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Hurley ME, Lang BH, Kostick-Quenet KM, Smith JN, Blumenthal-Barby J. Patient Consent and The Right to Notice and Explanation of AI Systems Used in Health Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-13. [PMID: 39288291 DOI: 10.1080/15265161.2024.2399828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Given the need for enforceable guardrails for artificial intelligence (AI) that protect the public and allow for innovation, the U.S. Government recently issued a Blueprint for an AI Bill of Rights which outlines five principles of safe AI design, use, and implementation. One in particular, the right to notice and explanation, requires accurately informing the public about the use of AI that impacts them in ways that are easy to understand. Yet, in the healthcare setting, it is unclear what goal the right to notice and explanation serves, and the moral importance of patient-level disclosure. We propose three normative functions of this right: (1) to notify patients about their care, (2) to educate patients and promote trust, and (3) to meet standards for informed consent. Additional clarity is needed to guide practices that respect the right to notice and explanation of AI in healthcare while providing meaningful benefits to patients.
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Kim S, Goncalo JA, Rodas MA. The cost of freedom: Creative ideation boosts both feelings of autonomy and the fear of judgment. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2023. [DOI: 10.1016/j.jesp.2022.104432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Biller A, Biller-Andorno N. From text to interaction: The digital advance directive method for advance directives. Digit Health 2023; 9:20552076221147414. [PMID: 36620435 PMCID: PMC9817014 DOI: 10.1177/20552076221147414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023] Open
Abstract
Advance directives allow people to specify individual treatment preferences in case of decision-making incapacity involving decisions of utmost importance. There are many tools that provide information on the topic, digital forms for structured data input, or platforms that support data storage and availability. Yet, there is no tool supporting the innermost process of an advance directive: decision making itself. To address this issue, we developed a visual-interactive, semi-quantitative method for generating digital advance directives (DiADs) that harnesses the potential of digitalization in healthcare. In this article, we describe the DiAD method and its app lined with the exemplary narrative of user Mr S. linking the theory to an exemplary use case. The DiAD method is intended to lower barriers and increase comfort in creating an advance directive by shifting the focus from heavily text-based processes to visual representation and interaction, that is, from text to reflection.
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Affiliation(s)
- Armin Biller
- Multi-Dimensional Medical Information (MDMI) Lab, Department of
Neuroradiology, University of Heidelberg, Germany,Armin Biller, Multi-Dimensional Medical
Information (MDMI) Lab Department of Neuroradiology, University of Heidelberg,
Im Neuenheimer Feld 400, 69120 Heidelberg, Baden-Württemberg, Germany.
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine,
University of
Zurich, Switzerland
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Grover D, Tekkalaki B, Yadawad V, Patil NM, Chate SS, Patil S. Capacity to Consent for Treatment in Patients with Psychotic Disorder: A Cross-Sectional Study from North Karnataka. Indian J Psychol Med 2022; 44:592-597. [PMID: 36339695 PMCID: PMC9615443 DOI: 10.1177/02537176221100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Recently, the Mental Healthcare Act (MHCA) 2017 was introduced in India. Being a right-based act, it has made the assessment of the capacity to consent an integral part of clinical work. To the best of our knowledge, there are no Indian studies on this topic. Hence, this study aimed to assess the capacity to consent to mental healthcare and treatment in patients with functional psychosis and the factors affecting the same. METHODS This cross-sectional study included participants with the ICD-10 DCR diagnosis of a psychotic disorder admitted in the psychiatry ward of a tertiary health care center in Karnataka, India. MacArthur Competence Assessment Tool for Treatment was used to assess the capacity to consent to treatment. Brief Psychiatric Rating Scale (BPRS) and the Beck Cognitive Insight Scale were applied to assess the severity of psychosis and level of insight, respectively. RESULTS A hundred participants were recruited. Twenty-four were found to have an intact capacity to consent to treatment. High BPRS scores (P value = 0.0002) and low insight scores (P value = 0.0002) were associated with an impaired capacity. CONCLUSION About one-fourth of participants had an intact capacity to consent to treatment. Higher severity of psychosis and a poorer insight into the illness were associated with impaired capacity to consent.
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Affiliation(s)
- Druhin Grover
- Dept. of Psychiatry, KAHER's J. N. Medical College, Belagavi, Karnataka, India
| | - Bheemsain Tekkalaki
- Dept. of Psychiatry, KAHER's J. N. Medical College, Belagavi, Karnataka, India
| | - Vishwas Yadawad
- Dept. of Psychiatry, KAHER's J. N. Medical College, Belagavi, Karnataka, India
| | - Nanasaheb M Patil
- Dept. of Psychiatry, KAHER's J. N. Medical College, Belagavi, Karnataka, India
| | - Sameeran S Chate
- Dept. of Psychiatry, KAHER's J. N. Medical College, Belagavi, Karnataka, India
| | - Sandeep Patil
- Dept. of Psychiatry, KAHER's J. N. Medical College, Belagavi, Karnataka, India
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Dixon E, Michaels R, Xiao X, Zhong Y, Clary P, Narayanan A, Brewer R, Lazar A. Mobile Phone Use by People with Mild to Moderate Dementia: Uncovering Challenges and Identifying Opportunities: Mobile Phone Use by People with Mild to Moderate Dementia. ASSETS. ANNUAL ACM CONFERENCE ON ASSISTIVE TECHNOLOGIES 2022; 2022:38. [PMID: 37283282 PMCID: PMC10202486 DOI: 10.1145/3517428.3544809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
With the rising usage of mobile phones by people with mild dementia, and the documented barriers to technology use that exist for people with dementia, there is an open opportunity to study the specifics of mobile phone use by people with dementia. In this work we provide a first step towards filling this gap through an interview study with fourteen people with mild to moderate dementia. Our analysis yields insights into mobile phone use by people with mild to moderate dementia, challenges they experience with mobile phone use, and their ideas to address these challenges. Based on these findings, we discuss design opportunities to help achieve more accessible and supportive technology use for people with dementia. Our work opens up new opportunities for the design of systems focused on augmenting and enhancing the abilities of people with dementia.
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Jin JE, Hue GE. The Need for Preservation of Medical Decision Making with Diminished Cognitive Capacity. AJOB Neurosci 2021; 12:224-226. [PMID: 34704903 DOI: 10.1080/21507740.2021.1941412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Neuro-Oncology Clinicians' Attitudes and Perspectives on Medical Assistance in Dying. Can J Neurol Sci 2021; 48:772-778. [PMID: 34321130 DOI: 10.1017/cjn.2021.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Medical assistance in dying (MAiD), also known as physician-assisted death, is currently legal in several locations across the globe. Brain cancer or its treatments can lead to cognitive impairment, which can impact decision-making capacity for MAiD. OBJECTIVE We sought to explore neuro-oncology clinicians' attitudes and perspectives on MAiD, including interpretation of decision-making capacity for patient MAiD eligibility. METHODS An online survey was distributed to members of national and international neuro-oncology societies. We asked questions about decision-making capacity and MAiD, in part using hypothetical patient scenarios. Multiple choice and free-text responses were captured. RESULTS There were 125 survey respondents. Impaired cognition was identified as the most important factor that would signal a decline in patient capacity. At least 26% of survey respondents had moral objections to MAiD. Respondents thought that different hypothetical patients had capacity to make a decision about MAiD (range 18%-58%). In other hypothetical scenarios, fewer clinicians were willing to support a MAiD decision for a patient with an oligodendroglioma (26%) vs. glioblastoma (41%-70%, depending on the scenario). Time since diagnosis, performance status, and patient age seemed to affect support for MAiD decisions (Fisher's exact P-values 0.007, < 0.001, and 0.049, respectively). CONCLUSION While there are differing opinions on the moral permissibility of MAiD in general and for neuro-oncology patients, most clinicians agree that capacity must be assessed carefully before a decision is made. End-of-life discussions should happen early, before the capacity is lost. Our results can inform assessments of patient capacity in jurisdictions where MAiD is legal.
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Jildeh TR, Abbas MJ, Hengy MH, O'Brien H, Gani GS, Okoroha KR. Informed Consent for the Orthopaedic Surgeon. JBJS Rev 2021; 9:01874474-202107000-00012. [PMID: 34270504 DOI: 10.2106/jbjs.rvw.21.00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» In the United States, orthopaedic surgeons have a legal obligation to obtain informed consent from patients before performing surgery; it is a process that includes a signed written document. » There are specific legal requirements that vary somewhat by state but generally include disclosure and documentation of the diagnosis, an explanation of the recommended procedure, a conversation about the risks and benefits of the procedure, and a discussion about alternative treatments. » Inadequate disclosure of risks and alternatives is associated with increased indemnity risk. » Studies have shown that many consent processes and forms are suboptimal.
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Affiliation(s)
- Toufic R Jildeh
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan
| | - Muhammad J Abbas
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan
| | | | | | - G Sal Gani
- Law Office of G. Sal Gani, P.C., Lansing, Michigan
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Minneapolis, Minnesota
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Pan CX, Thomson K, Costa BA, Morris J. Questioning Capacity in an Elderly Jamaican Man with Terminal Cancer Exhibiting Near-Death Awareness: A Case Report and Review of Literature. J Palliat Med 2021; 24:1413-1417. [PMID: 33970707 DOI: 10.1089/jpm.2020.0785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Near-death awareness (NDA) refers to visions and dreams commonly experienced by terminally ill individuals within months to hours before death. Methods: A case report of a 68-year-old Jamaican male diagnosed with advanced cholangiocarcinoma, who experienced visions of his deceased mother during hospitalization. Results: This article discusses how to differentiate NDA from delirium, core components for determining decisional capacity, and how clinicians can use a cultural guide to optimize patient-centered care. Conclusion: Improved recognition of NDA may promote cultural humility/competency and help to differentiate NDA from an underlying medical/psychiatric condition. It may assist the clinician in understanding the significance of NDA and the comfort and meaning these experiences may hold for both the individual and their family.
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Affiliation(s)
- Cynthia X Pan
- Division of Geriatrics and Palliative Care Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Kelly Thomson
- Division of General Internal Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Bruno A Costa
- Department of Internal Medicine, Walter Cantidio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Jane Morris
- Department of Internal Medicine, Walter Cantidio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Rajiah K, Sivarasa S, Maharajan MK. Impact of Pharmacists' Interventions and Patients' Decision on Health Outcomes in Terms of Medication Adherence and Quality Use of Medicines among Patients Attending Community Pharmacies: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4392. [PMID: 33918990 PMCID: PMC8122322 DOI: 10.3390/ijerph18094392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
Community pharmacists are responsible for providing the appropriate information on the use of medications to patients, which may enhance their medication adherence. The extent of control that patients have on their health care preferences creates many challenges for community pharmacists. This study aimed to determine the impact of pharmacist interventions and patient decisions on health outcomes concerning medication adherence and the quality use of medicines among patients attending community pharmacies. Appropriate studies were identified in a systematic search using the databases of Medline, Scopus, Google Scholar, and PubMed. The search included literature published between 2004 and 2019. The database searches yielded 683 titles, of which 19 studies were included after the full-text analysis with a total of 9313 participants. Metaprop command in Stata software version 14 was used for the analysis. This study was undertaken based on the general principles of the Cochrane Handbook for Systematic Reviews of Interventions and subsequently reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA) extension. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was directly used to rate the quality of evidence (high, moderate, low, or very low). The results revealed the effective interaction between patients and community pharmacists, the importance of pharmacist intervention on medication adherence and quality use of medicine, and the role of community pharmacists in counselling patients. Decision/choice of patients in self-care and self-medication is a factor contributing to health outcomes. Effective interaction of community pharmacists with patients in terms of medication adherence and quality use of medicines provided a better health outcome among patients. The community pharmacists influenced the decision/choice of patients in self-care and self-medications.
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Affiliation(s)
- Kingston Rajiah
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57200, Malaysia;
| | - Shreeta Sivarasa
- Student, Master in Pharmacy Practice, School of Postgraduate Studies, International Medical University, Kuala Lumpur 57200, Malaysia;
| | - Mari Kannan Maharajan
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57200, Malaysia;
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How Advance Directives Help When Patients Refuse Life-saving Treatment Because of Their Substance Use. J Addict Med 2021; 15:441-442. [PMID: 33481461 DOI: 10.1097/adm.0000000000000799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients with substance use disorder have higher rates of discharge against medical advice, despite frequently presenting to emergency departments with significant and life-threatening comorbid conditions. A Ulysses contract, in the form of a substance use advance directive, would allow these patients to maintain their autonomy while providing a means for them to complete treatment for these comorbid conditions.
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Schraegle WA, Young SR, Rettig EK, Payne AR, Wilson JK, Wedberg-Sivam EA, Titus JB. Improving Transitional Services for Adolescents and Young Adults with Epilepsy and Intellectual Disability. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe transition from pediatric to adult health care systems is challenging for many adolescents with epilepsy and their families, and those challenges are compounded for adolescents with comorbid intellectual disabilities and epilepsy (ID-E). Many traditional transition pathways to adult care are inadequate, as they fail to address important considerations unique to the ID-E population or are absent entirely. Poor organization of care during critical transition periods increases the risks of sudden unexpected death in epilepsy, suboptimal seizure control, inadequate management of comorbidities, and poor psychological and social outcomes. The literature lacks systematic studies on effective transition programs for this population. The present review provides an overview of the main themes important in care transitions for the ID-E population: (1) precise diagnosis and management of seizures; (2) mental health and medical comorbidities affecting care; (3) accessing behavioral, habilitative, legal, financial, and community resources; and (4) caretaker support. We propose a specific framework which includes targeted recommendations of minimum care standards for youth with ID-E transitioning to adult care.
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Affiliation(s)
- William A. Schraegle
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
| | - Stephanie R. Young
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
| | - Eman K. Rettig
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
| | - Angie R. Payne
- Ascension Seton’s Comprehensive Epilepsy Program, Dell Seton Medical Center at The University of Texas, Austin, Texas, United States
| | - Janet K. Wilson
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
| | - Elizabeth A. Wedberg-Sivam
- Ascension Seton’s Comprehensive Epilepsy Program, Dell Seton Medical Center at The University of Texas, Austin, Texas, United States
| | - Jeffrey B. Titus
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
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Eyuboglu TF, Gonenc FI. The effect of pain intensity levels and clinical symptoms on the treatment preferences of patients with endodontically involved teeth: A preliminary cross-sectional study. Eur Oral Res 2020; 54:142-147. [PMID: 33543120 PMCID: PMC7837708 DOI: 10.26650/eor.20200043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: This study aimed to evaluate the effect of pain intensity levels and clinical symptoms
on the treatment preferences of patients with endodontically involved teeth in a
local Turkish population. Subjects and methods: A total of 30 patients with symptomatic teeth requiring non-surgical root canal
treatment were included in the study. The patients’ demographic (age, gender,
and education level) and diagnostic data (tooth type, pain intensity, response to
percussion and palpation, presence of referred pain, and diagnosis) were analyzed.
Data on the patients’ explicit preferences (requested treatment, whether they are
willing to accept a proposed extraction, choice of treatment if an anterior tooth was
involved, and choice of treatment if the pain was not severe) as well as previous root
canal treatment experiences were also analyzed. Pain intensity levels were evaluated
using the Visual Analog Scale. Results: Pain intensity levels had a significant effect on the treatment requested by the
patient (p=0.001). Among the patients who requested extraction upon referral to
the clinic, the rate of those who reported that they would not accept extraction
if the pain was located in an anterior tooth was significantly lower than that of
patients stating that they would refuse (p=0.039). The presence of referred pain also
had a significant effect on the requested treatment (p=0.001). Conclusion: The intensity of pain and the presence of referred pain influence patients’ treatment
preferences.
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Affiliation(s)
- Tan Firat Eyuboglu
- Department of Endodontics, Istanbul Medipol University,Faculty of Dentistry, Istanbul,Turkey
| | - Fulya Ilcin Gonenc
- Department of Endodontics, Istanbul Medipol University,Faculty of Dentistry, Istanbul,Turkey
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14
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Wilson EH, Burkle CM. The Meaning of Consent and Its Implications for Anesthesiologists. Adv Anesth 2020; 38:1-22. [PMID: 34106829 DOI: 10.1016/j.aan.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elizabeth H Wilson
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, B6/319 CSC, 600 Highland Avenue, Madison, WI 53792-3272, USA
| | - Christopher M Burkle
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Dakić T. No research for the decisionally-impaired mentally ill: a view from Montenegro. BMC Med Ethics 2020; 21:47. [PMID: 32517748 PMCID: PMC7285582 DOI: 10.1186/s12910-020-00489-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/03/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many of the important elements of a valid informed consent - comprehension, voluntariness, and capacity - can be compromised or unmet in the context of psychiatric research. The inability to protect their own interests puts mentally ill subjects at an increased likelihood of being wronged or harmed and makes them particularly vulnerable in the context of clinical research. Therefore, they are due extra protection. Sometimes, these additional safeguards can significantly limit the possibilities for research involving subjects deemed unable to consent due to their mental illness. Montenegro, a middle-income country in Southern-Eastern Europe, goes so far in their policy to protect these subjects from harms of research, as to ban all biomedical research on mentally ill persons who are unable to provide consent. MAIN BODY Mental health research is often neglected and very low on the list of health research priorities, especially in low- and middle-income countries. Despite the fact that mental health disorders are among leading causes of disability, the need for evidence-based services and interventions for those affected remains unmet. To exclude all members of a certain group of subjects seems extremely restrictive and unnecessary. Such a policy is discriminatory and unethical, because it inflicts further harms and exclusion of those patients from participation in society. This unjust exclusion policy obstructs research of certain psychiatric disorders and implies that new treatments for conditions that directly affect these incapacitated subjects will not be developed. CONCLUSIONS Scientific and clinical development must not be precluded by overly restrictive, discriminatory and unjust practices, such as the normative ban on research on decisionally-impaired mentally ill subjects. Rather, there should be a regulative framework that ensures that those who cannot consent for themselves are respected and protected in research, the anticipated benefits maximized, risks minimized, their autonomy recognized and extended. These patient-subjects must be appropriately included unless there is a clear and compelling rationale and justification that inclusion is inappropriate with respect to the health of the participants or the purpose of the research.
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Affiliation(s)
- Tea Dakić
- Clinical Center of Montenegro, Clinic for Psychiatry, Ljubljanska bb, Podgorica, 81000, Montenegro.
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16
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Singh HK, Macdonald ME, Carnevale FA. Considering medical assistance in dying for minors: the complexities of children's voices. JOURNAL OF MEDICAL ETHICS 2020; 46:399-404. [PMID: 32332149 DOI: 10.1136/medethics-2019-105762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/22/2019] [Accepted: 01/13/2020] [Indexed: 06/11/2023]
Abstract
Medical assistance in dying (MAID) legislation in Canada followed much deliberation after the Supreme Court of Canada's ruling in Carter v. Canada Included in this deliberation was the Special Joint Committee on Physician Assisted Dying's recommendation to extend MAID legislation beyond the inclusion of adults to mature minors. Children's agency is a construct advanced within childhood studies literature which entails eliciting children's voices in order to recognise children as active participants in constructing their own childhoods. Using this framework, we consider the possible extension of MAID legislation to most minors. We highlight important questions regarding how insights from children's voices could be mobilised in the life or death context of MAID. We conclude that children's voices have the potential to help determine their eligibility for MAID; however, incorporating children's voices in the context of MAID requires careful consideration due to the complexity of voice.
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Affiliation(s)
- Harprit Kaur Singh
- Department of Philosophy, Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
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Sexual Expression in Alberta's Continuing Care Homes: Capacity, Consent, and Co-decision-making. Can J Aging 2020; 40:156-165. [PMID: 31973789 DOI: 10.1017/s0714980819000813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In this article, we explore the role of substitute decision-makers (SDMs) in matters of sexual expression for continuing care residents with diminished cognitive capacity. We examine how Alberta's current use of SDMs can enable an "all-or-none" approach to competence, wherein a person either has capacity to make all decisions or is incapable of making any. Three factors facilitate an environment in which this approach can influence residents' sexual expression. These include the wording of current legislation, lack of resources for SDMs, and relational dynamics between SDMs and care staff. We provide a critical review of existing legislation and empirical evidence of its challenges in practice. Though we focus on the Alberta context, there is reason to believe that similar issues persist in other Western jurisdictions. We offer several recommendations for how we can better support residents' sexual autonomy in continuing care and avoid pitfalls of the "all-or-none" approach to competence.
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Hamilton RKB, Phelan CH, Chin NA, Wyman MF, Lambrou N, Cobb N, Kind AJH, Blazel H, Asthana S, Gleason CE. The U-ARE Protocol: A Pragmatic Approach to Decisional Capacity Assessment for Clinical Research. J Alzheimers Dis 2020; 73:431-442. [PMID: 31868663 PMCID: PMC7388558 DOI: 10.3233/jad-190457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With increased longevity and growth in the number of older adults comes rising rates of individuals with cognitive impairment and dementia. The expansion of this population has important implications for research on aging and dementia syndromes, namely increased enrollment of older individuals in clinical research. Ethical prerogatives, as well as historical underrepresentation of persons with dementia in research studies due to the perceived burden of traditional decisional capacity evaluations, necessitates the development of pragmatic approaches to ascertain decisional abilities in research settings. We outline a protocol used in the Wisconsin Alzheimer's Disease Research Center (ADRC) that adopts a stepped approach to the evaluation of decisional capacity meant to maximize study visit efficiency while preserving participant safety and autonomy. The protocol specifies the structure of the consent process and incorporates a brief semi-structured interview based on Appelbaum & Grisso's theoretical model for evaluating a patient's decisional capacity to provide informed consent to participate in research. This protocol is easily implemented in a research study visit and is designed to minimize participant burden and ensure reliable assessment of decisional capacity in older adults across a wide range of research protocols. The protocol emphasizes capacity optimization, using memory aids and other compensatory strategies to preserve participant autonomy while protecting welfare.
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Affiliation(s)
- Rachel K. B. Hamilton
- Department of Psychology, University of Wisconsin – Madison, Madison, WI, USA
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Cynthia H. Phelan
- Aurora Center for Nursing Research and Practice, Advocate Aurora Health Care, Milwaukee, WI, USA
| | - Nathaniel A. Chin
- Department of Medicine – Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, USA
| | - Mary F. Wyman
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Medicine – Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, USA
| | - Nickolas Lambrou
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Nichelle Cobb
- Health Sciences IRBs Director, University of Wisconsin – Madison, Madison, WI, USA
| | - Amy J. H. Kind
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Medicine – Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, USA
| | - Hanna Blazel
- Department of Medicine – Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, USA
| | - Sanjay Asthana
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Medicine – Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, USA
| | - Carey E. Gleason
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Medicine – Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI, USA
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Detention, Capacity, and Treatment in the Mentally Ill-Ethical and Legal Challenges. Camb Q Healthc Ethics 2019; 28:752-758. [PMID: 31526417 DOI: 10.1017/s0963180119000690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
For individuals whose mental illness impair their ability to accept appropriate care-the depressed, acutely suicidal mother, or the psychotic lawyer too paranoid to eat any food-statutes exist to permit involuntary hospitalization, a temporary override of paternalistic benefice over personal autonomy. This exception to the primacy of personal autonomy at the core of bioethics has the aim of restoring the mental health of the temporarily incapacitated individual, and with it, their autonomy.
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Goals of Care: Development and Use of the Serious Veterinary Illness Conversation Guide. Vet Clin North Am Small Anim Pract 2019; 49:399-415. [PMID: 30853241 DOI: 10.1016/j.cvsm.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Goals of care (GOC) conversations and resulting goal-concordant treatment are the heart of palliative medicine. Despite repeated evidence that GOC conversations offer significant benefit and minimal harm, barriers to widespread and high-quality implementation persist in human medicine. One strategy to overcoming these barriers has been utilization of a structured checklist format for serious illness conversations. The Serious Illness Conversation Guide was developed for human patients and has been modified for use in the veterinary profession. The guide promotes individualized, goal-concordant care planning even when conflict and emotional demands are high.
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Voigt DKH, Lenz P, Friederichs H. Physicians' comprehension of the German Patients' Rights Act: A cross-sectional study. Health Policy 2018; 122:1249-1254. [PMID: 30217351 DOI: 10.1016/j.healthpol.2018.08.017] [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: 07/31/2017] [Revised: 07/21/2018] [Accepted: 08/30/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The German Patients' Rights Act (PRA), promulgated on February 25, 2013, was created to enhance transparency of patients' rights. This prospective study aimed to objectively measure physicians' comprehension of the PRA. METHODS We generated a controlled study design, developing a questionnaire consisting of six case scenarios with 4-7 dichotomous items each. The survey concluded with seven 5-point-Likert scale questions, dealing with the PRA's effects. Physicians teaching at the Westfälische Wilhelms-Universität (WWU) Münster served as the intervention group, and medical students from WWU Münster at the beginning of their clinical education formed the control group. Physicians were surveyed in November 2015; students were surveyed in February 2016. RESULTS A total 56 completed surveys of physicians and 134 of students were analyzed. Of a total 33 points, on average physicians answered 21.04 (95% confidence interval (CI) 20.43-21.64) items correctly, a significantly higher result than students' 19.74 (95% CI 19.31-20.17) points (p < 0.001; Hedges' g = 0.53). Estimations of the PRA's effects were ambiguous. Students agreed with the PRA's supporting effect more often than physicians (p < 0.001) whereas physicians felt increased uncertainty arising from the PRA. CONCLUSION Comprehension of the PRA increases significantly over the course of medical work experience; however, this comprehension is limited among medical experts. The PRA leads to ambiguity and uncertainty in the medical decision-making process.
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Affiliation(s)
- Daniel Karl-Heinz Voigt
- Deanery, Medical Faculty of the Westfälische Wilhelms-Universität Münster, Muenster, North Rhine-Westphalia, Germany.
| | - Philipp Lenz
- University Medical Center Muenster, Staff Section Palliative Medicine, Muenster, North Rhine-Westphalia, Germany.
| | - Hendrik Friederichs
- Institute of Medical Education and Student Affairs (IfAS), Hospital of Medical Education and Qualification Muenster, Muenster, North Rhine-Westphalia, Germany.
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Roohafza H, Sadeghi M, Khani A, Behnamfar O, Afshar H, Eduard Scheidt C. Patient competence in relation with medical and psychosocial characteristics in cardiology context: A cross-sectional study. ARYA ATHEROSCLEROSIS 2018; 14:196-204. [PMID: 30783409 PMCID: PMC6368194 DOI: 10.22122/arya.v14i5.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/13/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Growth of cardiovascular disease (CVD), variation in provision of medical services, rising costs, and increasing information availability through the media are making patients more actively involved in decision-making process of their treatment. The aim of this study was to better understand the components of patient competence in the context of coronary artery disease (CAD) and to further evaluate their relations with medical, demographic, and psychosocial characteristics. METHODS In this cross-sectional study, 148 patients with at least one year diagnosis of acute coronary syndrome (ACS) were enrolled in the study from April to June 2014. Data on demographic characteristics, depression, anxiety, quality of life (QOL), social support, and drug adherence were collected from participants. Pearson correlation, one way analysis of variance (ANOVA), and multiple linear regression tests were performed for analyzing data. RESULTS The mean age of patients was 53.63 ± 5.15. Of the participants, 58 (39.5%) and 61 cases (41.5%) were found to be depressed and anxious, respectively. Higher levels of self-regulation correlated with higher education years and social support, and also with lower depression and anxiety (P < 0.050). Stress management and confronting the threat were linked to education years, depression, anxiety, QOL, and social support (P < 0.050). CONCLUSION The patients with CAD, in order to be involved in the proper treatment process and manage their emotions during this process, need to have the required competencies. Patient competence as a whole and its components have been related to medical, demographic, and psychosocial characteristics.
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Affiliation(s)
- Hamidreza Roohafza
- Assistant Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Khani
- Research Assistant, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Behnamfar
- Resident, Department of Cardiovascular Medicine, University of California San Diego, San Diego, CA
| | - Hamid Afshar
- Professor, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Carl Eduard Scheidt
- Professor, Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany
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Souraya S, Hanlon C, Asher L. Involvement of people with schizophrenia in decision-making in rural Ethiopia: a qualitative study. Global Health 2018; 14:85. [PMID: 30134989 PMCID: PMC6103856 DOI: 10.1186/s12992-018-0403-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/01/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The involvement of people with psychosocial disabilities in decision-making is a fundamental component of a person-centred and recovery-oriented model of care, but there has been little investigation of this approach in low- and middle-income countries. The aim of this study was to explore the involvement of people with schizophrenia in decision-making relating to their care in rural Ethiopia. METHODS A qualitative study was conducted in rural Ethiopia as part of the Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE) project, involving two focus group discussions (n = 10) with community-based rehabilitation workers, and 18 in-depth interviews with people with schizophrenia, caregivers, health officers, supervisors and a community-based rehabilitation worker. Thematic analysis was used to examine major themes related to involvement in decision-making in this specific setting. RESULTS Involvement of people with schizophrenia in decision-making in this rural Ethiopian setting was limited and coercive practices were evident. People with schizophrenia tended to be consulted about their care only when they were considered clinically 'recovered'. Caregivers typically had a prominent role in decision-making, but they also acquiesced to the views of health care professionals. People with schizophrenia and caregivers were often unable to execute their desired choice due to inaccessible and unaffordable treatment. CONCLUSIONS Community-based rehabilitation, as a model of care, may give opportunities for involvement of people with schizophrenia in decision-making. In order to increase involvement of people with schizophrenia in rural Ethiopia there needs to be greater empowerment of service users, wider availability of treatment choices and a facilitating policy environment. Further studies are needed to explore concepts of person-centred care and recovery across cultural settings.
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Affiliation(s)
- Sally Souraya
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK. .,Health Services and Population Research Department, Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Charlotte Hanlon
- Health Services and Population Research Department, Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Laura Asher
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Orlins Z. A suicidal, dysarthric patient who wishes to discontinue life-sustaining treatments: A case report. Int J Psychiatry Med 2018; 53:306-309. [PMID: 29292667 DOI: 10.1177/0091217417749797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychiatrists may be among the clinicians to encounter a depressed and suicidal patient who wishes to discontinue life-sustaining treatment. A patient who is suffering from a condition such as dysarthria makes decision-making capacity (a physician's determination of a patient's ability to medically consent) increasingly difficult to assess. The clinician must balance ethical principles of autonomy, non-maleficence, beneficence, and justice in order to achieve a plan of care that is in the patient's best interest.
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Affiliation(s)
- Zachary Orlins
- 1 Heritage College of Osteopathic Medicine, Ohio University, Columbus, OH, USA
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26
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Tilburgs B, Vernooij-Dassen M, Koopmans R, van Gennip H, Engels Y, Perry M. Barriers and facilitators for GPs in dementia advance care planning: A systematic integrative review. PLoS One 2018; 13:e0198535. [PMID: 29924837 PMCID: PMC6010277 DOI: 10.1371/journal.pone.0198535] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/21/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Due to the disease's progressive nature, advance care planning (ACP) is recommended for people with early stage dementia. General practitioners (GPs) should initiate ACP because of their longstanding relationships with their patients and their early involvement with the disease, however ACP is seldom applied. AIM To determine the barriers and facilitators faced by GPs related to ACP with people with dementia. DATA SOURCES We systematically searched the relevant databases for papers published between January 1995 and December 2016, using the terms: primary healthcare, GP, dementia, and ACP. We conducted a systematic integrative review following Whittemore and Knafl's method. Papers containing empirical data about GP barriers and/or facilitators regarding ACP for people with dementia were included. We evaluated quality using the Mixed-Method-Appraisal-Tool and analyzed data using qualitative content analysis. RESULTS Ten qualitative, five quantitative, and one mixed-method paper revealed four themes: timely initiation of ACP, stakeholder engagement, important aspects of ACP the conversation, and prerequisites for ACP. Important barriers were: uncertainty about the timing of ACP, how to plan for an uncertain future, lack of knowledge about dementia, difficulties assessing people with dementia's decisional capacities, and changing preferences. Facilitators for ACP were: an early start when cognitive decline is still mild, inclusion of all stakeholders, and discussing social and medical issues aimed at maintaining normal life. CONCLUSION Discussing future care is difficult due to uncertainties about the future and the decisional capacities of people with dementia. Based on the facilitators, we recommend that GPs use a timely and goal-oriented approach and involve all stakeholders. ACP discussions should focus on the ability of people with dementia to maintain normal daily function as well as on their quality of life, instead of end-of-life-discussions only. GPs need training to acquire knowledge and skills to timely initiate collaborative ACP discussions.
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Affiliation(s)
- Bram Tilburgs
- Department of IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| | | | - Raymond Koopmans
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Hans van Gennip
- Independent Educational Researcher, Family carer, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Radboudumc, Nijmegen, The Netherlands
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Stohl HE. When Consent Does Not Help: Challenges to Women's Access to a Vaginal Birth After Cesarean Section and the Limitations of the Informed Consent Doctrine. AMERICAN JOURNAL OF LAW & MEDICINE 2017; 43:388-425. [PMID: 29452564 DOI: 10.1177/0098858817753405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pregnant women with a prior cesarean delivery face challenges in accessing a vaginal birth due to both hospital and provider preferences and practices. Although the doctrine of informed consent secures women's reproductive rights, it is not a viable legal remedy. Instead, women should champion increased maternity-related education and transparency as well as medical malpractice reform to increase the desired access.
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Affiliation(s)
- Hindi E Stohl
- Dr. Hindi Stohl is an Assistant Clinical Professor of Obstetrics and Gynecology at the David Geffen School of Medicine at UCLA. She is a board-certified and practicing perinatologist (high-risk obstetrician) at Harbor-UCLA Medical Center, where she is the Director of Maternal-Fetal Medicine services. Dr. Stohl has over ten years of experience in obstetrics and has cared for hundreds of women with prior cesarean deliveries. She routinely performs vaginal births after cesarean deliveries. Dr. Stohl is also a graduate of Southwestern Law School and admitted to the California State Bar
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28
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Denniss DL. Legal and ethical issues associated with Advance Care Directives in an Australian context. Intern Med J 2017; 46:1375-1380. [PMID: 27981764 DOI: 10.1111/imj.13288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 07/13/2016] [Accepted: 07/30/2016] [Indexed: 11/30/2022]
Abstract
The need for appropriate mechanisms guiding end-of-life care is increasingly vital. This commentary compares the use of Advance Care Directives (ACD) in New South Wales and South Australia in order to highlight the inconsistency in Australian legislation, before exploring common problems, legal concerns and ethical issues associated with their application in an adult population. The benefits and detriments of statutory legislation for ACD are also evaluated.
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Affiliation(s)
- D L Denniss
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Cheung EH, Heldt J, Strouse T, Schneider P. The Medical Incapacity Hold: A Policy on the Involuntary Medical Hospitalization of Patients Who Lack Decisional Capacity. PSYCHOSOMATICS 2017; 59:169-176. [PMID: 29096914 DOI: 10.1016/j.psym.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Medically hospitalized patients who lack decisional capacity may request, demand, or attempt to leave the hospital despite grave risk to themselves. The treating physician in this scenario must determine how to safeguard such patients, including whether to attempt to keep them in the hospital. However, in many jurisdictions, there are no laws that address this matter directly. In this absence, psychiatrists are often called upon to issue an involuntary psychiatric hold (civil commitment) to keep the patient from leaving. Yet, civil commitment statutes were not intended for, and generally do not address, the needs of the medically ill patient without psychiatric illness. Civil commitment is permitted for patients who pose a danger to themselves or others, or who are gravely disabled, specifically as the result of a mental illness, and allows the transport of such individuals to facilities for psychiatric evaluation. It does not permit detention for medical illnesses nor the involuntary administration of medical treatments. Therefore, the establishment of hospital policies and procedures may be the most appropriate means of detaining medically hospitalized patients who lack capacity to understand the risks of leaving the hospital, in addition to mitigating the potential tort risk faced by the physician for acting in a manner that protects the patient. OBJECTIVE The purpose of this article is to identify the array of clinical and medical-legal concerns in these scenarios, and to describe the development of a "medical incapacity hold" policy as a means of addressing this unresolved issue.
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Affiliation(s)
- Erick H Cheung
- Department of Psychiatry, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, Psychiatry, Los Angeles, CA.
| | - Jonathan Heldt
- Department of Psychiatry, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, Psychiatry, Los Angeles, CA
| | - Thomas Strouse
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Psychiatry, Los Angeles, CA
| | - Paul Schneider
- VA Greater Los Angeles Healthcare System, Bioethics, Los Angeles, CA
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30
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Steinbock B. Physician-Assisted Death and Severe, Treatment-Resistant Depression. Hastings Cent Rep 2017; 47:30-42. [DOI: 10.1002/hast.768] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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31
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Hirani SAA, Olson J. Concept Analysis of Maternal Autonomy in the Context of Breastfeeding. J Nurs Scholarsh 2017; 48:276-84. [PMID: 27111381 DOI: 10.1111/jnu.12211] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this article is to analyze the concept of maternal autonomy in the context of breastfeeding and propose a clearer definition of the concept. METHODS A concept analysis was undertaken using Walker and Avant's eight-stage approach. FINDINGS The concept analysis suggests that maternal autonomy in the context of breastfeeding refers to a mother's ability to make autonomous decisions using her control, agency, independence, and ethical reasoning. The antecedents are maternal competence, availability of support, nature of the setting, and available alternatives with respect to breastfeeding. The consequences are improvement in child health, maternal-child bonding, breastfeeding decisions, and maternal healthcare-seeking behavior. CONCLUSIONS A clearer understanding of maternal autonomy in the context of breastfeeding will guide the development of a conceptual framework and expand nursing knowledge development. CLINICAL RELEVANCE A clearer definition of the concept of maternal autonomy in the context of breastfeeding will guide clinicians, researchers, and policy makers in protecting, promoting, and supporting breastfeeding globally towards achieving the United Nations Sustainable Development Goals, 2015-2030.
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Affiliation(s)
- Shela Akbar Ali Hirani
- Rho Delta, Doctoral Student, Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Joanne Olson
- Mu Sigma, Iota Omicron, & Tau Upsilon, Professor, Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Tsai SL, Acosta E, Cardenas T, Sigall JK, Van Geem K. Legal, Social, Ethical, and Medical Perspectives on the Care of the Statutory Rape Adolescent in the Emergency Department. Ann Emerg Med 2017; 70:72-79. [DOI: 10.1016/j.annemergmed.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/24/2016] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
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Viaña JNM, Bittlinger M, Gilbert F. Ethical Considerations for Deep Brain Stimulation Trials in Patients with Early-Onset Alzheimer’s Disease. J Alzheimers Dis 2017; 58:289-301. [DOI: 10.3233/jad-161073] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- John Noel M. Viaña
- University of Tasmania, Hobart, Tasmania, Australia
- Ethics, Policy & Public Engagement (EPPE) Program, Australian Research Council Centre of Excellence for Electromaterials Science, Hobart, Tasmania, Australia
| | | | - Frederic Gilbert
- University of Tasmania, Hobart, Tasmania, Australia
- Ethics, Policy & Public Engagement (EPPE) Program, Australian Research Council Centre of Excellence for Electromaterials Science, Hobart, Tasmania, Australia
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34
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Spike JP. Informed Consent Is the Essence of Capacity Assessment. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2017; 45:95-105. [PMID: 28661281 DOI: 10.1177/1073110517703103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Informed consent is the single most important concept for understanding decision-making capacity. There is a steady pull in the clinical world to transform capacity into a technical concept that can be tested objectively, usually by calling for a psychiatric consult. This is a classic example of medicalization. In this article I argue that is a mistake, not just unnecessary but wrong, and explain how to normalize capacity assessment. Returning the locus of capacity assessment to the attending, the primary care doctor, and even to ethics consultation in today's environment will require a substantial effort to undo a strong but illusory impression of capacity assessment. Hospital attorneys as well as clinical ethicists with a sophisticated understanding of health law can be in the vanguard of this reorientation.
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Affiliation(s)
- Jeffrey P Spike
- Jeffrey P. Spike, Ph.D., is the Samuel E. Karff Chair and a Professor in the Department of Family Medicine at the Mc-Govern Center for Humanities and Ethics at the University of Texas Health Science Center at Houston (UTHealth)
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Bernstein J, LeBrun D, MacCourt D, Ahn J. Presumed consent: licenses and limits inferred from the case of geriatric hip fractures. BMC Med Ethics 2017; 18:17. [PMID: 28235413 PMCID: PMC5324244 DOI: 10.1186/s12910-017-0180-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/17/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hip fractures are common and serious injuries in the geriatric population. Obtaining informed consent for surgery in geriatric patients can be difficult due to the high prevalence of comorbid cognitive impairment. Given that virtually all patients with hip fractures eventually undergo surgery, and given that delays in surgery are associated with increased mortality, we argue that there are select instances in which it may be ethically permissible, and indeed clinically preferable, to initiate surgical treatment in cognitively impaired patients under the doctrine of presumed consent. In this paper, we examine the boundaries of the license granted by presumed consent and use the example of geriatric hip fracture to build an ethical framework for understanding the doctrine of presumed consent. DISCUSSION The license to act under presumed consent requires three factors: patient incapacity, clinical urgency and clarity on the correct course of action. All three can apply to geriatric hip fracture. The typical patient frequently lacks capacity. Delays in initiating surgical treatment are associated with markedly increased mortality rates. Last, there appears to be consensus that surgery is the preferred treatment. Nonetheless, because there is a window of safe delay during which treating physicians can stabilize the patient, address reversible causes of cognitive impairment and identify surrogate decision makers, presumed consent should be invoked only as a method of last resort. CONCLUSIONS A medical situation need not be characterized by risk of imminent and certain death for presumed consent to be relevant. Rather, there are two distinct windows that must be considered: the time interval in which action may be delayed without danger, and the time interval needed to obtain a better form of consent. Presumed consent is appropriate only when the latter exceeds the former.
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Affiliation(s)
| | | | | | - Jaimo Ahn
- University of Pennsylvania, Philadelphia, USA
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36
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End-Of-Life Decisions in Chronic Disorders of Consciousness: Sacrality and Dignity as Factors. NEUROETHICS-NETH 2016. [DOI: 10.1007/s12152-016-9257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Allen NG, Khan JS, Alzahri MS, Stolar AG. Ethical Issues in Emergency Psychiatry. Emerg Med Clin North Am 2015; 33:863-74. [DOI: 10.1016/j.emc.2015.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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Rovner M, Jackson WM, Dinwiddie SH. Evaluating Patients for Impaired Medical Decisional Capacity: An Overview of Ethical and Clinical Issues. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20150803-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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39
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Roohafza H, Sadeghi M, Khani A, Afshar H, Amirpour A, Sarrafzadegan N, Scheidt CE. Development and validation of cardiac patient competence questionnaire, Iranian version. ARYA ATHEROSCLEROSIS 2015; 11:220-7. [PMID: 26478729 PMCID: PMC4593657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim was to translate and develop a patient competence (PC) questionnaire in the context of cardiology and test its validity and reliability. METHODS In total, 148 cardiac patients who have inclusion criteria of the study were completed cardiac PC (CPC) questionnaire. Hospital Anxiety and Depression Scale and self-administered instrument European quality of life 5-dimensions were used to further validate the CPC questionnaire. The CPC was translated according to the recommended methodology for translating questionnaires, and psychometric properties including internal consistency, factor analysis, discriminant validity, construct validity, and concurrent criterion validity were tested. RESULTS Five domains in problem-focused task including search for information, self-regulation, being assertive, independent decision-making, and looking for social services, and three domains in emotion-focused task including stress management, confronting the threat, and avoidance were obtained by factor analysis. The standardized Cronbach's α of all domains were statistically significant (P < 0.001) and internal consistency for all domains was acceptable. Significant intercorrelations of CPC domains also indicated good criterion validity. As there were no cross-loadings, the domains have demonstrated good construct validity and discriminant validity. CONCLUSION The results of this study show that the Persian version of the CPC is a reliable and valid questionnaire. Although further improvement of this measure is clearly required, it suggests being a potential basis for investigating the determinants and health effects of CPC.
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Affiliation(s)
- Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Hamidreza Roohafza,
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Khani
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Afshar
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Amirpour
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Carl Eduard Scheidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany
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Rady RM, El Akkary IM, Haroun AN, Abd Elmoneum Fasseh N, Azmy MM. Respiratory Wheeze Sound Analysis Using Digital Signal Processing Techniques. 2015 7TH INTERNATIONAL CONFERENCE ON COMPUTATIONAL INTELLIGENCE, COMMUNICATION SYSTEMS AND NETWORKS 2015. [DOI: 10.1109/cicsyn.2015.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abstract
This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations. The global literature in PubMed, MEDLINE, PsycINFO, BIOSIS, Science Direct, and Cochrane Central was searched. Search terms included elder abuse, elder mistreatment, elder maltreatment, prevalence, incidence, risk factors, protective factors, outcomes, and consequences. Studies that existed only as abstracts, case series, or case reports or recruited individuals younger than 60; qualitative studies; and non-English publications were excluded. Tables and figures were created to highlight the findings: the most-detailed analyses to date of the prevalence of elder abuse according to continent, risk and protective factors, graphic presentation of odds ratios and confidence intervals for major risk factors, consequences, and practical suggestions for health professionals in addressing elder abuse. Elder abuse is common in community-dwelling older adults, especially minority older adults. This review identifies important knowledge gaps, such as a lack of consistency in definitions of elder abuse; insufficient research with regard to screening; and etiological, intervention, and prevention research. Concerted efforts from researchers, community organizations, healthcare and legal professionals, social service providers, and policy-makers should be promoted to address the global problem of elder abuse.
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Affiliation(s)
- Xin Qi Dong
- Rush Institute for Healthy Aging; Rush University Medical Center; Chicago Illinois
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Abstract
Assessing medical decision-making capacity is a clinical skill required of all medical professionals, but it is particularly essential for consultation- liaison psychiatrists. Medical decision-making capacity, often confused with competency, is evaluated by assessing 4 standards, which include whether a patient (1) can understand his or her medical situation, (2) can manipulate the information, (3) can evidence a choice about the proposed treatment, and (4) can appreciate the situation and its consequences. Multiple myths and pitfalls may be encountered during capacity evaluations; many of these can be avoided by proper education and training. We discuss the case of a 71-year-old man who presented to the emergency department by ambulance and was refusing non-emergent neurosurgery after a self-inflicted gunshot wound to the head. He was evaluated for medical decision-making capacity, specifically on whether he had the capacity to refuse neurosurgery and accept intravenous antibiotic treatment. In discussing this case, which illustrates the elements, challenges, and ethical dilemmas of the capacity evaluation, we review several mental illnesses that may prevent individuals from having medical decision-making capacity. Myths and pitfalls of capacity evaluations and possible methods for avoiding them are proposed. Specifically, we emphasize the importance of communication between the primary team and the consultationliaison psychiatry service and describe possible solutions to common communication problems that may arise between services. It is hoped that this case presentation and review will help educate psychiatry residents and other physicians so that they are well prepared to perform a medical decision-making capacity evaluation.
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Chase J. A clinical decision algorithm for hospital inpatients with impaired decision-making capacity. J Hosp Med 2014; 9:527-32. [PMID: 24863188 DOI: 10.1002/jhm.2214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Impaired decision-making capacity is a frequent complication of inpatient hospitalization, with potential negative impacts on patients and the healthcare system. Studies of clinician behavior show difficulty in diagnosis and management of capacity impairment. Appropriate management of incapacitated patients may benefit safety, medical outcomes, and healthcare expenditure. OBJECTIVE To create a clinical decision algorithm for identification and management of hospital inpatients with impaired capacity. METHODS The Department of Risk Management at San Francisco General Hospital (SFGH) convened a multidisciplinary workgroup to improve management of incapacitated patients. The workgroup studied institutional data and case experience, solicited mental health expertise, and performed a brief review of published tools for management of incapacitated patients. The workgroup produced a clinical decision algorithm for hospital inpatients with impaired decision-making capacity. RESULTS The algorithm is explained via 3 common scenarios, and notable details include identification and management in a single visual diagram, emphasis on safety planning for a high-risk subset of incapacitated patients, and explanation for multiple disciplines of consultation. The algorithm was disseminated to providers, workshops were conducted, and associated quality improvements were implemented. Initial feedback was positive, relating to clinical competency, decreased practice anxiety, and improved teamwork. CONCLUSIONS Impaired decision-making capacity is frequent among hospitalized patients, including at SFGH. An algorithm, based on institutional review and prior published work, is presented as an example to address the common challenge of acutely ill patients with impaired decision-making capacity.
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Affiliation(s)
- Jack Chase
- Family Medicine Inpatient Service, San Francisco General Hospital, and Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
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Aydin Er R, Sehiralti M. Comparing assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool. JOURNAL OF MEDICAL ETHICS 2014; 40:453-457. [PMID: 23824965 DOI: 10.1136/medethics-2012-100928] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool. METHODS This study was carried out at the psychiatry clinic of Kocaeli University Hospital from June 2007 to February 2008. The decision-making competence of the 83 patients who participated in the study was assessed by physicians, nurses, relatives and MacCAT-T. RESULTS Of the 83 patients, the relatives of 73.8% of them, including the parents of 47.7%, were interviewed during the study. A moderately good consistency between the competency assessments of the nurses versus those of the physicians, but a poor consistency between the assessments of the physicians and nurses versus those of the patients' relatives, was determined. The differences in the competency assessment obtained with the MacCAT-T versus the evaluations of the physicians, nurses and patients' relatives were statistically significant. CONCLUSIONS Our findings demonstrate those physicians, nurses and the patients' relatives have difficulty in identifying patients lacking decision-making competence. Therefore, an objective competence assessment tool should be used along with the assessments of physicians and nurses, both of whom can provide clinical data, as well as those of relatives, who can offer insights into the patient's moral values and expectations.
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Affiliation(s)
- Rahime Aydin Er
- Vocational School of Health, Kocaeli University, Kocaeli, Turkey
| | - Mine Sehiralti
- Department of History of Medicine and Ethics, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Geurts M, Macleod MR, van Thiel GJMW, van Gijn J, Kappelle LJ, van der Worp HB. End-of-life decisions in patients with severe acute brain injury. Lancet Neurol 2014; 13:515-24. [PMID: 24675048 DOI: 10.1016/s1474-4422(14)70030-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Most in-hospital deaths of patients with stroke, traumatic brain injury, or postanoxic encephalopathy after cardiac arrest occur after a decision to withhold or withdraw life-sustaining treatments. Decisions on treatment restrictions in these patients are generally complex and are based only in part on evidence from published work. Prognostic models to be used in this decision-making process should have a strong discriminative power. However, for most causes of acute brain injury, prognostic models are not sufficiently accurate to serve as the sole basis of decisions to limit treatment. These decisions are also complicated because patients often do not have the capacity to communicate their preferences. Additionally, surrogate decision makers might not accurately represent the patient's preferences. Finally, in the acute stage, prediction of how a patient would adapt to a life with major disability is difficult.
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Affiliation(s)
- Marjolein Geurts
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Malcolm R Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Jan van Gijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
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Pregnancy in the severely mentally ill patient as an opportunity for global coordination of care. Am J Obstet Gynecol 2014; 210:32-7. [PMID: 23911382 DOI: 10.1016/j.ajog.2013.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 11/24/2022]
Abstract
Although obstetricians commonly care for pregnant patients with psychiatric disorders, little has been written about the implications of managing a pregnancy during a prolonged psychiatric hospitalization for severe mental illness. Multidisciplinary care may optimize obstetric and psychiatric outcomes. We describe a severely mentally ill patient at 27 weeks' gestation (G1P0) who was admitted after a suicide attempt. She exhibited intermittently worsening depression and anxiety throughout a 2-month inpatient psychiatric hospitalization, during which her psychiatric and obstetric providers collaborated regarding her care. We review recommendations for antepartum and intrapartum treatment of the acutely suicidal and severely mentally ill patient and, in particular, the evidence that a multidisciplinary coordinated approach to planning can maximize patient physical and mental health and facilitate preparedness for delivery.
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Farisco M, Laureys S, Evers K. Externalization of consciousness. Scientific possibilities and clinical implications. Curr Top Behav Neurosci 2014; 19:205-22. [PMID: 25146416 DOI: 10.1007/7854_2014_338] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The paper starts by analyzing recent advancements in neurotechnological assessment of residual consciousness in patients with disorders of consciousness and in neurotechnology-mediated communication with them. Ethical issues arising from these developments are described, with particular focus on informed consent. Against this background, we argue for the necessity of further scientific efforts and ethical reflection in neurotechnological assessment of consciousness and 'cerebral communication' with verbally non-communicative patients.
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Affiliation(s)
- Michele Farisco
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden,
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Amer AB. Informed consent in adult psychiatry. Oman Med J 2013; 28:228-31. [PMID: 23904913 PMCID: PMC3725243 DOI: 10.5001/omj.2013.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/29/2013] [Indexed: 11/03/2022] Open
Abstract
This article addresses some of the groundwork of informed consent in people with mental illness whose decision-making capacity has obviously been compromised. This article examines four crucial aspects in particular, namely: i) the main elements of informed consent; ii) difficulties pertaining to psychiatric illnesses; iii) the effect of psychiatric disorders on the patient's capability; iv) how to assess situations in which consents may not be required.
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Affiliation(s)
- Ahmed Bait Amer
- Senior Registrar, Department of Behavioral Medicine, Sultan Qaboos University Hospital, Al-Khoud, Sultanate of Oman
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Bilgel F. The effectiveness of transplant legislation, procedures and management: Cross-country evidence. Health Policy 2013; 110:229-42. [DOI: 10.1016/j.healthpol.2012.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/09/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
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Aydin Er R, Sehiralti M, Aker AT. Preliminary Turkish study of psychiatric in-patients' competence to make treatment decisions. Asia Pac Psychiatry 2013; 5:E9-E18. [PMID: 23857795 DOI: 10.1111/appy.12000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 08/15/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Competence is a prerequisite for informed consent. Patients who are found to be competent are entitled to accept or refuse the proposed treatment. In recent years, there has been an increased interest in studies examining competence for treatment in psychiatric patients. In this study, we aimed to investigate the decision-making competencies of inpatients with a range of psychiatric diseases. METHODS This study was carried out at the psychiatry clinic of Kocaeli University Hospital in Turkey from June 2007 to February 2008. Decision-making competence was assessed in 83 patients using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). RESULTS The study groups consisted of patients with mood (39.8%), psychotic (27.7%) and anxiety disorders (18.1%), and alcohol/substance addiction (14.5%). There was a significant relation between decision-making competence and demographic and clinical characteristics. Appreciation of the given information was more impaired in psychotic disorder patients than in other patients, but understanding and reasoning of the given information was similar in all groups. DISCUSSION These results reveal the importance of evaluating decision-making competencies of psychiatric patients before any treatment or intervention is carried out to ascertain their ability to give informed consent to treatment. Institutional and national policies need to be determined and put into practice relating to the assessment and management of competence in patients with psychiatric disorders.
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Affiliation(s)
- Rahime Aydin Er
- Vocational School of Health, Kocaeli University, Kocaeli, Turkey.
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