghalang mereka daripada mendapatkan sokongan yang diperlukan.
Intervensi dan Sokongan
Untuk mengatasi masalah gangguan personaliti di kalangan rakyat Malaysia, beberapa langkah boleh diambil:
Meningkatkan Kesedaran dan Pendidikan:
Melalui kempen kesedaran awam dan program pendidikan di sekolah untuk mengurangkan stigma dan meningkatkan pemahaman mengenai gangguan personaliti.
Penglibatan media dalam menyebarkan maklumat yang betul dan mengurangkan stereotaip negatif tentang gangguan ini.
Memperbaiki Akses kepada Rawatan:
Meningkatkan bilangan pakar kesihatan mental dan kemudahan di seluruh negara, terutamanya di kawasan luar bandar.
Menyediakan latihan untuk profesional kesihatan agar mereka lebih bersedia untuk menangani kes gangguan personaliti.
Menyokong Keluarga dan Komuniti:
Menyediakan sokongan dan sumber untuk keluarga dan individu yang terjejas, seperti kumpulan sokongan dan perkhidmatan kaunseling.
Menggalakkan persekitaran yang inklusif dan penyayang dalam komuniti untuk membantu individu yang menghadapi gangguan personaliti.
Mengembangkan Polisi dan Sokongan Kerajaan:
Kerajaan perlu menggubal dasar yang menyokong penjagaan kesihatan mental yang komprehensif dan mudah diakses.
Meningkatkan pembiayaan dan sumber untuk program kesihatan mental di seluruh negara.
Gangguan personaliti adalah isu yang signifikan dan memerlukan perhatian serius di Malaysia. Dengan meningkatkan kesedaran, memperbaiki akses kepada rawatan, mengurangkan stigma, dan menyediakan sokongan yang berkesan, kita boleh membantu mereka yang terjejas oleh gangguan ini untuk menjalani kehidupan yang lebih baik dan lebih bermakna.
Rujukan
American Psychiatric Association. (2013).Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.
Institute for Public Health. (2015).National Health and Morbidity Survey (NHMS) 2015. Ministry of Health Malaysia.
Teoh, H. J., & Rose, P. (2001).Child mental health: An integrated approach to the planning and delivery of services with respect to culturally diverse communities. Asia Pacific Journal of Social Work and Development, 11(2), 80-91.
This study relies on the notion of persuasion
to anticipate reactions to marketers' attempts to convince customers with
varying levels of persuasion expertise. The report includes a meta-analysis of
the findings from 148 studies and 171 separate data sets. Persuasion knowledge
effects are significant when compared to persuasion attempts, but it cannot
suppress or eliminate persuasion effects in the marketplace since it only
reaches roughly 50% of the explanatory power of persuasion. The impacts of
persuasion knowledge on assessments and coping are dependent on the parameters
of the persuasive process. All persuasion factors assist customers in
identifying and better understanding benefits not just for themselves, but also
for marketers and how marketers realize those benefits.
Discussion
According to Campbell &
Kirmani in their 2008 research in terms of the substance and structure of
persuasion knowledge effects, research shows that persuasion knowledge enhances
consumers' coping reactions and leads to fewer positive ratings. Additionally,
other studies indicate that the persuasive impact is not as positive. However,
other studies claim that they have discovered a wide range in the impact of
persuasive information and that in some circumstances, it may even result in a favourable
assessment of the persuasive agent.
Other than that,
we go to another side of researchers said consumers' understanding and opinions
about marketers' attempts at persuasion, as well as their motivations and
strategies behind those efforts, are referred to as their level of persuasion
knowledge. It is the notion of persuasion is at the heart of persuasion
knowledge, thus knowing what persuasion comprises is necessary to define
persuasion knowledge. The prevalent understanding of persuasion is that it is a
deliberate attempt through communication to influence a recipient who has some
degree of freedom of choice, despite the fact that there are several
definitions, conceptualizations, and persuasion models. In conclusion,
persuasiveness in business is advantageous to all parties involved, including
the sender and the influencer This, together with persuasive expertise, is a
typical assumption in persuasion models.
After that, we also
want to take you to another angle to think about the definition of the concept
of persuasion, knowledge of persuasion can apply to and have an impact on
results that the influencer either intends or does not intend. This means the
judgments, intentions, behaviour, and recollections of customers that are
connected to a brand, a channel, or a company are referred to as the
influencers' desired results in a marketing setting. If customers learn
persuasive strategies that are advantageous to both them and the marketer, and
if they notice that marketers employ potentially manipulative tactics and may
even be trying to limit consumers' options. Finally, they found out that This
overwhelming response is the result that the marketer did not intend. they
develop resilience and response to persuasion results.
Jakarta 2022
Article critique
From the Journal sentence
criticism 1: In this study, we refer to the concept of persuasion to
systematize consumer responses triggered by persuasion knowledge and to
identify relevant moderators of persuasion knowledge effects.
In my point of view,
this journal should provide a comprehensive study, in terms of the response of
persuasion in marketing. This is because it can happen in many forms and
persuasive advertising can be quite impersonal, unlike direct sales, when the
salesperson often talks one-on-one with the consumer. Advertisers can only
customize advertising so much without compromising their mass appeal because
they want their ads to reach as many potential customers as possible.
From the Journal sentence
criticism 2: Insights about persuasion knowledge effects are of interest to
researchers, marketers, consumers, and public policymakers because they carry
major implications for marketing actions’ effectiveness and consumers’
susceptibility to these actions.
This is because in my perception this kind of action is not
professional and It will attempt to influence the most fundamental human
emotions and utilize that manipulation to take advantage of unsuspecting
clients. An illustration of an unethical commercial is one that exploits
people's fears. It can appear that if customers do not buy the offered goods,
their health would be in jeopardy.
In conclusion, the persuasive strategy plays on the buyer's
fears and emphasizes what they would lose if they didn't buy the good or
service. In my opinion, I would like to suggest some things for improvement in
this strategy without jeopardizing their investments to buy goods from
marketers. To provide a basis for future research ideas on persuasion knowledge
is very necessary to ensure the quality of goods and public knowledge. Limitations
in giving persuasion can reduce pressure on buyers and anxiety about the
situation.
▪ DSM-IV-TR recognizes two broad types of mood disorders: those
that involve only depressive symptoms (depressive disorders) and
those involve manic symptoms (bipolar disorders).
Depressive disorders 🙇
▪ The symptoms of depression include profound sadness and/or an
inability to experience pleasure.
▪ When people develop a depressive disorder, their heads may
reverberate with self-recriminations. They may become focused on
their flaws and deficits.
▪ Paying attention can be so exhausting that they have difficulty
absorbing what they read and hear. They often view things in a
very negative light, and they tend to lose hope.
▪ Physical symptoms of depression are also common, including
fatigue and low energy as well as physical aches and pains.
Depressive disorders
▪ Although people with depression typically feel exhausted – they may find it
hard to fall asleep and may wake up frequently. Other people sleep throughout
the day.
▪ They may find that food tastes bland or that their appetite is gone, or they may
experience an increase in appetite.
▪ Sexual interest disappears.
▪ Thought and movement may slow for some (psychomotor retardation), but
others can’t sit still – they pace, fidget, and wring their hands (psychomotor
agitation).
▪ When people become utterly dejected and hopeless, thoughts about suicide
are common.
Depressive disorders
▪ Under depressive disorders, there are another two types of disorders as mentioned
in DSM-IV-TR. They are:
1. Major depressive disorder (MDD)
2. Dysthymic disorder (also called dysthymia).
Major depressive disorder
▪ The DSM-IV-TR diagnosis of major depressive disorder (MDD) requires depressive
symptoms to be present for at least 2 weeks.
▪ As shown in the DSM-IV-TR criteria, at least 4 additional symptoms must be
present. They are:
i. Changes in sleep
ii. Changes in appetite;
iii. Changes in concentration and decision-making
iv. Feeling of worthlessness;
v. Suicidal
vi. Psychomotor agitation or retardation.
▪ MDD is called an episodic disorder – because symptoms tend to be present for
period of time and then clear. Even though episodes tend to dissipate over time,
an untreated episode may stretch on for 5 months or even longer.
▪ Major depressive episodes tend to recur – once given episode clear, a person is
likely to experience another episode.
Dysthymic disorder
▪ Dysthymic disorder shares many of the symptoms of major depressive disorder
but differ in its course. The symptoms are somewhat milder but remain
relatively unchanged over long period of time, sometimes 20 or 30 years or
more.
▪ Dysthymic disorder is defined as a persistently depressed mood that continues
at least 2 years, during the patient cannot be symptom free for more than 2
months at a time.
▪ Dysthymic disorder differs from a major depressive episode only in the severity,
chronicity, and number of its symptoms, which are milder and fewer but last
longer.
▪ Typically, dysthymic disorder develops first, perhaps at an early age, and then
one or more major depressive episodes occur later.
Bipolar disorders
▪ DSM-IV-TR recognizes 3 forms of bipolar disorders:
1. Bipolar I disorder
2. Bipolar II disorder
3. Cyclothymic disorder.
▪ Manic symptoms are the defining feature of each of these
disorders.
▪ These disorders are labelled “bipolar” because most people who
experience mania will also experience depression during their
lifetime
▪ What is mania?
▪ People may experience with abnormally exaggerated elation, joy, or euphoria.
▪ In mania, individuals find extremely pleasure in every activity: they become
extraordinary active (hyperactive), require little sleep, and may develop
grandiose plan, believing they can accomplish anything they desire.
▪ Speech is typically rapid and may become incoherent (attempting to express
so many exciting ideas at once: flight of ideas)
▪ Hospitalization may require – if individual was engaging self-destructive
activities.
Bipolar I disorder
▪ In DSM-IV-TR, the criteria for diagnosis of bipolar I disorder
(formerly known as manic-depressive disorder) include a single
episode of mania or a single mixed episode during the course of a
person’s life.
Bipolar II disorder
▪ DSM-IV-TR also includes a milder form of bipolar disorder, called
bipolar II disorder.
Cyclothymic disorder
▪ A milder but chronic version of bipolar disorder called cyclothymic disorder is
similar in many ways to dysthymic disorder.
▪ Cyclothymic disorder is a chronic alternation of mood elevation and major
depression that does not reach the severity of manic or major depressive
episodes.
▪ Individual who have this tend to be in one mood state or the other years with
relatively few periods of neutral mood.
Causes of mood disorders
▪ Neurotransmitters:
▪ 3 neurotransmitters have been studied the most in terms of their possible
roles in mood disorders:
▪ Norepinephrine;
▪ Dopamine;
▪ Serotonin.
▪ Original models suggested that depression would be tied to low levels of
norepinephrine and dopamine.
▪ Mania would be tied to high levels of norepinephrine and dopamine
▪ Mania and depression were also both posited to be tied to low
levels of serotonin.
▪ Researchers initially believed that mood disorders would be
explained by absolute levels of neurotransmitters in the synaptic
cleft that were either too high or too low.
▪ Brain imaging studies:
▪ Brain imaging studies suggest that episodes of MDD are associated with
changes in many of the brain systems that are activated when a person without
symptoms of depression experiences strong emotions.
▪ As one might expect, many different brain structures become involved when a
person experiences emotion: the person needs to attend to and interpret the
stimuli that are causing the emotion and then must make plans to deal with
those stimuli.
▪ Psychological:
▪ Various aspects of personality and its development appear to be integral to
the occurrence and persistence of depression.
▪ Although depressive episodes are strongly correlated with adverse events, a
person's characteristic style of coping may be correlated with his or her
resilience.
▪ In addition, low self-esteem and self-defeating or distorted thinking are
related to depression.
▪ Social:
▪ Poverty and social isolation are associated with increased risk of mental health
problems in general.
▪ Child abuse (physical, emotional, sexual, or neglect) is also associated with
increased risk of developing depressive disorders later in life.
▪ Abuse of the child by the caregiver is bound to distort the developing personality
and create a much greater risk for depression and many other debilitating
mental and emotional states.
▪ Disturbances in family functioning, such as parental (particularly maternal)
depression, severe marital conflict or divorce, death of a parent, or other
disturbances in parenting are additional risk factors.
▪ Medications:
▪ The effectiveness of antidepressants is none to minimal in those with mild or
moderate depression but significant in those with very severe disease.
▪ The effects of antidepressants are somewhat superior to those of psychotherapy,
especially in cases of chronic major depression.
▪ Antidepressant medication treatment is usually continued for 16 to 20 weeks
after remission, to minimize the chance of recurrence, and even up to one year of
continuation is recommended
Treatment of Mood Disorders
▪ Electroconvulsive Therapy and Transcranial Magnetic Stimulation (ECT):
Electroconvulsive therapy (ECT) is a procedure whereby pulses of electricity are
sent through the brain via two electrodes, hospital psychiatrists may recommend
ECT for cases of severe major depression that have not responded to
antidepressant medication or, less often, psychotherapy or supportive
interventions.
ECT can have a quicker effect than antidepressant therapy and thus may be the
treatment of choice in emergencies such as catatonic depression where the
person has stopped eating and drinking, or where a person is severely suicidal.
▪ Psychological treatments for depression:
▪ Cognitive-Behavioral Therapy:
▪ Clients are taught to examine carefully their thought processes while they are
depressed and to recognize “depressive” errors in thinking.
▪ Clients are thought that errors in thinking can directly cause depression.
▪ Treatment involves correcting cognitive errors and substituting less
depressing and more realistic thoughts and appraisals.
▪ Interpersonal Psychotherapy:
▪ After identifying life stressors that seem to precipitate the depression, the
therapist and patient work collaboratively on the patient’s current
interpersonal problems’:
Dealing with interpersonal role disputes – marital conflicts;
Adjusting to the loss of a relationship;
Acquiring new relationships;
Identifying and correcting deficits in social skills.
▪ After helping identifying the dispute… the next steps?
✓Negotiation stage – both partners are aware it is a dispute, and they are
trying to renegotiate it.
✓Impasse stage – the dispute smolders beneath the surface and results in lowlevel resentment, but no attempts are made to resolve it.
✓Resolution stage – the partners are taking some action, such as divorce,
separation or recommitting to the marriage.
Stress is your body's way of responding to any kind of demand.
It can be caused by both good and bad experiences.
When people feel stressed by something going on around
them, their bodies react by releasing chemicals into the blood.
These chemicals give people more energy and strength, which
can be a good thing if their stress is caused by physical danger.
But this can also be a bad thing, if their stress is in response to
something emotional and there is no outlet for this extra energy
and strength
What cause of stress
Many different things can cause stress.
From physical (such as fear of something dangerous) to
emotional (such as worry over your family or job) – these often
referred as “stressors.”
Some of the most common sources of stress are:
Survival Stress - You may have heard the phrase "fight or flight"
before. This is a common response to danger in all people and
animals. When you are afraid that someone or something may
physically hurt you, your body naturally responds with a burst of
energy so that you will be better able to survive the dangerous
situation (fight) or escape it all together (flight). This is survival
stress.
Internal Stress - Have you ever caught yourself worrying about
things you can do nothing about or worrying for no reason at
all? This is internal stress and it is one of the most important kinds
of stress to understand and manage. Internal stress is when
people make themselves stressed. This often happens when we
worry about things we can't control or put ourselves in situations
we know will cause us stress. Some people become addicted
to the kind of hurried, tense, lifestyle that results from being
under stress. They even look for stressful situations and feel stress
about things that aren't stressful.
Environmental Stress - This is a response to things around you
that cause stress, such as noise, crowding, and pressure from
work or family. Identifying these environmental stresses and
learning to avoid them or deal with them will help lower your
stress level.
Fatigue and Overwork - This kind of stress builds up over a long
time and can take a hard toll on your body. It can be caused
by working too much or too hard at your job(s), school, or
home. It can also be caused by not knowing how to manage
your time well or how to take time out for rest and relaxation.
Good stress vs Bad stress
So if stress can be so bad for you, how can there be "good" or
"positive" stress?
If you are suffering from extreme stress or long-term stress, your
body will eventually wear itself down. But sometimes, small
amounts of stress can actually be good.
Understanding your stress level is important. If nothing in your life
causes you any stress or excitement, you may become bored
or may not be living up to your potential. If everything in your
life, or large portions of your life, cause you stress, you may
experience health or mental problems that will make your
behavior worse.
Understanding the illness link about the stress:
Neurobiological perspectives:
The body pays a price if must constantly adapt to stress.
This ‘price’ can be expressed in terms of what is referred to as
allostatic load - (allostatic (or allotasis) - is the process of achieving
stability, or homeostasis, through physiological or behavioral
change).
If the body is exposed to high levels of stress hormones such as
cortisol and becomes susceptible to disease because of altered
immune system functioning – a high allostatic load.
Psychodynamic perspectives:
Franz Alexander (1950) – repressed emotional impulses created
a chronic negative emotional state that impacted health, thus
setting the stage for problems like ulcers, asthma, or essential
hypertension.
Cognitive and personality perspectives:
Physical threats obviously create stress – so do negative
emotions such as resentment, regret, and worry.
Negative emotions stimulate sympathetic nervous system
activity and may keep the body’s stress systems aroused and
the body in a continual state of emergency, sometimes for far
longer than it can bear, as suggested by the notion of allostatic
load.
Personality traits have been linked to immune system
functioning – e.g. negative emotions linked to slow antibody
production.
Physical and mental signs of short-term stress
Often occurring in quick 'bursts' in reaction to something in your
environment, short-term stress can affect your body in many ways.
Some examples:
•Making your heartbeat and breath faster
•Making you sweat more
•Leaving you with cold hands, feet, or skin
•Making you feel sick to your stomach
•Tightening your muscles or making you feel tense
•Leaving your mouth dry
•Making you have to go to the bathroom frequently
•Increasing muscle spasms, headaches, fatigue, and shortness of
breath.
While this burst of energy may help you in physical situations where
your body needs to react quickly, it can have bad effects on your
mind and performance if there is no outlet or reason for your stress.
These effects may include:
•Interfering with your judgment and causing you to make bad
decisions
•Making you see difficult situations as threatening
•Reducing your enjoyment and making you feel bad
•Making it difficult for you to concentrate or to deal with
distraction
•Leaving you anxious, frustrated or mad
•Making you feel rejected, unable to laugh, afraid of free time,
unable to work, and not willing to discuss your problems with
others.
Physical and mental signs of short-term stress
Long-term stress or stress that is occurring over long periods of time can
have an even greater effect on your body and mind. Long-term stress can
affect your body by:
Changing your appetite (making you eat either less or more)
Changing your sleep habits (either causing you to sleep too much or
not letting you sleep enough)
Encouraging 'nervous' behavior such as twitching, fiddling, talking too
much, nail biting, teeth grinding, pacing, and other repetitive habits
Causing you to catch colds or the flu more often and causing other
illnesses such as asthma, headaches, stomach problems, skin problems,
and other aches and pains
Affecting your sex life and performance
Making you feel constantly tired and worn out.
Long-term stress can also have serious effects on your mental health and
behavior:
Worrying and feeling anxious (which can sometimes lead to anxiety
disorder and panic attacks)
Feeling out of control, overwhelmed, confused, and/or unable to make
decisions
Experiencing mood changes such as depression, frustration, anger,
helplessness, irritability, defensiveness, irrationality, overreaction, or
impatience and restlessness
Increasing dependence on food, cigarettes, alcohol, or drugs
Neglecting important things in life such as work, school, and even
personal appearance
Developing irrational fears of things such as physical illnesses, natural
disasters like thunderstorms and earthquakes, and even being terrified of
ordinary situations like heights or small spaces.
Stress Management
Relaxation training – the most common form of relaxation training is
progressive muscle relaxation, which involves systematically tensing
and then relaxing each major muscle group in the body.
Cognitive restructuring – includes approaches to alter people’s belief
systems and reduce the negativity of their interpretations of
experience.
Behavioral skills training – practice in skills such as time management
and effective prioritizing.
Abnormal Breathing Technique
Breathing exercises such as this one should be done twice a day or
whenever you find your mind dwelling on upsetting thoughts or when
you are experiencing pain:
Place one hand on your chest and the other on your abdomen.
When you take a deep breath in, the hand on the abdomen
should rise higher than the one on the chest. This insures that the
diaphragm is pulling air into the bases of the lungs.
After exhaling through the mouth, take a slow deep breath in
through your nose imagining that you are sucking in all the air in
the room and hold it for a count of 7 (or as long as you are able,
not exceeding 7).
Slowly exhale through your mouth for a count of 8. As all the air is
released with relaxation, gently contract your abdominal muscles
to completely evacuate the remaining air from the lungs. It is
important to remember that we deepen respiration not by
inhaling more air but through completely exhaling it.
Repeat the cycle four more times for a total of 5 deep breaths
and try to breathe at a rate of one breath every 10 seconds (or 6
breaths per minute). At this rate our heart rate variability increases
which has a positive effect on cardiac health.
Ethical quandaries develop when individuals or
communities are forced to make difficult judgements involving moral principles
or values that are in contradiction with one another. These quandaries
frequently give rise to challenges and disputes. Because they require
individuals to make decisions between opposing interests, ethical dilemmas can
offer substantial problems. However, there is not always a straightforward
answer to these conundrums. Its include decision-making conflicts, stakeholder
conflicts, legal and regulatory conflicts, public perception and reputation and
emotional distress.
It is essential to confront ethical conundrums in a
methodical and reflective manner, taking into account a variety of viewpoints,
ethical frameworks, and the potential outcomes of one's actions. Participating
in open discourse, looking for ethical counsel, and fostering a culture of
ethical awareness are all things that may help reduce the likelihood of
disputes and make it easier to deal with these issues. The decision to put an
end to one's life presents complicated obstacles and tensions since it requires
one to make challenging choices regarding medical treatment, care, and the
preservation of human life in the face of severe circumstances or terminal
sickness. This moral conundrum emerges when individuals, families, and
healthcare professionals are put in a position where they must make decisions
that will have an effect on the persons' quality of life, autonomy, and dignity
as they draw closer to the end of their lives.
Communication that is both open and empathic is necessary
to address the problems and tensions that are inherent in end-of-life choice
dilemmas. This communication must involve patients, their families, healthcare
providers, and other stakeholders. Access to palliative care, advance care
planning, and ethical frameworks, such as shared decision making models can all
be helpful in navigating these issues and promoting compassionate
decision-making in end of life circumstances.
1.Case Study 1
Adam was a 2-year-old child
with congenital acute myeloid leukemia. He was admitted to the pediatric
intensive care unit (PICU) after receiving an allogeneic bone marrow
transplant. One week after the transplant, a severe pulmonary infection
developed, resulting in irreversible lung injury; he was ventilator dependent.
Adam was a patient in the PICU for 2 months and he had good and bad days. On his bad days, the PICU
staff struggled to manage his hypoxemia, hypercapnia, and hemodynamic
instability. He had several close calls to death, including being resuscitated
twice after having cardiac arrests. Neurologically at times, he opened his eyes;
he had limited motor ability. When he became restless, he was given sedative
drugs.
Several family meetings
occurred over his 2-month PICU stay. The palliative care team was consulted 5
weeks into his stay. At the most recent meeting, the palliative care APRN
reviewed Adam’s illness trajectory, discussed his current condition and told Adam’s
parents that the team would like to consider a change in the focus of Adam’s
care.
The pediatric intensivist
discussed Adam’s poor prognosis and his parents were given time to ask
questions. The palliative care APRN discussed the possibility of focusing
Adam’s care on comfort and suggested that it was time to consider decisions
such as withholding cardiopulmonary resuscitation (CPR) if Adam’s heart were to
stop again. She asked Adam’s parents whether they would support this decision.
Adam’s mother said that she agreed that CPR should not be started if her son’s
heart stopped. Adam’s father became angry and stated that the staff was giving
up on his son. He absolutely wanted all treatment continued, including CPR. He
got up and stormed out of the conference room.
Adam’s PICU nurse was not
sure whether to stay in the meeting or leave. She decided to leave and look for
Adam’s father. She found him sitting at his son’s bedside crying. He told her
that he needed a little time alone, so the nurse left and gave him time with
his son. When she returned, she acknowledged how difficult it must be to
participate in these types of decisions. Adam’s father told her that he did not
want to give up on his son. The nurse reinforced what good parents both he and
his wife were. Adam’s father said that he needed time to think about
everything. He had hoped that his son would recover and he was just starting to
realize that he might not. The PICU nurse emphasized that Adam would continue
to receive the best care possible, regardless of what decision was made, and
that the team was there to help not only Adam but also his family. (Wiegand, 2015, pg. 145)
This case study presents a
conflicting decision between both parents of a terminally ill 2-year-old boy
with acute myeloid leukemia. Despite a poor prognosis as well as multiple
resuscitations from cardiac arrests, the father refused to discontinue resuscitation
attempts with the perception that the medical team is giving up on his son. The
mother, however, was accepting of the decision due to the condition of her son.
The medical team, however, was adhering to the ethical principle of autonomy,
by allowing both of the parents, the autonomous legal guardian of their son, to
give their final decision on this end-of-life matter. Despite wanting to
provide the best treatment that may benefit the patient (beneficence), the
medical team also would like to reduce and minimize any harm that may be
inflicted on the 2-year-old boy (non-maleficence).
One of the dilemmas that
may be seen here is the contradiction between the father’s decision from the
medical team’s advice. Other than the literal physical definition of ‘alive’
towards the patient, the decision-maker, in this case, the parents, must also
consider the weight of their son’s quality of life should the treatment and
resuscitation be continued, apart from the consideration of their cultural and
religious norm. The process of end-of-life decision-making should consider the
well-being of the patient from all aspects; physical, emotional, religious, and
even personal beliefs (Puteri, 2015). Though admittedly, a 2-year-old may have
less consideration for religion and personal beliefs, the consideration of
end-of-life decisions should also include the immediate family and guardian.
The counsel team did a
praiseworthy job in assuring the parents that they will strive in providing the
best care possible for whichever path the parents choose to decide. Should the
parents choose the continue treatment, the medical team will work hard in
providing the best treatment that benefits the patient, and if the parents
choose to discontinue treatment and resuscitation, the medicals team will also
give as much effort in maximizing comfort and care if the provision of the best
palliative care for their son, Adam.
Ethically, this end-of-life
decision may only be made by the parents and should not be interfered with by
any other party. However, the medical team and the psychological support team,
if any, should be ready to be transparent and honest (veracity) in providing a
full, detailed explanation of Adam’s condition to both parents. The parents
should be able to make a fully informed decision and psychological and
emotional support services should be made available to the parents should they
need them. End-of-life care is an all-hands-on-deck situation where every party
serves a huge role in ensuring the best outcome for the patient, the parents as
well as the medical team. Despite everyone’s involvement, both decisions of
continuing or discontinuing treatment are not ethical violations as long as all
information is given and received by all parties involved
2.Case
Study 2
The case of Ms. Rahimah is
a hypothetical case study of a 65-year-old woman with end-stage chronic
obstructive pulmonary disease (COPD), a condition characterized by the
progressive deterioration of the airways in the lungs. Despite undergoing
various treatments for her condition over the years, her COPD has continued to
worsen, and she has now reached a point where her doctors have determined that
there are no more viable treatment options available. They have explained that
her condition will ultimately lead to her death, and they have suggested that
she and her family begin to think about her end-of-life care.
Rahimah has expressed to
her doctors and family that she does not want to prolong her suffering any
further, and she has decided to elect hospice care. Hospice care is a form of
palliative care that provides comfort and pain relief to patients who are dying,
and it often involves the withdrawal of life-preservation interventions such as
intubation or resuscitation. Ms. Rahimah's decision to elect hospice care
reflects her desire to prioritize comfort and quality of life overextending her
life at all costs.
While Ms. Rahimah's
decision may be a difficult one for some family members to understand, it is
ultimately her right to self-determination, as she is entitled to make
decisions about her healthcare based on her values and preferences. Her
decision is an example of the importance of open and honest discussions about
end-of-life care and the role that patients, families, and healthcare
professionals play in these discussions. By taking an approach to end-of-life
care, we can help patients and families make informed decisions that prioritize
comfort, dignity, and quality of life.
End-of-life decisions are
complex and require careful consideration of the patient's preferences and
values. The case of Ms. Rahimah illustrates the importance of respecting a
patient's autonomy in making these decisions, and providing care that
prioritizes comfort, relief from suffering, and an increase in quality of life.
Autonomy is a fundamental
principle in ethics and is especially important in end-of-life care. It
involves allowing a patient to make their own healthcare decisions, including
decisions about their end-of-life care. By treating a patient as autonomous person,
we respect their dignity and agency, and we help to ensure that their values
and preferences are considered in care planning.
In the case of Ms. Rahimah,
it was important to respect her autonomy in making her decision to elect
hospice care. She had the right to make this decision, and it was not
appropriate for others to impose their own beliefs or values on her. Healthcare
professionals should provide information, support, and guidance to help
patients make informed decisions, but they should not pressure patients to
choose a particular course of care.
Aside from respecting
autonomy, it is also important to provide care that is non-maleficent or that
does not cause harm. Hospice care is designed to provide comfort and relief
from suffering, rather than to prolong life at all costs. Healthcare professionals
should ensure that they are not providing treatments or interventions that
could cause harm or prolong suffering and should instead focus on providing
palliative care that addresses the patient's needs and aims to improve their
quality of life.
In addition to
non-maleficence, it is also important to provide care that is beneficial or
that brings about good. End-of-life care should not only be about avoiding harm
but should also be about providing benefits to the patient, such as relief from
pain and distress, and an increase in their quality of life. Palliative care is
designed to do just that, and healthcare professionals should take a holistic
approach to care that addresses the patient's physical, emotional, and
spiritual needs.
Finally, justice is a
principle that requires individuals to be treated fairly and equitably and not
be subjected to discrimination or bias. In the case of Ms. Jones, it is
important that healthcare professionals do not discriminate against her based
on her age, or gender.
3.Case
Study 3
John Anderson, a
68-year-old man, has been living with end-stage heart failure for the past two years. Current Condition severe shortness of breath, fluid retention, declining
organ function. Despite various medical interventions, his condition has progressively
worsened. John's heart function has significantly declined, leading to severe
shortness of breath and fluid retention. He is frequently hospitalized for
complications related to his heart failure. The medical team believes that John
is approaching the end stages of his illness.
Ethical Dilemma:
John's family and
healthcare providers are facing an ethical dilemma regarding end-of-life
decisions. John's condition is unlikely to improve, and his quality of life is
greatly compromised. The medical team and family members have different
opinions on the best course of action. Some family members advocate for
continuing
aggressive interventions, while others believe that
focusing on comfort care and ensuring a peaceful end is more appropriate.
Options Considered:
Continuation of Aggressive Interventions:
Continue with advanced
medical treatments, such as cardiac interventions, mechanical circulatory
support, or transplantation, with the goal of extending John's life. Engage in
ongoing discussions with the medical team to assess the potential benefits, risks,
and burdens of these interventions. Understanding these factors will help John
and his loved ones make informed decisions regarding the continuation of
aggressive treatments. Ensure that John's goals and preferences are considered
in the decision-making process.
Transition to Palliative Care and Symptom
Management:
Transitioning to palliative
care signifies a shift in the treatment approach, placing emphasis on improving
John's quality of life. Instead of pursuing aggressive interventions, the focus
now shifts to providing holistic care that addresses his physical, emotional,
and spiritual well-being. Palliative care aims to alleviate symptoms, manage
pain, and enhance overall comfort, allowing John to make the most of his
remaining time. Symptom management is a vital aspect of palliative care.
Medications are commonly used to alleviate symptoms such as pain, nausea,
anxiety, and shortness of breath. The palliative care team, in collaboration
with John, will develop an individualized plan tailored to his specific needs.
This approach ensures that medication regimens are optimized, providing
effective relief while minimizing potential side effects. Shortness of breath
is a distressing symptom often experienced by individuals with advanced medical
conditions. In palliative care, oxygen therapy and non-invasive ventilation can
significantly improve John's breathing and enhance his comfort. These
interventions aim to alleviate breathlessness, allowing him to engage in
activities that bring joy and maintain a sense of independence.
Shared Decision-Making and Advance Care Planning:
Shared decision-making is
crucial in the continuation of aggressive interventions. It involves
collaboration between John, his family, and the medical team. By providing
comprehensive information about the available treatment options, their
potential outcomes, and associated risks, the medical team can empower John and
his family to actively participate in the decision-making process. This
collaborative approach ensures that the final decision aligns with John's
values, preferences, and long-term goals.
4.Conclusion
From the case study
presented, there are 3 prong conflicts that can be observed regarding
decision-making for end-of-life care; the patient’s advocate vs healthcare
worker, the patient vs her family member, and the patient’s family member vs
the healthcare worker.
In this dire situation,
everyone involved does have their best intention at heart, aiming for the best
outcome for the patient, but when it concerning the end of life care, the
willingness to participate in the conversation is varied, both for the patient’s
themself and their relatives as it is emotionally challenging (Gjerberg, E. et
al, 2015) and it poses communication challenge even with the healthcare
provider (Naomi, R. et al. 2016). Adding the weight of the situation is when
the patient can’t exercise their autonomy, the responsibility to make the
decision will fall onto their legal next-of-kin, as this has always been part
of hospital policies.
However, many of the
patient’s relatives did not really know what the patient’s needs were, despite
the patient’s belief in them (Georg Bollig et al. 2016).
Since all the case studies
happen in hospital settings and involve palliative care, referring to
Palliative Care Services Operational Policy 2010 by the Ministry of Health
(MOH) is essential as it provides ethical guidelines for handling the
situation. As palliative care is generally a new medical specialty recognized
by MOH in 2005, another guideline that can be helpful to assist in the
decision-making for the professional parties is Handbook in Palliative Medicine
in Malaysia, developed in 2015. The reasons this was emphasized was that this
policy and handbook can assist in making better solutions for the case studies,
as it is coherence with Principal A: Beneficence and Non-Maleficence, of APA
General Principle (2010) when the psychologists' scientific and professional
judgments and actions may affect the lives of others, they need to be alert and
guarded against personal, financial, social, organizational, or political
factors that might lead to misuse of their influence.
According to the policy,
effective communication skills are essential tools in palliative care and
healthcare providers must develop these skills, including effective listening,
providing information, facilitating decision making and coordinating care among
the patient, family, and other healthcare providers, as this has proven to
better prepare the patient for their final outcome and reduce moral distress
for their relatives (Georg Bollig et al. 2016). This provision is aligned with
Principle E: Respect for People's Rights and Dignity, of APA General Principle
(2010), where individual differences are respected and taking these differences
into consideration when working with others.
Managing end-of-life care
decision’s making can also be guided by the Resolution on Palliative Care and
End-of-life Issues, adopted by the APA Council of Representatives, which
“endorses the principles that care for individuals with advanced serious illness
should be comprehensive, high quality, integrated, interdisciplinary,
patient-centered and family oriented, coordinated across all providers and
settings; accessible, and available through governmental and private health
insurers and care delivery programs. Individuals should have the opportunity to
engage in conversations about their health care, the results of which should be
incorporated into ongoing care plans.” (2017, para 74).
eorg Bollig, Eva
Gjengedal and Jan Henrik Rosland (2016) They know! —Do they? A qualitative
study of residents and relatives’ views on advance care planning, end-of-life
care, and decision-making in nursing homes. Palliative Medicine Vol. 30(5)
456–470 DOI: 10.1177/0269216315605753
Gjerberg, E.,
Lillemoen, L., Førde, R. et al. (2015) End-of-life care communications and
shared decision-making in Norwegian nursing homes - experiences and
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Naomi R. George,
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