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Dalmijn EW, Visse MA, van Nistelrooij I. Decision-making in case of an unintended pregnancy: an overview of what is known about this complex process. J Psychosom Obstet Gynaecol 2024; 45:2321461. [PMID: 38469857 DOI: 10.1080/0167482x.2024.2321461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/16/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision.Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a 'sense of knowing' is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience.
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Affiliation(s)
- Eline W Dalmijn
- Faculty of Philosophy, Theology and Religious Studies, Radboud University, Nijmegen, The Netherlands
- Fiom, Centre of Expertise in Unwanted Pregnancy and Ancestry, 's-Hertogenbosch, The Netherlands
| | - Merel A Visse
- Caspersen School of Graduate Studies, Medical and Health Humanities, Drew University, Madison, Wisconsin, USA
| | - Inge van Nistelrooij
- Care Ethics and Policy, University of Humanistic Studies, Utrecht, The Netherlands
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André M, Enez J, Charras K, Besançon M, Delouvée S. Autonomy, independence, and participation of nursing home habitants addressed by assistive technology: a scoping review. Disabil Rehabil Assist Technol 2024:1-13. [PMID: 38832368 DOI: 10.1080/17483107.2024.2359472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
CONTEXT Assistive technologies have been identified by researchers and public policies of the Western world to be promising tools to face the challenge of maintaining quality of life of older people, and especially for nursing home habitants. Independence, autonomy, and participation are major determinants of quality of life of nursing homes habitants. Maintaining quality of life is nowadays a priority for public health policies and institutions of the where the population is growing older every year. METHOD This PRISMA-ScR review aims to determine which assistive technologies are used to promote autonomy, independence, and social participation of nursing home habitants. An electronic search was conducted for English, French articles to identify research studies using CINAHL, PubMed, Cochrane Library, PsycINFO, and Googlescholar. RESULTS 12 papers published between 2009 and 2023 described 6 assistive technologies: technologies integrated into the environment, monitoring technologies, surveillance technologies, information and communication technology, social assistance robots, virtual reality. Six types of AT are currently used worldwide to maintain autonomy, independence and participation of people living in nursing homes. Their use is mainly perceived as positive by habitants, care and non-care staff, next of kin, and experts despite some concerns regarding ethical, financial, consideration. DISCUSSION Nevertheless, their impact on habitant's autonomy, independence and participation still needs to be measured using suitable tools to understand their real impact on the quality of life of the elderly.
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Affiliation(s)
- Marielle André
- Living Lab Vieillissements et Vulnérabilités (LL2V), Université Rennes, Service de gériatrie, CHU Rennes, Rennes, France
- Univ Rennes, LP3C (Laboratoire de Psychologie: Cognition, Comportement, Communication), Université de Bretagne Sud, Université de Brest, Université de Rennes 2, Institut Brestois des Sciences de l'Homme et de la Société, Rennes, France
| | - Jérémy Enez
- Living Lab Vieillissements et Vulnérabilités (LL2V), Université Rennes, Service de gériatrie, CHU Rennes, Rennes, France
- IFPEK, Institut de Formation en Pédicurie-Podologie, Ergothérapie, Masso-Kinésithérapie, Rennes, France
| | - Kevin Charras
- Living Lab Vieillissements et Vulnérabilités (LL2V), Université Rennes, Service de gériatrie, CHU Rennes, Rennes, France
- Univ Rennes, LP3C (Laboratoire de Psychologie: Cognition, Comportement, Communication), Université de Bretagne Sud, Université de Brest, Université de Rennes 2, Institut Brestois des Sciences de l'Homme et de la Société, Rennes, France
| | - Maud Besançon
- Univ Rennes, LP3C (Laboratoire de Psychologie: Cognition, Comportement, Communication), Université de Bretagne Sud, Université de Brest, Université de Rennes 2, Institut Brestois des Sciences de l'Homme et de la Société, Rennes, France
| | - Sylvain Delouvée
- Univ Rennes, LP3C (Laboratoire de Psychologie: Cognition, Comportement, Communication), Université de Bretagne Sud, Université de Brest, Université de Rennes 2, Institut Brestois des Sciences de l'Homme et de la Société, Rennes, France
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From the challenge of assessing autonomy to the instruments used in practice: A scoping review. Porto Biomed J 2022; 7:e153. [PMID: 36186121 PMCID: PMC9521790 DOI: 10.1097/j.pbj.0000000000000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/26/2021] [Indexed: 11/26/2022] Open
Abstract
Autonomy is one of the essential components to live a quality life. Monitoring this autonomy is, in effect, essential, to allow the nurses to conceive, implement and evaluate interventions aimed at its promotion or even maintenance. For this reason, this scoping review aims to map the evidence to identify and analyze the instruments used to assess the person’s autonomy, which emerges from scientific production.
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Bergamin J, Luigjes J, Kiverstein J, Bockting CL, Denys D. Defining Autonomy in Psychiatry. Front Psychiatry 2022; 13:801415. [PMID: 35711601 PMCID: PMC9197585 DOI: 10.3389/fpsyt.2022.801415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Mental illness undermines a patient's personal autonomy: the capacities of a person that enables them to live a meaningful life of their own making. So far there has been very little attention given to personal autonomy within psychiatry. This is unfortunate as personal autonomy is disturbed in different ways in psychiatric disorders, and understanding how autonomy is affected by mental illness is crucial for differential diagnosis and treatment, and also for understanding personal recovery. We will argue that disturbance of personal autonomy is related to patient's diminished quality of life and suffering that motivates seeking treatment. We hypothesize that (1) personal autonomy is generally reduced by mental illness but (2) the effects on autonomy are expressed differently according to the underlying psychopathology, and also vary according to the (3) context, and perspective of the individual patient. We provide a discussion of how autonomy can be affected in five prototypical mental disorders; Major Depressive Disorder, Substance-use Disorders, Obsessive Compulsive Disorder, Anorexia Nervosa and Schizophrenia. We take these disorders to be illustrative of how diminished autonomy is a central but overlooked dimension of mental illness. We will use our discussion of these disorders as the basis for identifying key dimensions of autonomy that could be relevant to innovate treatment of psychiatric disorders.
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Affiliation(s)
- Jessy Bergamin
- Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
| | - Judy Luigjes
- Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
| | | | | | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
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Ethics of Vaccination in Childhood-A Framework Based on the Four Principles of Biomedical Ethics. Vaccines (Basel) 2021; 9:vaccines9020113. [PMID: 33540732 PMCID: PMC7913000 DOI: 10.3390/vaccines9020113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023] Open
Abstract
Although vaccination is recognised as the top public health achievement of the twentieth century, unequivocal consensus about its beneficence does not exist among the general population. In countries with well-established immunisation programmes, vaccines are “victims of their own success”, because low incidences of diseases now prevented with vaccines diminished the experience of their historical burdens. Increasing number of vaccine-hesitant people in recent years threatens, or even effectively disables, herd immunity levels of the population and results in outbreaks of previously already controlled diseases. We aimed to apply a framework for ethical analysis of vaccination in childhood based on the four principles of biomedical ethics (respect for autonomy, nonmaleficence, beneficence and justice) to provide a comprehensive and applicable model on how to address the ethical aspects of vaccination at both individual and societal levels. We suggest finding an “ethical equilibrium”, which means that the degree of respect for parents’ autonomy is not constant, but variable; it shall depend on the level of established herd immunity and it is specific for every society. When the moral obligation of individuals to contribute to herd immunity is not fulfilled, mandatory vaccination policies are ethically justified, because states bear responsibility to protect herd immunity as a common good.
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Abstract
Respect for autonomy is a central moral principle in bioethics. It is sometimes argued that authenticity, i.e., being "real," "genuine," "true to oneself," or similar, is crucial to a person's autonomy. Patients sometimes make what appears to be inauthentic decisions, such as when (decision-competent) anorexia nervosa patients refuse treatment to avoid gaining weight, despite that the risk of harm is very high. If such decisions are inauthentic, and therefore non-autonomous, it may be the case they should be overridden for paternalist reasons. However, it is not clear what justifies the judgment that someone or something is inauthentic. This article discusses one recent theory of what justifies judgments of inauthenticity. It is argued that the theory is seriously limited, as it only provides guidance in three out of nine identified cases. There are at least six authenticity-related problems to be solved, and autonomy theorists thus have reason to engage with the topic of authenticity in practical biomedicine.
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