title: A relational ethical approach to end-of-life delirium.
abstract: Delirium is a condition of acute onset and fluctuating course in which a person's level of consciousness and cognition become disturbed. Delirium is a common and distressing phenomenon in end-of-life care, yet it is underrecognized and undertreated. In this article, we review qualitative descriptions of the delirium experience in end-of-life care, found through a systematic search of academic databases, to generate insight into the intersubjective nature of the delirium experience. Our analysis of retrieved studies advances an understanding of the relational ethical dimensions of this phenomenon, that is, how delirium is lived by patients, families, and health care providers and how it affects the relationships and values at stake. We propose three themes that explain the distressing nature of delirium in palliative care: 1) experiences of relational tension; 2) challenges in recognizing the delirious person; and 3) struggles to interpret the meaning of delirious behaviors. By approaching end-of-life delirium from a perspective of relational ethics, attention is focused on the implications for the therapeutic relationship with patients and families when delirium becomes part of the dying trajectory.
authors.affiliation: Department of Biomedical Ethics, McGill University, Montreal, Quebec, Canada; Department of Palliative Care, Jewish General Hospital, Montreal, Quebec, Canada. Electronic address: dwrig079@uottawa.ca.
authors.forename: David Kenneth
authors.initials: DK
authors.lastname: Wright
authors.affiliation: School of Nursing, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Brajtman
authors.affiliation: Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; Pediatric Palliative Care Research, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Macdonald
mesh_terms: D017028:Caregivers / Q000523:psychology; D003693:Delirium / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D005190:Family / Q000523:psychology; D006801:Humans; D010166:Palliative Care / Q000941:ethics / Q000379:methods; D013727:Terminal Care / Q000941:ethics* / Q000379:methods*
keywords: Delirium; end-of-life care; hospice; palliative care; qualitative research; relational ethics