Everyday ethics and help-seeking in early rheumatoid arthritis.
BACKGROUND
Sociological understandings of chronic illness have revealed tensions and complexities around help-seeking. Although ethics underpins healthcare, its application in the area of chronic illness is limited. Here we apply an ethical framework to interview accounts and identify ethical challenges in the early rheumatoid arthritis (RA) experience.


METHODS
In-depth interviews were conducted with eight participants who had been diagnosed with RA in the 12 months prior to recruitment. Applying the concepts of autonomous decision-making and procedural justice highlighted ethical concerns which arose throughout the help-seeking process. Analysis was based on the constant-comparison approach.


RESULTS
Individuals described decision-making, illness actions and the medical encounter. The process was complicated by inadequate knowledge about symptoms, common-sense understandings about the GP appointment, difficulties concerning access to specialists, and patient-practitioner interactions. Autonomous decision-making and procedural justice were compromised. The accounts revealed contradictions between the policy ideals of active self-management, patient-centred care and shared decision-making, and the everyday experiences of individuals.


CONCLUSIONS
For ethical healthcare there is a need for: public knowledge about early RA symptoms; more effective patient-practitioner communication; and increased support during the wait between primary and secondary care. Healthcare facilities and the government may consider different models to deliver services to people requiring rheumatology consults.
Townsend
A
A
CIHR Ethics of Health Research Health and Training Program, The W. Maurice Young Centre for Applied Ethics, University of British Columbia, 235-6356 Agricultural Road, Klinck Building, Vancouver, British Columbia V6T 1Z2, Canada. atownsen@interchange.ubc.ca
Adam
P
P
Cox
S M
SM
Li
L C
LC
D001172:Arthritis, Rheumatoid / Q000523:psychology* / Q000628:therapy; D001294:Attitude to Health; D003657:Decision Making; D042241:Early Diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology*; D018579:Patient Selection / Q000941:ethics*; D026684:Personal Autonomy; D011795:Surveys and Questionnaires