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Informed consent and autonomy

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https://www.readbyqxmd.com/read/27891023/capacity-issues-and-decision-making-in-dementia
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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...
September 22, 2016: Midwifery
https://www.readbyqxmd.com/read/27782924/recovery-oriented-mental-health-practice-in-a-community-care-unit-an-exploratory-study
#7
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 25, 2016: Journal of Forensic Nursing
https://www.readbyqxmd.com/read/27779152/role-of-demographic-and-job-related-variables-in-determining-work-related-quality-of-life-of-hospital-employees
#8
K Shukla, S Shahane, W D'Souza
BACKGROUND: Considering a huge working population in health sector faced with stressful work life, limited autonomy in work and declining work contentment calls for an overemphasis on evaluating and monitoring their satisfaction associated with work-related quality of life (WRQoL). This study evaluates WRQoL of hospital employees and validates the bilingual (English and Marathi) version of WRQoL scale. METHODS: The study was conducted during March-April'2014 on employees of a corporate hospital of Pune, India after ethical approval and informed consent from employees...
October 24, 2016: Journal of Postgraduate Medicine
https://www.readbyqxmd.com/read/27727472/while-respecting-autonomy-don-t-throw-out-the-baby-with-the-antenatal-consultation
#9
Michael van Manen
Antenatal consultation is recognized as a core activity of specialists in neonatal-perinatal medicine. Fundamentally, the intent is for practitioner and parent to meet prior to the birth of a child to contribute to the care of the mother and also the newborn. Antenatal consults may therefore serve a multitude of purposes such as obtaining informed consent, relieving parental anxiety, elaborating medical treatment plans, and supporting parenting practices depending on the various situational and contextual factors underlying the consult...
October 11, 2016: Acta Paediatrica
https://www.readbyqxmd.com/read/27691377/ethics-of-coercive-treatment-and-misuse-of-psychiatry
#10
Tilman Steinert
The author discusses a pragmatic approach to decisions about coercive treatment that is based on four principles from principle-based ethics: respect for autonomy, nonmaleficence, beneficence, and justice. This approach can reconcile psychiatry's perspective with the U.N. Convention on the Rights of Persons With Disabilities. Coercive treatment can be justified only when a patient's capacity to consent is substantially impaired and severe danger to health or life cannot be prevented by less intrusive means...
October 3, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/27689223/-autonomy-and-welfare-in-intensive-care-medicine-practical-approach-in-difficult-situations
#11
M Gruß, F Salomon
In intensive care units far-reaching decisions are often made at short notice that require the consent of the informed patient. If this is not possible due to the patient's condition, physicians and legal representatives must ascertain the previously expressed or presumed will of the patient and act accordingly. The legal principles are specified in the Patient Advance Directives Act and the Patient Rights Act. Any indications for medical treatment need a clearly defined aim of the therapy, which can be questioned during the progress of the disease...
September 29, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27682425/nurses-perspectives-on-moral-distress-a-q-methodology-approach
#12
Pei-Pei Chen, Hsiao-Lu Lee, Shu-He Huang, Ching-Ling Wang, Chiu-Mieh Huang
BACKGROUND: Moral distress occurs when nurses experience ethical dilemmas. Issues related to these dilemmas are addressed in some nursing education courses. Nurses' reaction to dilemma such as moral distress is relatively less noticed. OBJECTIVE: This study aimed to identify and describe the various types of perceptions of moral distress exhibited by nurses. RESEARCH DESIGN: This study applied Q methodology to explore the perspectives of nurses regarding moral distress...
September 28, 2016: Nursing Ethics
https://www.readbyqxmd.com/read/27681338/reasons-for-family-involvement-in-elective-surgical-decision-making-in-taiwan-a-qualitative-study
#13
Mei-Ling Lin, Chuen-Teng Huang, Ching-Huey Chen
AIMS AND OBJECTS: The aim of this study was to inquire into the reasons for family involvement in adult patients' surgical decision-making processes from the point of view of the patients' family. BACKGROUND: Making a patient the center of medical decision-making is essential for respecting individual's autonomy. However, in a Chinese society, family members are often deeply involved in a patient's medical decision-making. Although family involvement has long been viewed as an aspect of the Chinese culture, empirical evidence of the reasons for family involvement in medical decision-making has been lacking...
September 29, 2016: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/27677435/natural-childbirth-ideology-is-endangering-women-and-babies
#14
Hans Peter Dietz, Lynda Exton
Natural childbirth ideology has become dominant across much of the developed world. This ideology increasingly clashes with the reality of modern obstetrics, which is dealing with a demographic that is getting older and more obese, hence more complicated, and it has become a danger to the health of women and babies. The most visible expression of these trends is the focus on caesarean section rates which have become a key performance indicator of obstetric services. This trend is resulting in increasingly obvious negative consequences for morbidity and mortality, as chronicled in the Morecambe Bay Report, published in the UK last year...
October 2016: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27634714/the-effects-of-closed-loop-medical-devices-on-the-autonomy-and-accountability-of-persons-and-systems
#15
Philipp Kellmeyer, Thomas Cochrane, Oliver Müller, Christine Mitchell, Tonio Ball, Joseph J Fins, Nikola Biller-Andorno
Closed-loop medical devices such as brain-computer interfaces are an emerging and rapidly advancing neurotechnology. The target patients for brain-computer interfaces (BCIs) are often severely paralyzed, and thus particularly vulnerable in terms of personal autonomy, decisionmaking capacity, and agency. Here we analyze the effects of closed-loop medical devices on the autonomy and accountability of both persons (as patients or research participants) and neurotechnological closed-loop medical systems. We show that although BCIs can strengthen patient autonomy by preserving or restoring communicative abilities and/or motor control, closed-loop devices may also create challenges for moral and legal accountability...
October 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/27628458/focusing-on-relationships-not-information-respects-autonomy-during-antenatal-consultations
#16
Nathalie Gaucher, Antoine Payot
: Policy statements regarding antenatal consultations for preterm labour are guided by physicians' concerns for upholding the legal doctrine of informed consent, through the provision of standardised homogeneous medical information. This approach, led by classical in-control conceptions of patient autonomy, conceives moral agents as rational, independent, self-sufficient decision-makers. Recent studies on these antenatal consultations have explored patients' perspectives, and these differ from guidelines' suggestions...
September 15, 2016: Acta Paediatrica
https://www.readbyqxmd.com/read/27615030/ethical-issues-in-the-evaluation-of-adults-with-suspected-genetic-neuromuscular-disorders
#17
REVIEW
Xiaowei Su, Peter B Kang, James A Russell, Zachary Simmons
Genetic testing is rapidly becoming an increasingly significant part of the diagnostic armamentarium of neuromuscular clinicians. Although technically easy to order, the results of such testing, whether positive or negative, have potentially enormous consequences for the individual tested and for family members. As a result, ethical considerations must be in the forefront of the physician's agenda when obtaining genetic testing. Informed consent is an important starting point for discussions between physicians and patients, but the counseling embedded in the informed consent process must be an ongoing part of subsequent interactions, including return of results and follow-up...
December 2016: Muscle & Nerve
https://www.readbyqxmd.com/read/27587445/achieving-informed-consent-for-cellular-therapies-a-preclinical-translational-research-perspective-on-regulations-versus-a-dose-of-reality
#18
Aileen J Anderson, Brian J Cummings
A central principle of bioethics is "subject autonomy," the acknowledgement of the primacy of the informed consent of the subject of research. Autonomy requires informed consent - the assurance that the research participant is informed about the possible risks and benefits of the research. In fact, informed consent is difficult when a single drug is being tested, although subjects have a baseline understanding of the testing of a pharmacological agent and the understanding that they can stop taking the drug if there were an adverse event...
September 2016: Journal of Law, Medicine & Ethics: a Journal of the American Society of Law, Medicine & Ethics
https://www.readbyqxmd.com/read/27586379/known-unknowns-building%C3%A2-an-ethics-of-uncertainty-into-genomic-medicine
#19
Ainsley J Newson, Samantha J Leonard, Alison Hall, Clara L Gaff
BACKGROUND: Genomic testing has reached the point where, technically at least, it can be cheaper to undertake panel-, exome- or whole genome testing than it is to sequence a single gene. An attribute of these approaches is that information gleaned will often have uncertain significance. In addition to the challenges this presents for pre-test counseling and informed consent, a further consideration emerges over how - ethically - we should conceive of and respond to this uncertainty. To date, the ethical aspects of uncertainty in genomics have remained under-explored...
2016: BMC Medical Genomics
https://www.readbyqxmd.com/read/27554038/autonomy-consent-and-responsibility-part-ii-informed-consent-in-medical-care-and-in-the-law
#20
J M Mellado
Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent...
August 20, 2016: Radiología
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