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Informed consent and autonomy

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https://www.readbyqxmd.com/read/29656801/-the-law-of-march-5-2007-and-the-care-of-persons-placed-under-guardianship
#1
Matthieu Modot, Clotilde Rougé-Maillart
The care of persons placed under guardianship has changed considerably since the law of March 5, 2007, as greater autonomy is granted to them. By advocating greater autonomy of protected adults, the French Civil Code is in opposition with the French Public Health Code since the latter states that the systematic consent of the guardian is required in addition to that of the protected adult for so-called general care. In cases of serious injury to bodily integrity, the guardianship judge's opinion must be sought by the guardian...
April 12, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29648601/compensating-injury-to-autonomy-in-english-negligence-law-inconsistent-recognition
#2
Tsachi Keren-Paz
Recently in Shaw v Kovac, the Court of Appeal seemed to have rejected a standalone injury to autonomy (ITA) as actionable in negligence, in an informed consent case. In this article, I argue that Shaw can be explained away, and that English law recognizes ITA as actionable in a series of cases, some of which-Bhamra, Tracey, and Yearworth-were not hitherto understood to do so. However, the under-theorization in the cases leads to inconsistencies. Like cases (Rees/Yearworth; Chester/Tracey) are not treated alike; ITA is misunderstood to be about 'religious offence' (Bhamra) and property loss (Yearworth) and worse still, the more serious type 2 ITA (Rees) gives rise to a weaker remedy (of exceptional nature aside) than the less serious type 1 injury (Chester)...
April 10, 2018: Medical Law Review
https://www.readbyqxmd.com/read/29605143/refusal-of-recommended-maternity-care-time-to-make-a-pact-with-women
#3
Bec Jenkinson, Sue Kruske, Sue Kildea
BACKGROUND: The right to refuse medical treatment can be contentious in maternity care. Professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy, but there is little guidance available to clinicians about the appropriate clinical responses when women decline recommended care. OBJECTIVES: We propose a comprehensive, woman-centred, systems-level framework for documentation and communication with the goal of supporting women, clinicians and health services in situations of maternal refusal...
March 28, 2018: Women and Birth: Journal of the Australian College of Midwives
https://www.readbyqxmd.com/read/29605112/ionising-radiation-risk-disclosure-when-should-radiographers-assume-a-duty-to-inform
#4
C W E Younger, C Douglas, H Warren-Forward
INTRODUCTION: Autonomy is a fundamental patient right for ethical practice, and informed consent is the mechanism by which health care professionals ensure this right has been respected. The ethical notion of informed consent has evolved alongside legal developments. Under Australian law, a provider who fails to disclose risk may be found to be in breach of a duty of disclosure, potentially facing legal consequences if the patient experiences harm that is attributable to an undisclosed risk...
May 2018: Radiography
https://www.readbyqxmd.com/read/29587567/exploring-moral-problems-and-moral-competences-in-midwifery-a-qualitative-study
#5
Stephan Oelhafen, Settimio Monteverde, Eva Cignacco
BACKGROUND: Most undergraduate midwifery curricula comprise ethics courses to strengthen the moral competences of future midwives. By contrast, surprisingly little is known about the specific moral competences considered to be relevant for midwifery practice. Describing these competences not only depends on generic assumptions about the moral nature of midwifery practice but also reflects which issues practitioners themselves classify as moral. OBJECTIVE: The goal of this study was to gain insight into the ethical issues midwives encounter in their daily work, the key competences and resources they consider indispensable to understand and deal with them, and to assess phenomena linked to moral distress...
January 1, 2018: Nursing Ethics
https://www.readbyqxmd.com/read/29572339/-montgomery-informed-consent-and-causation-of-harm-lessons-from-australia-or-a-uniquely-english-approach-to-patient-autonomy
#6
Malcolm K Smith, Tracey Carver
The UK Supreme Court in Montgomery v Lanarkshire Health Board adopts an approach to information disclosure in connection with clinical treatment that moves away from medical paternalism towards a more patient-centred approach. In doing so, it reinforces the protection afforded to informed consent and autonomous patient decision making under the law of negligence. However, some commentators have expressed a concern that the widening of the healthcare providers' duty of disclosure may provide impetus, in future cases, for courts to adopt a more rigorous approach to the application of causation principles...
March 23, 2018: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29529932/ethical-research-practice-or-undue-influence-symbolic-power-in-community-and-individual-level-informed-consent-processes-in-community-based-participatory-research-in-swaziland
#7
Michelle Brear
In community-based participatory research (CBPR), community-level consent is assumed to enhance ethical rigor, when obtained prior to individual informed consent. However, community leaders' permission to conduct research may influence individuals' agency to decline participation. This article presents findings of a Bourdieusian analysis of ethnographic data documenting CBPR in rural Swaziland. The findings reveal that the "symbolic power" of leaders who provide community-level consent constrains individual agency and reproduces existing relations of power, if individual informed consent is simply a procedure...
March 1, 2018: Journal of Empirical Research on Human Research Ethics: JERHRE
https://www.readbyqxmd.com/read/29514575/a-qualitative-description-of-service-providers-experiences-of-ethical-issues-in-hiv-care
#8
Motshedisi B Sabone, Keitshokile Dintle Mogobe, Ellah Matshediso, Sheila Shaibu, Esther I Ntsayagae, Inge B Corless, Yvette P Cuca, William L Holzemer, Carol Dawson-Rose, Solymar S Soliz Baez, Marta Rivero-Mendz, Allison R Webel, Lucille Sanzero Eller, Paul Reid, Mallory O Johnson, Jeanne Kemppainen, Darcel Reyes, Kathleen Nokes, Dean Wantland, Patrice K Nicholas, Teri Lingren, Carmen J Portillo, Elizabeth Sefcik, Ellen Long-Middleton
BACKGROUND: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. PURPOSE: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care...
January 1, 2018: Nursing Ethics
https://www.readbyqxmd.com/read/29512408/supporting-autonomy-of-nursing-home-residents-with-dementia-in-the-informed-consent-process
#9
Elizabeth Beattie, Maria O'Reilly, Deirdre Fetherstonhaugh, Mitchell McMaster, Wendy Moyle, Elaine Fielding
Background In studies involving people with dementia, researchers have historically defaulted to seeking consent from a proxy, the assumption being that people with dementia are unable to provide their own informed consent. This choice denies people with dementia a voice in the consent process, thus disregarding their autonomy and agency. Recently, other options for improving the consent process have been explored. Objective This study aimed to determine whether nursing home residents with dementia could demonstrate an ability to provide their own informed consent as determined by the Evaluation to Sign Consent instrument...
January 1, 2018: Dementia
https://www.readbyqxmd.com/read/29511041/from-whom-do-physicians-obtain-consent-for-surgery
#10
Zahra Jarayedi, Fariba Asghari
OBJECTIVE: To evaluate the knowledge and performance of surgical residents regarding the person from whom informed consent should be taken for surgery and from whom the consent is taken in practice. MATERIALS AND METHODS: This study was done in 2013. The population of this study was all residents of urology, surgery, orthopaedic surgery and gynaecology of Tehran and Iran University of Medical Sciences. The study tool was a self-administered questionnaire, containing questions on their knowledge and performance regarding informed consent acquisition from patients with different conditions in terms of age, sex, marital status and their capacity to make treatment decisions...
March 6, 2018: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29430418/audiovisual-recording-of-the-consenting-process-in-clinical-research-experiences-from-a-tertiary-referral-center
#11
Parvan A Shetty, Mitesh R Maurya, Brinal H Figer, Urmila M Thatte, Nithya J Gogtay
The quality of the written informed consent process is one of the most important aspects of clinical research, as it is the single tool that serves as a metric of autonomy. Several challenges have been identified with the informed consent process in developing countries the most important of which is the ability to assimilate and understand the information presented in the consent form. In India, a unique aspect of the informed consent process is the need for audio-video [AV] recording of the process for vulnerable populations and new chemical entities...
January 2018: Perspectives in Clinical Research
https://www.readbyqxmd.com/read/29424409/-does-therapeutic-privilege-have-a-place-in-modern-medicine
#12
Rodrigo R Salinas, Carlos Echeverría B, Anamaría Arriagada U, Alejandro Goic G, Carlos Quintana V, Alberto Rojas O, Alejandro Serani M, Paulina Taboada R, Ricardo Vacarezza Y
During the last years, bioethical discussion has highlighted the role of the patients' autonomy, being informed consent its particular expression, about decisions that they should make about their own health. The Hippocratic tradition, the deontological positions of the Geneva Declaration of the World Medical Association and numerous codes of ethics in various countries, require that the physician, above all, should ensure patients' health. In this context the discussion on pros and cons for the so-called "therapeutic privilege" are discussed...
September 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/29415551/caesarean-section-deliveries-experiences-of-mothers-of-midwifery-care-at-a-public-hospital-in-nelson-mandela-bay
#13
Thobeka P Jikijela, Sindiwe James, Balandeli S I Sonti
BACKGROUND: The rate of caesarean section deliveries has increased globally and mothers are faced with challenges of postoperative recovery and caring thereof. Midwives have a duty to assist these mothers to self-care. OBJECTIVE: The objective was to explore and describe experiences of post-caesarean section delivered mothers of midwifery care at a public hospital in Nelson Mandela Bay. METHODS: A qualitative, descriptive and explorative research design was used in the study...
January 30, 2018: Curationis
https://www.readbyqxmd.com/read/29406774/photorealistic-avatar-and-teen-physical-activity-feasibility-and-preliminary-efficacy
#14
Deborah I Thompson, Dora Cantu, Chishinga Callender, Yan Liu, Mayur Rajendran, Madhur Rajendran, Yuting Zhang, Zhigang Deng
OBJECTIVE: Exergames played with a photorealistic avatar may enhance motivation to play, in addition to frequency, duration, and intensity of game-play. This article reports the feasibility and preliminary efficacy of an exergame played with a photorealistic avatar on physical activity (PA) intensity in a laboratory-based study. MATERIALS AND METHODS: Teens (12-14 years old) were recruited from a large, metropolitan area of the southwestern United States. Parents provided written informed consent...
February 6, 2018: Games for Health
https://www.readbyqxmd.com/read/29325614/ethical-issues-in-neurogenetics
#15
Wendy R Uhlmann, J Scott Roberts
Many neurogenetic conditions are inherited and therefore diagnosis of a patient will have implications for the patient's relatives and can raise ethical issues. Predictive genetic testing offers asymptomatic relatives the opportunity to determine their risk status for a neurogenetic condition, and professional guidelines emphasize patients' autonomy and informed, voluntary decision making. Beneficence and nonmaleficence both need to be considered when making decisions about disclosure and nondisclosure of genetic information and test results...
2018: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/29304845/testing-decision-making-competency-of-schizophrenia-participants-in-clinical-trials-a-meta-analysis-and-meta-regression
#16
Sorin Hostiuc, Mugurel Constantin Rusu, Ionut Negoi, Eduard Drima
BACKGROUND: The process of assessing the decision-making capacity of potential subjects before their inclusion in clinical trials is a legal requirement and a moral obligation, as it is essential for respecting their autonomy. This issue is especially important in psychiatry patients (such as those diagnosed with schizophrenia). The primary purpose of this article was to evaluate the degree of impairment in each dimension of decision-making capacity in schizophrenia patients compared to non-mentally-ill controls, as quantified by the (MacCAT-CR) instrument...
January 5, 2018: BMC Psychiatry
https://www.readbyqxmd.com/read/29302597/ethical-challenges-involved-in-obtaining-consent-for-research-from-patients-hospitalized-in-the-intensive-care-unit
#17
Fiona Ecarnot, Jean-Pierre Quenot, Guillaume Besch, Gaël Piton
Clinical research remains a vital contributor to medical knowledge, and is an established and integral part of the practice of medicine worldwide. Respect for patient autonomy and ethical principles dictate that informed consent must be obtained from subjects before they can be enrolled into clinical research, yet these conditions may be difficult to apply in real practice in the intensive care unit (ICU). A number of factors serve to complexify the consent process in critically ill patients, notably decisional incapacity of the patient due to illness or sedation...
December 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29297375/the-role-of-male-partners-in-women-s-participation-in-research-during-pregnancy-a-case-study-from-the-partners-demonstration-project
#18
Kenneth Ngure, Susan Brown Trinidad, Kristin Beima-Sofie, Jared M Baeten, Nelly R Mugo, Elizabeth A Bukusi, Renee Heffron, Grace John-Stewart, Maureen C Kelley
The exclusion of pregnant women from health research remains a significant challenge globally. In settings where cultural traditions and gender norms support a more restricted decision-making role for women in general, little is known about the attitudes of male partners toward the inclusion of women in research during pregnancy. Understanding the expectations of both men and women in such cultural settings offers an opportunity to engage and address local ethical concerns to improve women's access to research during pregnancy and enhance intervention development...
December 14, 2017: Reproductive Health
https://www.readbyqxmd.com/read/29290004/a-republican-argument-against-nudging-and-informed-consent
#19
Paul Hamilton
I argue that it is impermissible to use nudges as a tool to influence patients in the context of informed consent. The motivation for such nudges is that their use can help reconcile potential conflicts between a physician's duty of beneficence and duty to respect patient autonomy. I argue that their use places physicians in a position of domination over patients. That is, it violates the republican freedom of patients because it grants physicians the power to arbitrarily interfere. I also argue that if one tries to adjust the duty of beneficence to avoid this conclusion, then the republican freedom of patients is still threatened under conditions of clinical equipoise...
December 30, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/29201387/a-half-century-of-electronic-fetal-monitoring-and-bioethics-silence-speaks-louder-than-words
#20
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
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