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Biomedical subjects

Evert van Leeuwen

Publications and source records attributed to Evert van Leeuwen.

6 recordsLinked to original sources
PubMed2005

The human body as field of conflict between discourses.

The approach to AIDS as a disease and a threat for social discrimination is used as an example to illustrate a conceptual thesis. This thesis is a claim that concerns what we call a medical issue or not, what is medicalised or needs to be demedicalised. In the friction between medicalisation and demedicalisation as discursive strategies the latter approach can only be effected through the employment of discourses or discursive strategies other than medicine, such as those of the law and of economics. These discourses each realise different values, promote a different subject, and have a different concept of man. The concept of discourse is briefly outlined against concepts such as the linear growth concept of science and the growth model of science as changes in paradigm. The issue of testing for AIDS shows a conflict between the medical and the legal discourse and illustrates the title of our contribution: the human body as field of conflict between discourses.

Acquired Immunodeficiency Syndrome↗
PubMed2004

The medical practice of patient autonomy and cancer treatment refusals: a patients' and physicians' perspective.

The idea that patients should take up an autonomous position in the decision-making process is generally appreciated. However, what patient autonomy means in the case of patients who refuse a recommended oncological treatment has not been investigated. This study aims to clarify how the concept of patient autonomy can be applied to patients who refuse a recommended oncological treatment. Focus questions are: (1) what is meant by patient autonomy, i.e. how is this autonomy conceptualised and (2) which factors influence patient autonomy. A qualitative study design with in-depth interviews was performed. The study sample included 30 cancer patients and 16 physicians. All patients had refused a recommended oncological treatment. Patient autonomy was revealed to be a comprehensive concept with elaborations on 'making decisions' and 'defining life choices' as sub-concepts of patient autonomy. In contrast to what is generally believed, decisions of patients to refuse an oncological treatment do not so much rely on the medical information about disease and treatment options, but are rather inspired by patients' own experiences or those of close others. The medical information and the role of the physician do, however, influence patients' experiences of being free and/or of having a choice. The results show that the extent of pressure physicians will exert to persuade the patient to be treated as recommended depends on the medical distinction between a curative and a non-curative treatment goal. It seems that there exists a shift in respecting patient autonomy, which depends on factors like treatment goal. Discussing the respect shift may serve to clarify underlying thoughts and principles in the decision-making process for both physicians and patients.

Adult↗
PubMed2004

Instruments to assess decision-making capacity: an overview.

OBJECTIVE: The main objective of this article is to evaluate and describe instruments for assessing decision-making capacity in psychiatry and psychogeriatrics, and to evaluate them for use in daily practice. METHODS: The instruments were selected in Medline articles. We focus on the relationship between these instruments and the concept of competence, represented in the following elements: context in which an instrument is developed, disclosure of information, standards to assess decision-making capacity, the scale or threshold model, and validity and reliability. RESULTS: The developmental context influences how information is provided and standards defined. Although it is not clear how decision-making capacity relates to competency judgments, most instruments provide good reliability. CONCLUSIONS: Comparison of the different instruments opens directions for future research. Although instruments can never replace a physician's judgment, they may provide a clear starting point for a discussion on competence. In daily practice assessments, attention should be given to information disclosure, the influence of our own normative values in evaluating standards of decision-making capacity, and the relation between decision-making capacity and competence.

Aged↗
PubMed2004

On the origin, use and destination of human embryos.

The moral acceptability or non-acceptability of the use of human embryos in research raises questions on several philosophical levels. The mixing-up of these levels results in strongly defended and endless debates. In this contribution, arguments on three levels will be discussed, the ontological, the practical and instrumental and the level of human relationships. It is concluded that, on the latter level, the moral problems of the other two are significant, but not conclusive. The decision to allow or to ban research with human embryos is charged with full human responsibility.

Animals↗
PubMed2002

[The assessment of competence in cognitively impaired elderly persons: a closer look at the vignette method].

This article focuses on the assessment of competence of elderly persons both with and without cognitive impairment. In total 113 patients of a geriatric clinic were interviewed. Competence was assessed by using two clinical vignettes, representing respectively a hypothetical treatment situation with mild consequences (endoscopy) and one with severe consequences (operation for colon cancer). Competence was evaluated using the following standards: the ability to evidence a choice, the ability to understand a situation, the ability to reason about a choice, and the ability to appreciate a situation. In the vignette with mild consequences, elderly persons with cognitive impairment performed significantly worse on understanding, reasoning and appreciation than elderly persons without cognitive impairment. In the vignette with severe consequences, elderly persons with cognitive impairment performed significantly worse only on understanding as compared to elderly persons without cognitive impairment. No differences were found for reasoning and appreciation between the cognitively impaired and non-impaired elderly persons. We conclude that competence is less limited by cognitive impairment when assessed in a treatment situation with severe consequences. Therefore, the use of hypothetical vignettes should be carefully reconsidered.

Aged↗