title: Solicitude: balancing compassion and empowerment in a relational ethics of hope-an empirical-ethical study in palliative care.
abstract: The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of (false) hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships.
authors.affiliation: Section of Medical Ethics, Department of General Practice, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. erik.olsman@amc.uva.nl.
authors.forename: Erik
authors.initials: E
authors.lastname: Olsman
authors.affiliation: Section of Medical Ethics, Department of General Practice, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Willems
authors.affiliation: Department of Ethics of Care, University of Humanistic Studies, Utrecht, The Netherlands.
authors.forename: Carlo
authors.initials: C
authors.lastname: Leget
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003142:Communication; D004645:Empathy; D005190:Family / Q000523:psychology; D005260:Female; D033062:Friends / Q000523:psychology; D065026:Hope; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009014:Morals; D033262:Narration; D010166:Palliative Care / Q000941:ethics* / Q000523:psychology*; D011209:Power, Psychological; D011369:Professional-Patient Relations; D036301:Qualitative Research; D029181:Spirituality
keywords: Compassion; Empowerment; Ethics; Hope; Palliative care; Qualitative research; Solicitude