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Informed consent and autonomy

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https://www.readbyqxmd.com/read/28195536/patient-autonomy-within-real-or-valid-consent-samira-kohli-s-case
#1
Supriya Subramani
In bioethics literature, the primary justification for the requirement of informed consent has been the protection of autonomous choices. To allow patients to be autonomous decision-makers, physicians are supposed to disclose and share information related to all treatment, procedures and risks. Advocates of the autonomy-based informed consent model argue that in informed consent cases, the disclosure of information should be according to the reasonable person standard or reasonable patient standard, rather than the average competent physician standard...
January 18, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28190696/ethical-issues-in-research
#2
REVIEW
Raul Artal, Sheldon Rubenfeld
Biomedical research is currently guided by ethical standards that have evolved over many centuries. Historical and political events, social and legal considerations, and continuous medical and technological advances have led to the prevailing research ethics and practice. Currently, patients and research subjects have complete autonomy while under medical care or when volunteering as research subjects. Enrolling volunteers in human subjects research includes a detailed and meaningful informed consent process that follows the cardinal principles of ethics: autonomy, beneficence, nonmaleficence, and justice...
January 23, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28170159/a-novel-emergency-department-based-community-notification-method-for-clinical-research-without-consent
#3
Gerald F O'Malley, Patricia Giraldo, Kenneth Deitch, Elizabeth Andrea Aguilera, Sorin Cadar, Claudia Lares, Rika Nagakuni O'Malley, Nino Oqroshidze, Manisha Verma, Carl Chudnofsky
Providing and receiving informed consent to critically ill or moribund subjects is ethically and practically challenging.(1) Historically the concept of autonomy requires research subjects to receive and provide informed consent prior to participating in clinical research. The nature of resuscitation research prevents two-way communication and ethical informed consent. In 1996 the FDA released a set of guidelines allowing for exception from informed consent (EFIC) for emergency research, provided certain requirements are met (21 CF 50...
February 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28150264/-the-use-of-informed-consent-in-clinical-nursing-practice
#4
Chun-Ting Cheng, Chiu-Chu Lin
Obtaining informed consent and ensuring patient autonomy are critical to implementing a patient-centered model of healthcare. Informed consent is a complex process of communication that includes three elements: disclosure, competence in making decisions, and voluntariness. However, individual patient factors, doctor-patient interaction, and cultural issues are known to influence the process of obtaining informed consent. Individual patient factors include the ability of patients to understand and determine their intent; doctor-patient interaction includes communication skills; and cultural issues include the expectations of patients with regard to family involvement in medical decision-making and in decision-making motives...
February 2017: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/28148333/ethical-considerations-of-transparency-informed-consent-and-nudging-in-a-patient-with-paediatric-aortic-stenosis-and-symptomatic-left-ventricular-endocardial-fibroelastosis
#5
Constantine D Mavroudis, Thomas Cook, Jeffrey P Jacobs, Constantine Mavroudis
A 9-year-old boy who was born with bicuspid aortic stenosis underwent two unsuccessful aortic valvuloplasty interventions, and by 2 years of age he developed restrictive cardiomyopathy caused by left ventricular endocardial fibroelastosis and diastolic dysfunction. The attending cardiologist referred the patient to a high-volume, high-profile congenital cardiac surgical programme 1000 miles away that has a team with considerable experience with left ventricular endocardial fibroelastosis resection and a reputation of achieving good results...
December 2016: Cardiology in the Young
https://www.readbyqxmd.com/read/28140662/pediatric-issues-in-return-of-results-and-incidental-findings-weighing-autonomy-and-best-interests
#6
Ingrid A Holm
Nowhere are the ethical issues in genomic research more complex than in pediatrics. Balancing the sometime conflicting autonomy of the parent and the child, and the best interest of the family and the child, brings up many challenging issues. Addressing this balance, especially in the context of the child's developing maturity and comprehension, requires deep analysis and discussion. Issues discussed include the impact of genetic information on the family, parental versus the child's autonomy, the best interests of the child versus the family, potential limitations on the parents' right to know or not know information about their child, and changing role of the developing child in return of research results...
January 31, 2017: Genetic Testing and Molecular Biomarkers
https://www.readbyqxmd.com/read/28134008/prioritising-patient-care
#7
Helge Skirbekk, Marit Helene Hem, Per Nortvedt
BACKGROUND: There is little research comparing clinicians' and managers' views on priority settings in the healthcare services. During research on two different qualitative research projects on healthcare prioritisations, we found a striking difference on how hospital executive managers and clinical healthcare professionals talked about and understood prioritisations. AIM: The purpose of this study is to explore how healthcare professionals in mental healthcare and somatic medicine prioritise their care, to compare different ways of setting priorities among managers and clinicians and to explore how moral dilemmas are balanced and reconciled...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28078909/apparent-treatment-resistant-hypertension-patient-physician-relationship-and-ethical-issues
#8
Julian E Mariampillai, Per Anders Eskås, Sondre Heimark, Anne Cecilie K Larstorp, Fadl Elmula M Fadl Elmula, Aud Høieggen, Per Nortvedt
BACKGROUND: Poor drug adherence is a major cause of apparent treatment-resistant hypertension. As a consequence, several methods have been developed and attempted implemented in clinical practice to reveal non-adherence and to monitor drug adherence. There are, however, several hitherto unresolved ethical aspects regarding potential methods for drug monitoring in these patients. RESULTS: The most striking challenge is the balance between patient autonomy and the physician's desire for the patient to adhere to the prescribed therapy...
January 12, 2017: Blood Pressure
https://www.readbyqxmd.com/read/28043243/-association-between-sense-of-coherence-and-occupational-stress-of-workers-in-modern-service-industry-in-shanghai-china
#9
X Y Lu, J M Dai, N Wu, C Shu, J L Gao, H Fu
Objective: To investigate understand the current status of the sense of coherence and occupational stress in modern service workers, and to analyze the association between occupational stress and the sense of coherence. Methods: From March to April, 2016, 834 modern service workers from 3 companies in Shanghai, China (in air transportation industry, marketing industry, and travel industry) were surveyed by non-ran-dom sampling. The self-completion questionnaires were filled out anonymously given the informed consent of the workers...
October 20, 2016: Chinese Journal of Industrial Hygiene and Occupational Diseases
https://www.readbyqxmd.com/read/27996923/a-framework-for-unrestricted-prenatal-whole-genome-sequencing-respecting-and-enhancing-the-autonomy-of-prospective-parents
#10
Stephanie C Chen, David T Wasserman
Noninvasive, prenatal whole genome sequencing (NIPW) may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions...
January 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/27934774/the-moral-agency-of-institutions-effectively-using-expert-nurses-to-support-patient-autonomy
#11
Sonya Charles
Patient autonomy-with an emphasis on informed consent and the right to refuse treatment-is a cornerstone of modern bioethics. Within discussions about patient autonomy, feminist bioethicists have argued for a relational approach to autonomy. Under a relational framework, we must look beyond the individual moment of choice to include the role relationships and specific contexts can play in supporting or undermining autonomy. Given the day-to-day interactions they have with patients, nurses play a significant role in helping patients understand the nature of their illnesses and make truly informed decisions...
December 1, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27922563/-sign-here-nursing-value-and-the-process-of-informed-consent
#12
Wesley E Cook
Protecting patient autonomy is a key nursing role. The Code of Ethics (American Nurses Association, 2010), contextualizes the nurse's call to advocacy within the doctrine of informed consent. This article offers a primer on the legal, ethical, and practical aspects of procedural informed consent and examines the value of nursing's role within the process. The theory of nursing's value is sound, but the literature lacks data. Higher levels of evidence are necessary to make sound decisions about best practice for the process of informed consent...
October 2016: Plastic Surgical Nursing
https://www.readbyqxmd.com/read/27922504/genetic-testing-of-presymptomatic-individuals-at-risk-for-progressive-myopathy
#13
Zachary Simmons
Patients and their family members often ask about genetic testing for asymptomatic individuals who are at risk for developing a genetic disorder. Ordering a genetic test is a complex process involving consideration of many basic ethical principles including autonomy, beneficence, and nonmaleficence, as well as the physician's duty to act in the patient's best interest. Physicians have many choices regarding what tests to order, and they must develop the knowledge and skills to best discuss genetic testing with their patients...
December 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27891023/capacity-issues-and-decision-making-in-dementia
#14
REVIEW
Soumya Hegde, Ratnavalli Ellajosyula
Capacity to make one's own decisions is fundamental to the autonomy of the individual. Capacity is a functional assessment made by a clinician to determine if a patient is capable of making a specific decision. Competency is a global assessment and legal determination made by a judge in court. Capacity evaluation for a patient with dementia is used to determine whether the patient is capable of giving informed consent, participate in research, manage their finances, live independently, make a will, and have ability to drive...
October 2016: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/27884857/implementing-shared-decision-making-in-interprofessional-home-care-teams-the-ipsdm-sw-study-protocol-for-a-stepped-wedge-cluster-randomised-trial
#15
France Légaré, Nathalie Brière, Dawn Stacey, Guy Lacroix, Sophie Desroches, Serge Dumont, Kimberly D Fraser, Louis-Paul Rivest, Pierre J Durand, Stéphane Turcotte, Monica Taljaard, Henriette Bourassa, Lise Roy, Geneviève Painchaud Guérard
INTRODUCTION: The frail elderly in Canada face a tough decision when they start to lose autonomy: whether to stay at home or move to another location. This study seeks to scale up and evaluate the implementation of shared decision-making (SDM) in interprofessional (IP) home care teams caring for elderly clients or their caregivers facing a decision about staying at home or moving elsewhere. METHODS: A stepped wedge cluster randomised trial involving 8 Health and Social Service Centers (HSSCs) will be conducted with IP home care teams...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27883307/informed-consent-in-the-medical-care-of-transgender-and-gender-nonconforming-patients
#16
Timothy Cavanaugh, Ruben Hopwood, Cei Lambert
Informed consent as a model of care has evolved as an alternative to the standard model of care recommended by the World Professional Association for Transgender Health's Standards of Care, version 7, which emphasizes the importance of mental health professionals' role in diagnosing gender dysphoria and in assessing the appropriateness and readiness for gender-affirming medical treatments. By contrast, the informed consent model for gender-affirming treatment seeks to acknowledge and better support the patient's right to, and capability for, personal autonomy in choosing care options without the required involvement of a mental health professional...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27833931/patient-and-physician-views-about-protocolized-dialysis-treatment-in-randomized-trials-and-clinical-care
#17
Ashley Kraybill, Laura M Dember, Steven Joffe, Jason Karlawish, Susan S Ellenberg, Vanessa Madden, Scott D Halpern
BACKGROUND: Pragmatic trials comparing standard-of-care interventions may improve the quality of care for future patients, but raise ethical questions about limitations on decisional autonomy. We sought to understand how patients and physicians view and respond to these questions in the contexts of pragmatic trials and of usual clinical care. METHODS: We conducted scenario-based, semi-structured interviews with 32 patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis in outpatient dialysis units and with 24 nephrologists...
2016: AJOB Empirical Bioethics
https://www.readbyqxmd.com/read/27803362/toward-optimal-decision-making-among-vulnerable-patients-referred-for-cardiac-surgery-a-qualitative-analysis-of-patient-and-provider-perspectives
#18
Ryan A Gainer, Janet Curran, Karen J Buth, Jennie G David, Jean-Francois Légaré, Gregory M Hirsch
OBJECTIVES: Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population...
November 1, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27788415/increasing-possibilities-increasing-dilemmas-a-qualitative-study-of-swedish-midwives-experiences-of-ultrasound-use-in-pregnancy
#19
Kristina Edvardsson, Ann Lalos, Annika Åhman, Rhonda Small, Sophie Graner Md PhD, Ingrid Mogren
OBJECTIVE: to explore Swedish midwives' experiences and views of the use of obstetric ultrasound in clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. DESIGN: an exploratory qualitative study based on focus group discussions (FGDs) was undertaken in 2013 as part of the CROss Country Ultrasound Study (CROCUS). Data were analysed using qualitative content analysis. SETTING AND PARTICIPANTS: midwives (N=25) were recruited from four public hospitals located in the northern and central parts of Sweden...
November 2016: Midwifery
https://www.readbyqxmd.com/read/27782924/recovery-oriented-mental-health-practice-in-a-community-care-unit-an-exploratory-study
#20
Brian McKenna, Jane Oakes, Niki Fourniotis, Nigel Toomey, Trentham Furness
A recovery-oriented model of care has become the major focus of mental health service delivery in the state of Victoria, Australia. However, there is a total absence of knowledge of recovery-oriented mental health practice in community care units (CCUs). Therefore, the aims of this exploratory study were to: (a) describe what aspects of the current model of care fit within the domains of recovery; and (b) describe the pragmatic processes that staff use to mold their care within the domains of recovery. Twenty-one key stakeholders provided informed voluntary consent to participate in one-to-one interviews...
October 2016: Journal of Forensic Nursing
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