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Informed consent and autonomy

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https://www.readbyqxmd.com/read/28642690/autonomy-in-depressive-patients-undergoing-dbs-treatment-informed-consent-freedom-of-will-and-dbs-potential-to-restore-it
#1
Timo Beeker, Thomas E Schlaepfer, Volker A Coenen
According to the World Health Organization, depression is one of the most common and most disabling psychiatric disorders, affecting at any given time approximately 325 million people worldwide. As there is strong evidence that depressive disorders are associated with a dynamic dysregulation of neural circuits involved in emotional processing, recently several attempts have been made to intervene directly in these circuits via deep brain stimulation (DBS) in patients with treatment-resistant major depressive disorder (MDD)...
2017: Frontiers in Integrative Neuroscience
https://www.readbyqxmd.com/read/28638327/noninvasive-brain-stimulation-and-personal-identity-ethical-considerations
#2
Jonathan Iwry, David B Yaden, Andrew B Newberg
As noninvasive brain stimulation (NIBS) technology advances, these methods may become increasingly capable of influencing complex networks of mental functioning. We suggest that these might include cognitive and affective processes underlying personality and belief systems, which would raise important questions concerning personal identity and autonomy. We give particular attention to the relationship between personal identity and belief, emphasizing the importance of respecting users' personal values. We posit that research participants and patients should be encouraged to take an active approach to considering the personal implications of altering their own cognition, particularly in cases of neurocognitive "enhancement...
2017: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/28606067/through-the-client-s-eyes-using-narratives-to-explore-experiences-of-care-transfers-during-pregnancy-childbirth-and-the-neonatal-period
#3
Cherelle M V van Stenus, Mark Gotink, Magda M Boere-Boonekamp, Anneke Sools, Ariana Need
BACKGROUND: The client experience is an important outcome in the evaluation and development of perinatal healthcare. But because clients meet different professionals, measuring such experiences poses a challenge. This is especially the case in the Netherlands, where pregnant women are often transferred between professionals due to the nation's approach to risk selection. This paper explores questions around how clients experience transfers of care during pregnancy, childbirth, and the neonatal period, as well as how these experiences compare to the established quality of care aspects the Dutch Patient Federation developed...
June 12, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28599638/development-of-a-consensus-operational-definition-of-child-assent-for-research
#4
Alan R Tait, Michael E Geisser
BACKGROUND: There is currently no consensus from the relevant stakeholders regarding the operational and construct definitions of child assent for research. As such, the requirements for assent are often construed in different ways, institutionally disparate, and often conflated with those of parental consent. Development of a standardized operational definition of assent would thus be important to ensure that investigators, institutional review boards, and policy makers consider the assent process in the same way...
June 9, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28585456/potential-conflicts-in-midwifery-practice-regarding-conscientious-objection-to-abortions-in-scotland
#5
Valerie Fleming, Yvonne Robb
BACKGROUND: This study was developed as a result of a court case involving conflicts between midwives' professional practice and their faith when caring for women undergoing abortions in Scotland. RESEARCH QUESTIONS: What are practising Roman Catholics' perspectives of potential conflicts between midwives' professional practice in Scotland with regard to involvement in abortions and their faith? How relevant is the 'conscience clause' to midwifery practice today? and What are participants' understandings of Canon 1398 in relation to midwifery practice? RESEARCH DESIGN: The theoretical underpinning of this study was Gadamer's hermeneutic out of which the method developed by Fleming et al...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28576618/giving-birth-expectations-of-first-time-mothers-in-switzerland-at-the-mid-point-of-pregnancy
#6
Valerie Fleming, Yvonne Meyer, Franziska Frank, Susanne van Gogh, Laura Schirinzi, Bénédicte Michoud, Claire de Labrusse
PROBLEM AND BACKGROUND: Despite a generally affluent society, the caesarean section rate in Switzerland has steadily climbed in recent years from 22.9% in 1998 to 33.7% in 2014. Speculation by the media has prompted political questions as to the reasons. However, there is no clear evidence as to why the Swiss rate should be so high especially in comparison with neighbouring countries. AIM: To describe the emerging expectations of giving birth of healthy primigravid women in the early second semester of pregnancy in four Swiss cantons...
May 30, 2017: Women and Birth: Journal of the Australian College of Midwives
https://www.readbyqxmd.com/read/28559690/terminal-patients-and-the-right-to-refuse-medical-treatment-in-argentina
#7
Martín Hevia, Daniela Schnidrig
The right to health has many dimensions. On the one hand, it entails positive duties for states to protect the health of individuals. On the other, it encompasses patient decision making regarding personal health, an idea which is closely linked to the right to autonomy and the right to free development of the individual-that is, to dignity.(1) This is why the informed consent of the patient and her right to make a choice according to her own values should be honored, even when her decision may seem irrational or imprudent...
December 2016: Health and Human Rights
https://www.readbyqxmd.com/read/28551904/-unknown-title
#8
Moshe Shiller, Vladimir Gens, Ganem Kassem, Wisam Sbeit
BACKGROUND: The relationships between physicians and patients are very complex. One of their principles is to receive informed consent from the patient. This principle facilitates patient autonomy. The physician must explain to the patient: his condition, treatment alternatives, stating the advantages and disadvantages of each option, to enable the patient to choose between them. There are various attitudes towards the health system as a result of different cultures in different societies...
May 2017: Harefuah
https://www.readbyqxmd.com/read/28541237/treatment-decision-making-capacity-in-hospitalized-patients-with-schizophrenia
#9
N Bilanakis, V K Peritogiannis, Aik Vratsista
In contemporary medical ethics and clinical practice the autonomy of patients and their right to accept or refuse an offered treatment is acknowledged and respected. Prerequisite for the right of a patient to consent to any medical act is the capacity to make valid decisions regarding his/ her treatment. The objective of our study was to assess -for the first time in our country- treatment decision-making capacity of hospitalized patients with schizophrenia; to explore any possible association with demographic and clinical variables; and to compare treatment decision-making capacity of patients with schizophrenia with medical patients' capacity...
January 2017: Psychiatrikē, Psychiatriki
https://www.readbyqxmd.com/read/28537834/when-respecting-autonomy-is-harmful-a-clinically-useful-approach-to-the-nocebo-effect
#10
John T Fortunato, Jason Adam Wasserman, Daniel Londyn Menkes
Nocebo effects occur when an adverse effect on the patient arises from the patient's own negative expectations. In accordance with informed consent, providers often disclose information that results in unintended adverse outcomes for the patient. While this may adhere to the principle of autonomy, it violates the doctrine of "primum non nocere," given that side-effect disclosure may cause those side effects. In this article we build off previous work, particularly by Wells and Kaptchuk ( 2012 ) and by Cohen ( 2013 ), to suggest ethical guidelines that permit nondisclosure in the case when a nocebo effect is likely to occur on of the basis of nonmaleficence...
June 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/28526428/extensively-drug-resistant-bacteria-which-ethical-issues
#11
P Vassal, P Berthelot, J P Chaussinand, S Jay, J P de Filippis, C Auboyer, F Renoux, D Bedoin
OBJECTIVE: The increased bacterial resistance to antibiotics has now become a public health concern. How can we preserve the well-being of patients presenting with infections caused by extensively drug-resistant bacteria (EDRBs) and that of their contacts without inducing any loss of chance of survival, all the while living together and controlling the spread of these EDRBs? METHOD: Terre d'éthique, a French territorial ethics committee, was asked to reflect on this topic by the infection control unit of a French University Hospital as it raises many ethical issues...
May 16, 2017: Médecine et Maladies Infectieuses
https://www.readbyqxmd.com/read/28503832/the-voluntary-nature-of-decision-making-in-addiction-static-metaphysical-views-versus-epistemologically-dynamic-views
#12
Eric Racine, Simon Rousseau-Lesage
The degree of autonomy present in the choices made by individuals with an addiction, notably in the context of research, is unclear and debated. Some have argued that addiction, as it is commonly understood, prevents people from having sufficient decision-making capacity or self-control to engage in choices involving substances to which they have an addiction. Others have criticized this position for being too radical and have counter-argued in favour of the full autonomy of people with an addiction. Aligning ourselves with middle-ground positions between these two extremes, we flesh out an account of voluntary action that makes room for finer-grained analyses than the proposed all-or-nothing stances, which rely on a rather static metaphysical understanding of the nature of the voluntariness of action...
June 2017: Bioethics
https://www.readbyqxmd.com/read/28477297/engaging-rural-communities-in-genetic-research-challenges-and-opportunities
#13
Caress Dean, Amanda J Fogleman, Whitney E Zahnd, Alexander E Lipka, Ripan Singh Malhi, Kristin R Delfino, Wiley D Jenkins
Statistical analyses of health and disease in rural communities is frequently limited by low sample counts. Still, some studies indicate increased risk for some diseases even after adjustment for known risk factors. It has been hypothesized that the context of community formation in rural areas facilitates the propagation of genetic founder effects-potentially impacting disease susceptibility. However, outright examination of genetic diversity in such communities has not been performed. Our objective was to engage otherwise research-inexperienced rural communities of largely European descent in genomic research in the context of cancer susceptibility...
May 5, 2017: Journal of Community Genetics
https://www.readbyqxmd.com/read/28453700/a-need-to-simplify-informed-consent-documents-in-cancer-clinical-trials-a-position-paper-of-the-arcad-group
#14
H Bleiberg, G Decoster, A de Gramont, P Rougier, A Sobrero, A Benson, B Chibaudel, J Y Douillard, C Eng, C Fuchs, M Fujii, R Labianca, A K Larsen, E Mitchell, H J Schmoll, D Sprumont, J Zalcberg
Background: In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants...
May 1, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28452627/sexual-consent-capacity-ethical-issues-and-challenges-in-long-term-care
#15
Jennifer Hillman
More than two million Americans live in nursing homes and other long-term care facilities. Available research suggests that the majority of older nursing home residents, including those with some degree of cognitive impairment, place significant value upon a variety of sexual activities. With nearly half of all residents suffering from dementia, psychologists and other mental health professionals often face significant challenges in the assessment of their patients' sexual consent capacity. A primary ethical issue is to balance an individual resident's rights to autonomy and privacy with a facility's need to protect residents from harm...
January 2017: Clinical Gerontologist
https://www.readbyqxmd.com/read/28425315/caring-in-nursing-homes-to-promote-autonomy-and-participation
#16
Maria Hedman, Elisabeth Häggström, Anna-Greta Mamhidir, Ulrika Pöder
BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care. OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation. RESEARCH DESIGN: A descriptive design with a phenomenological approach was used...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28419019/complexities-of-consent-ethics-in-the-pediatric-emergency-department
#17
Naomi Dreisinger, Nathan Zapolsky
Informed consent is a communicative process of sharing information with patients, which helps assure their understanding of the information provided and asks for their permission to proceed. Informed consent allows a patient or a patient's family to use his or her own value system to determine the need for a particular procedure or test. Asking a patient for permission to treat requires the provider to respect the patient's autonomy through allowing him or her to be an active part of the decision-making process...
April 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28405783/how-do-clinical-genetics-consent-forms-address-the-familial-approach-to-confidentiality-and-incidental-findings-a-mixed-methods-study
#18
Sandi Dheensa, Gillian Crawford, Claire Salter, Michael Parker, Angela Fenwick, Anneke Lucassen
Genetic test results can be relevant to patients and their relatives. Questions thus arise around whether clinicians regard genetic information as confidential to individuals or to families, and about how they broach this and other issues, including the potential for incidental findings, in consent (forms) for genetic testing. We conducted a content analysis of UK-wide genetic testing consent forms and interviewed 128 clinicians/laboratory scientists. We found that almost all genetic services offered patients multiple, sometimes unworkable, choices on forms, including an option to veto the use of familial genetic information to benefit relatives...
April 12, 2017: Familial Cancer
https://www.readbyqxmd.com/read/28398474/expect-the-unexpected-screening-for-secondary-findings-in-clinical-genomics-research
#19
Michael P Mackley, Benjamin Capps
Background: Due to decreasing cost, and increasing speed and precision, genomic sequencing in research is resulting in the generation of vast amounts of genetic data. The question of how to manage that information has been an area of significant debate. In particular, there has been much discussion around the issue of 'secondary findings' (SF)-findings unrelated to the research that have diagnostic significance. Sources of data: The following includes ethical commentaries, guidelines and policies in respect to large-scale clinical genomics studies...
June 1, 2017: British Medical Bulletin
https://www.readbyqxmd.com/read/28394963/-informed-consent-in-clinical-practice-persistent-doubts
#20
Miguel Kottow
Informed consent is the core aspect of the patient-physician relationship. Since its beginnings, clinical bioethics was opposed to the authoritarian paternalism characteristic of medicine since the 19th century. The informed consent was developed to provide patients with sufficient information to allow autonomous decisions when faced with medical diagnostic and therapeutic alternatives. In spite of bioethics’ effort to perfect informed consent, the discipline has been unable to avoid informed consent from becoming an impersonal and administrative procedure...
November 2016: Revista Médica de Chile
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