Mireille LavoiePh.D.

Dr. Lavoie is a nurse, associate professor and Dean for graduate studies and research at the Laval University School of Nursing. She is also a researcher at the Centre de recherche du CHU de Québec–Axe oncologie, more specifically within the Réseau Québécois de recherche en Soins PALliatifs et de fin de vie (RQSPAL) and the Équipe de Recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs (ERMOS).

Graduated in nursing sciences (B.Sc., M.Sc.), she obtained a doctorate degree in philosophy (Ph.D.) regarding palliative care. Moreover, she completed a postdoctoral internship at the Institute of Human Becoming (Pittsburgh) in order to study the practical implications of the caring approach “Human becoming” (Parse, 1998, 2003, 2007) in the context of end-of-life. Her research program focuses on the experience of relational autonomy and the implementation of caring practices in palliative care which promotes the respect of patients’ autonomy by taking into account their capabilities and limitations. It is composed of three axes: (1) to deepen the experience of autonomy of end-of-life patients; (2) to contribute to the development of a caring practice which can facilitate the expression and the respect of the autonomy of end-of-life patients; (3) to study the limits of certain practices surrounding the respect of autonomy during end-of-life.

Palliative care; Experience and respect of autonomy; Death and dying; Existential-humanist philosophy; Philosophy and theory of nursing sciences; Ethics

To deepen the experience of autonomy during end-of-life

The first focus explores the experience of autonomy in a palliative care setting from the perspective of patients suffering from incurable diseases. An initial project with SSHRC funding allowed for the definition and exploration of six essential aspects of these patients’ experience: affirmation of identity as a human being, ability to act by oneself, generation of positive impacts on well-being, experience of difficult and sometimes painful feelings, altered relationships, and adoption of different attitudes with regard to the future. Through this research, it was possible to critically examine the attitudes of healthcare professionals, for example as manifested in their tendency to act for the patient—acts perhaps motivated by a desire to do good, but nevertheless an “affront” to the patients’ expressed autonomy.

To contribute to the development of a caring practice which can facilitate the expression and the respect of the autonomy of end-of-life patients

The second focus concerns the development of caregiving practices that encourage the expression and respect of palliative care patients’ autonomy. A first research project (SSHRC) describes the changes observed in the practices and beliefs of caregivers, in the experience of patients’ loved ones, and in the documentation of the patients’ expressed wishes following the application of Parse’s theory (2003). Once this theory is put into practice, data analysis demonstrates, among other findings, a shift in caregivers’ focus from completing a task to understanding the patient’s perspective; caregivers placing increased emphasis on listening to patients and on respecting the patients’ priorities and choices. While respect for patient autonomy does present new challenges, the research takes into account solutions and techniques used by caregivers to provide even greater autonomy.

To study the limits of certain practices surrounding the respect of autonomy during end-of-life

This third research focus includes an additional project entitled “De la philosophie des soins palliatifs aux pratiques cliniques actuelles” (associate researcher, SSHRC). The project’s aim is to explore and describe current practices in healthcare facilities that appear at odds with the philosophy of palliative care (e.g., by failing to respect patient autonomy) and that are unconducive to the proper provision of palliative care.