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Informed consent and autonomy

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https://www.readbyqxmd.com/read/29201387/a-half-century-of-electronic-fetal-monitoring-and-bioethics-silence-speaks-louder-than-words
#1
REVIEW
Thomas P Sartwelle, James C Johnston, Berna Arda
Bioethics abolished the prevailing Hippocratic tenet instructing physicians to make treatment decisions, replacing it with autonomy through informed consent. Informed consent allows the patient to choose treatment after options are explained by the physician. The appearance of bioethics in 1970 coincided with the introduction of electronic fetal monitoring (EFM), which evolved to become the fetal surveillance modality of choice for virtually all women in labor. Autonomy rapidly pervaded all medical procedures, but there was a clear exemption for EFM...
2017: Maternal Health, Neonatology and Perinatology
https://www.readbyqxmd.com/read/29197378/informed-consent-for-clinical-treatment-in-low-income-setting-evaluating-the-relationship-between-satisfying-consent-and-extent-of-recall-of-consent-information
#2
Ikenna I Nnabugwu, Fredrick O Ugwumba, Emeka I Udeh, Solomon K Anyimba, Oyiogu F Ozoemena
BACKGROUND: Treatment informed consent aims to preserve the autonomy of patients in the clinician - patient relationship so as to ensure valid consent. An acceptable method of evaluating understanding of consent information is by assessing the extent of recall by patients of the pieces information believed to have been passed across. When concerns are not satisfactorily addressed from the patients' perspective, recall of consent information may be low. METHODS: This study is a questionnaire - based cross - sectional interview of consecutive adult surgical patients who could give their respective medical histories and who were booked for elective major surgical procedures over a period of 7 months in a tertiary health institution in southeastern Nigeria...
December 2, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29191351/how-issues-of-autonomy-and-consent-differ-between-children-and-adults-kids-are-not-just-little-people
#3
Sean Reynolds, Jane M Grant-Kels, Lionel Bercovitch
Decision making in dermatology practice with adult patients is in most cases a relatively straightforward process, involving a back-and-forth exchange of information, ideas and opinions between the physician and patient. This process is more complex in the field of pediatric dermatology. It involves the triad of the patient, parent or guardian, and physician. It utilizes a model, common to many fields in pediatrics, whereby the physician seeks to obtain informed permission from the parent with the assent of the child, all the while endeavoring to act in the best interests of the child...
November 2017: Clinics in Dermatology
https://www.readbyqxmd.com/read/29182458/multimedia-aided-consent-for-alzheimer-s-disease-research
#4
Barton W Palmer, Alexandrea L Harmell, Laura B Dunn, Scott Y Kim, Luz L Pinto, Shahrokh Golshan, Dilip V Jeste
OBJECTIVES: Optimizing the research consent process simultaneously fosters respect for autonomy and protection of those with diminished capacity for autonomy. This study evaluated the effectiveness of an enhanced research consent procedure, employing multimedia disclosure and corrective feedback, in improving decisional capacity among 114 people with mild-to-moderate Alzheimer's disease (AD) and 134 non-psychiatric comparison (NC) subjects. METHODS: Participants were randomized to consent type (routine versus enhanced) and protocol type (lower versus higher risk)...
September 5, 2017: Clinical Gerontologist
https://www.readbyqxmd.com/read/29171894/the-future-of-reproductive-autonomy
#5
Josephine Johnston, Rachel L Zacharias
In a project The Hastings Center is now running on the future of prenatal testing, we are encountering clear examples, both in established law and in the practices of individual providers, of failures to respect women's reproductive autonomy: when testing is not offered to certain demographics of women, for instance, or when the choices of women to terminate or continue pregnancies are prohibited or otherwise not supported. But this project also raises puzzles for reproductive autonomy. We have learned that some clinicians and patients do not discuss the fact that prenatal testing can lead to a decision about whether to terminate a pregnancy-they just don't talk about it...
December 2017: Hastings Center Report
https://www.readbyqxmd.com/read/29171889/the-shifting-landscape-of-prenatal-testing-between-reproductive-autonomy-and-public-health
#6
Vardit Ravitsky
Since the 1970s, prenatal testing has been integrated into many health care systems on the basis of two competing and largely irreconcilable rationales. The reproductive autonomy rationale focuses on nondirective counseling and consent as ways to ensure that women's decisions about testing and subsequent care are informed and free of undue pressures. It also represents an easily understandable and ethically convincing basis for widespread access to prenatal testing, since the value of autonomy is well established in Western bioethics and widely recognized by funders of health care...
December 2017: Hastings Center Report
https://www.readbyqxmd.com/read/29151393/ethics-of-smart-house-welfare-technology-for-older-adults-a-systematic-literature-review
#7
Veralia Gabriela Sánchez, Ingrid Taylor, Pia Cecilie Bing-Jonsson
BACKGROUND: The University College of Southeast Norway has an on-going project to develop a smart house welfare system to allow older adults and people with disabilities to remain in their homes for as long as they wish in safe, dignified, living conditions. OBJECTIVES: This article reviews reported ethical challenges to implementing smart houses for older adults. METHODS: A systematic literature review identified twenty-four articles in English, French, Spanish, and Norwegian, which were analyzed and synthesized using Hofmann's question list to investigate the reported ethical challenges...
November 20, 2017: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/29148951/reframing-consent-for-clinical-research-a-function-based-approach
#8
Neal W Dickert, Nir Eyal, Sara F Goldkind, Christine Grady, Steven Joffe, Bernard Lo, Franklin G Miller, Rebecca D Pentz, Robert Silbergleit, Kevin P Weinfurt, David Wendler, Scott Y H Kim
Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions...
December 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/29145863/assessing-quality-of-maternity-care-in-hungary-expert-validation-and-testing-of-the-mother-centered-prenatal-care-mcpc-survey-instrument
#9
Nicholas Rubashkin, Imre Szebik, Petra Baji, Zsuzsa Szántó, Éva Susánszky, Saraswathi Vedam
BACKGROUND: Instruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women. METHODS: Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context...
November 16, 2017: Reproductive Health
https://www.readbyqxmd.com/read/29129020/ethical-aspects-of-medical-age-assessment-in-the-asylum-process-a-swedish-perspective
#10
Erik Malmqvist, Elisabeth Furberg, Lars Sandman
According to European regulations and the legislations of individual member states, children who seek asylum have a different set of rights than adults in a similar position. To protect these rights and ensure rule of law, migration authorities are commonly required to assess the age of asylum seekers who lack reliable documentation, including through various medical methods. However, many healthcare professionals and other commentators consider medical age assessment to be ethically problematic. This paper presents a simplified and amended account of the main findings of a recent ethical analysis of medical age assessment in the asylum process commissioned by the Swedish National Board of Health and Welfare...
November 11, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/29118785/advance-directives-as-support-of-autonomy-for-persons-with-dementia-a-pilot-study-among-persons-with-dementia-and-their-informal-caregivers
#11
Martina Schmidhuber, Sandra Haeupler, Velislava Marinova-Schmidt, Andreas Frewer, Peter L Kolominsky-Rabas
Background: Advance directives could be an important instrument to support a person's will once he/she is not able to consent anymore - if composed competently. A survey was conducted to identify the level of knowledge concerning possibilities and limits of advance directives. Methods: The study was conducted as part of the Bavarian Dementia Survey (BayDem). Data were collected from January 2014 to December 2015 by structured face-to-face interviews. Study participants were persons with dementia and their informal caregivers (n = 74)...
September 2017: Dementia and Geriatric Cognitive Disorders Extra
https://www.readbyqxmd.com/read/29103136/a-study-of-the-opinions-of-swedish-healthcare-personnel-regarding-acceptable-outcome-following-decompressive-hemicraniectomy-for-ischaemic-stroke
#12
Magnus Olivecrona, Stephen Honeybul
BACKGROUND: Decompressive hemicraniectomy (DC) is an established lifesaving treatment for malignant infarction of the middle cerebral artery (mMCAI). However, surgical decompression will not reverse the effects of the stroke and many survivors will be left severely disabled. The objective of this study was to assess what neurological outcome would be considered acceptable in these circumstances amongst Swedish healthcare workers. METHOD: Healthcare workers were invited to participate in a presentation that outlined the pathophysiology of mMCAI, the rationale behind DC and outcome data from randomised controlled trials that have investigated efficacy of the procedure...
November 4, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29089184/patient-counselling-and-consent
#13
REVIEW
Akanksha Sood, Janesh Gupta
To the patient, illness entails not only the physical discomfort but all the psychological, social and emotional ramifications. Patient autonomy and choice are now an integral part of patient care pathways. There has been a steady shift in patient counselling and consent towards supporting patient autonomy over medical paternalism. Patients should be the prime decision makers but they can only do this if they are fully informed. The ultimate and desired goal for the health care teams is to provide a high quality clinical service, which is consistent with evidence based guidelines...
October 13, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29063996/dr-google-and-premature-consent-patients-who-trust-the-internet-more-than-they-trust-their-provider
#14
John K Davis
A growing number of patients make up their minds about some medical issue before they see their provider, either by googling their symptoms or asking a friend. They've made up their minds before coming in, and they resist their provider's recommendations even after receiving information and advice from their provider. This is a new kind of medical autonomy problem; it differs from cases of standard consent, futility, or conscientious refusal. Providers sometimes call this problem "Dr. Google." I call it premature consent...
October 24, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28993074/obtaining-waivers-of-parental-consent-a-strategy-endorsed-by-gay-bisexual-and-queer-adolescent-males-for-health-prevention-research
#15
Dalmacio Flores, Ross McKinney, Joyell Arscott, Julie Barroso
BACKGROUND: Requiring parental consent in studies with sexual minority youth (SMY) can sometimes be problematic as participants may have yet to disclose their sexual orientation, may not feel comfortable asking parents' permission, and may promote a self-selection bias. PURPOSE: We discuss rationale for waiving parental consent, strategies to secure waivers from review boards, and present participants' feedback on research without parents' permission. METHODS: We share our institutional review board proposal in which we made a case that excluding SMY from research violates ethical research principles, does not recognize their autonomy, and limits collection of sexuality data...
September 18, 2017: Nursing Outlook
https://www.readbyqxmd.com/read/28983835/biomedical-big-data-new-models-of-control-over-access-use-and-governance
#16
Effy Vayena, Alessandro Blasimme
Empirical evidence suggests that while people hold the capacity to control their data in high regard, they increasingly experience a loss of control over their data in the online world. The capacity to exert control over the generation and flow of personal information is a fundamental premise to important values such as autonomy, privacy, and trust. In healthcare and clinical research this capacity is generally achieved indirectly, by agreeing to specific conditions of informational exposure. Such conditions can be openly stated in informed consent documents or be implicit in the norms of confidentiality that govern the relationships of patients and healthcare professionals...
October 5, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28981744/using-and-disclosing-confidential-patient-information-and-the-english-common-law-what-are-the-information-requirements-of-a-valid-consent
#17
Victoria Chico, Mark J Taylor
The National Health Service in England and Wales is dependent upon the flow of confidential patient data. In the context of consent to the use of patient health data, insistence on the requirements of an 'informed' consent that are difficult to achieve will drive reliance on alternatives to consent. Here we argue that one can obtain a valid consent to the disclosure of confidential patient data, such that this disclosure would not amount to a breach of the common law duty of confidentiality, having provided less information than would typically be associated with an 'informed consent'...
August 17, 2017: Medical Law Review
https://www.readbyqxmd.com/read/28974311/informed-consent-it-s-more-than-a-signature-on-a-piece-of-paper
#18
Christine S Cocanour
Informed consent is an ethical concept that is codified in the law and is in daily practice at every health care institution. Three fundamental criteria are needed for clinical informed consent: the patient must be competent, adequately informed and not coerced. Physician-patient interaction is rooted in the ethical concept of beneficence, but over the 19th and 20th centuries, case law and societal changes brought respect for autonomy and with it--informed consent. This article briefly reviews the basics of informed consent, when is it required, how did informed consent evolve into what it is today and what can the surgeon do to truly achieve informed consent...
September 20, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28956967/undertaking-research-on-people-who-lack-decision-making-capacity
#19
Richard Griffith
The Declaration of Helsinki requires that health care research takes place with the informed consent of those who participate in the study. This approach upholds the autonomy of the participants, but restricts research to subjects who have decision-making capacity. The Mental Capacity Act 2005 introduced safeguards that enable researchers to investigate the care and treatment of people with incapacity, while protecting this vulnerable patient group. These safeguards allow people who lack decision-making capacity to benefit from research findings...
October 2, 2017: British Journal of Community Nursing
https://www.readbyqxmd.com/read/28951264/discussing-sarcoma-risks-during-informed-consent-for-nonhysterectomy-management-of-fibroids-an-unmet-need
#20
Brandon-Luke L Seagle, Amy L Alexander, Anna E Strohl, Shohreh Shahabi
There is no reliable way to distinguish symptomatic uterine fibroids from sarcoma without a surgical specimen. Many women with a uterine sarcoma are initially managed without hysterectomy under a presumed fibroid diagnosis, without understanding sarcoma risks. Currently many alternatives to hysterectomy, including medical and procedural interventions, for treatment of fibroids are promoted. The sarcoma incidence among women with presumed fibroids is 0.29% (1/340) to 0.05% (1/2000). Nonmetastatic leiomyosarcoma has a 63% 5-year survival rate whereas metastatic leiomyosarcoma has a 14% 5-year survival rate...
September 23, 2017: American Journal of Obstetrics and Gynecology
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