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Biomedical subjects

R E Ladd

Publications and source records attributed to R E Ladd.

8 recordsLinked to original sources
PubMed1995

Adolescent decision-making: giving weight to age-specific values.

Adults who give proxy consent for medical treatment for adolescents must decide how much weight to give to adolescents' own preferences. There is evidence that some adolescents choose treatments different from what adults see as most reasonable. It is argued that adolescents choose according to age-specific values, i.e. values they hold, as adolescents, and which fulfil important developmental needs. Because not fulfilling these needs may do serious psychological damage, it is urged that proxies give weight to these values, up to the limit where it would endanger or profoundly limit future life.

Adolescent↗
PubMed1989

Women in labor: some issues about informed consent.

Women wishing hospital admission for childbirth are asked to sign very general pre-admission consent forms. The use of such forms suggests that women in labor are considered incompetent to give informed consent. This paper explores some of the problems with advance directives and general consent, and argues that since women in labor are not generally incompetent, it is not appropriate to require this kind of consent of them.

Advance Directives↗
PubMed1989

Telling the truth in the face of medical uncertainty and disagreement.

The pediatric oncologist often must face medical uncertainty and differing opinions among consultants. This raises a dilemma about telling the truth: Does the ethical requirement for telling the truth include informing parents about uncertainties and disagreements, or does the obligation to protect from emotional burden justify withholding information? Answering this question requires an analysis of the nature of medical disagreements. It is argued that disagreements that arise because of medical uncertainties are not disagreements about facts, but disagreements in attitude, where appeal to expertise is not possible. Thus, treatment recommendations must be offered carefully, in order to avoid imposing values on patients. Physicians should make clear the reasoning behind their recommendations, as well as areas of uncertainty. This approach offers the only possibility for parents to give informed consent and to participate in responsible decision making for their child that is consistent with their own values.

Child↗
PubMed1985

Patients without choices: the ethics of decision-making in emergency medicine.

Patients who use emergency department services generally have no choice of facilities or medical personnel. This fact affects the nature of the physician-patient relationship and the moral rules that govern it. Because a long-term relationship has not been developed, a more formal, legalistic relationship seems inevitable and appropriate. Moreover, the emotional stress of the emergency situation on the patient and the fact that the baseline mental status is unknown to the medical personnel often make it difficult to determine competency for decision-making, especially in cases of refusal of treatment. Although standards of informed consent apply in emergency care, there seem to be discrepancies between theory and practice, and emergency physicians may be more guilty than others of unjustified paternalism. Ways must be found to ensure patients the greatest degree possible of autonomy and informed consent analogous to what they would have in a nonemergency doctor-patient relationship.

Decision Making↗
PubMedDate not supplied

What to do when the end is near: ethical issues in home health care nursing.

As managed care shortens the length of hospital stays, home settings for the practice of nursing will become increasingly important. In spite of community health nursing's long tradition of family-centered care delivered in the home, many discussions of the nurse/patient relationship in the medical ethics literature assume the hospital setting for the practice of nursing and seem to neglect the impact of family and significant others for the nurse/patient relationship. Through a case-based analysis, this article highlights the special ethical and legal issues encountered in caring for patients who are dying at home. This analysis demonstrates that traditional frameworks for the nurse/patient relationship are inadequate for capturing the richness of the relationship the home health care nurse has with both patient and family. By developing a new framework for the nurse/patient/family relationship that (a) recognizes the patient's decision-making authority and autonomy, (b) allows the exercise of the nurse's moral rights, and (c) recognizes the patient's relationships to significant others, the authors attempt to resolve some challenging legal and ethical questions concerning who should be allowed to decide what to do when the end is near. The discussion details the implications of this framework for nursing assessment in the home care setting.

Advance Directives↗