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Daniel Oppenheim

Publications and source records attributed to Daniel Oppenheim.

8 recordsLinked to original sources
PubMed2006

[Refusing treatment: patient responsibility and autonomy. About a French National Consultative Ethics Committee statement(no 87, April 2005)].

A recent French National Consultative Ethics Committee statement confirms that medical doctors are required by law to accept a patient's refusal of treatment, even if the consequence is the loss of chances of being cured. This refusal raises difficult clinical and ethical issues. Respecting a patient's decision is only valid when he/she is fully responsible, able to understand the proposed treatments and the consequences of his/her refusal, uninfluenced by friends and relatives, ignorance, disarray, an excessively pessimistic appraisal of the situation, a conflict with the doctors or with medicine. Doctors must avoid passively accepting a refusal without discussion but must also avoid paternalism or moral pressure. Adequate mutual knowledge of the way they think, their values and their objectives helps to maintain mutual respect and confidence in the patient-doctor relationship: the doctor is not a "supertechnician" nor is the patient a treatment consumer. Information, knowledge of the possibilities and limits of current medicine and of patients'complex, conscious and unconscious motives (which justifies the psycho-oncologist's role), recommendations of medical societies, experience of difficult ethical issues help to avoid unauthentic refusals, conflicts and staff burnout.

Decision Making↗
PubMed2004

[Psycho-oncology and the present tasks of psycho-oncologists].

This article aims to contribute to a better apprehension by oncologists of the work done by psycho-oncologists, by diminishing misconceptions and misunderstandings end promoting collaboration between them. First, we describe the main aspects of their practice, which is still too poorly apprehended, the landmarks they use (when they support a patient they take into account his/her body, social and professional position, personal and family history, objectives, psychopathology and the family), and the tools they have at their disposal. We then describe how psycho-oncology is currently organised, the "players" in the field and their allies (oncology on one side, social and human sciences on the other) and the main practice and research themes as reported in recent congresses and articles. More and more psychotherapeutic groups, community support, the patient's social, cultural and ethnic specificity and family, information, genetic issues, burn out among care providers, and children are being considered important. We hope this article gives a true image and a sufficiently detailed, though not exhaustive, account of psycho-oncology today, of the range of its possibilities, of its central interests.

Humans↗
PubMed2004

An ethics dilemma: when parents and doctors disagree on the best treatment for the child.

The increasing complexity of present day medicine--with highly effective and yet risky treatments, individual and collective expectations, and evolving ideological and cultural landmarks--often gives rise to difficult ethical problems. Specific meetings are valuable for understanding such problems, acquiring the relevant skills and for gaining and transmitting experience on how to solve them. Parents and doctors may disagree about what is the best treatment. Such a difference of opinion is not rare but usually a solution can easily be found. This is not the case when the child is treated for a severe illness and when there is no clearly defined or satisfactory treatment for him\her. We present how a dramatic conflict arose between the parents and the doctors faced with such a case (mostly because the staff failed to understand early enough the psychological factors at the root of the father's demands), how clinical, institutional and ethical problems were analysed during a meeting, and how they were solved.

Attitude of Health Personnel↗
PubMed2003

Valid informed consent and participative decision-making in children with cancer and their parents: a report of the SIOP Working Committee on psychosocial issues in pediatric oncology.

This is the tenth official document of the SIOP Working Committee on psychosocial issues in pediatric oncology, instituted in 1991. It is addressed to the pediatric oncology community. Children clearly have a right to participate in medical decisions regarding their own treatment, based on the developmental level of the child. The objective of these guidelines is to encourage physicians to share with the child developmentally relevant medical information specific to that particular child's health status, in the context of the child's own culture, so that he or she can actively participate in the decision-making process regarding his or her own health. These guidelines, geared toward this objective, discuss the child's right to medical information, the parents' legal responsibility for but not exclusive right over the child's health, and ways of encouraging the younger child's active participation in his or her own health care at an age-appropriate level of understanding. For adolescents, there should be a full and legally mandated power to make their own decisions regarding medical treatment.

Adolescent↗
PubMed2002

A child and parent illustrating non-compliance with treatment: understanding non-compliance with treatment.

BACKGROUND: In children and adolescents non-compliance with treatment is a major concern. To shed light on its mechanisms, we present a family demonstrating non-compliance. PROCEDURE: B, a 10 year-old boy, treated for medulloblastoma, refused high-dose chemotherapy and Autologous Bone Marrow Transplantation. Six psychotherapeutic interviews with B, his parents and staff resolved the causative issues. RESULTS: B's behavior expressed his parents' ambivalence, despite their informed consent. Their reasons were conscious and unconscious, rational and irrational, linked to both the past and present experiences. The mother was convinced that he would die. The discussions helped both parents to assume their parental role, B perceived their ability to truly accept the treatment and support him. CONCLUSIONS: Non-compliance should not be viewed as a child's or parents' intrapsychic problem, but as the result of multi-determined interaction between the child, the parents, the staff interacting with present and past events. When the child's death is a possibility, the parents' ambivalence confuses their understanding and acception of the therapy. The development of confidence between the staff, the child and parents and clear agreement about the goals of therapy is necessary to avoid the occurrence of and escalation of non-compliance, which raises difficult clinical, legal and ethical questions.

Antineoplastic Agents↗
PubMed2002

[Difficulties in coping with treatment: causes, solutions].

We present a case of parents who had difficulties accepting their child's treatment (HD chemotherapy and stem cell transplantation) and coping with it. The conversation between the paediatrician and the mother revealed that she feared being dispossessed of her maternal role by the nurses, that constraints would interfere with her relationship with her son, that the medical team would make her feel intellectually, culturally and socially inferior, that the conflict the couple was facing would be exacerbated in this setting. Collaboration between the paediatrician, the nursing staff and the psycho-oncologist allowed these conscious and unconscious elements to be understood. Talking, not conflict nor constraints, served to allay their fears, to avoid inappropriate reactions of the medical team, to preserve the therapeutic alliance. The child accepted this trying treatment because he saw that his parents were reassured about its quality and about preserving their sense of identity and their value. Coping difficulties may stem from fear of treatment (too trying physically and psychologically), from its consequences (destabilisation of the family, the individual's social and professional status, his/her sense of identity), from rekindled old problems that were not adequately solved (jealousy, revolt, trauma, bereavement). Dialogue and team work are necessary to solve them.

Attitude of Health Personnel↗