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At least 559 records · Page 31Linked to original sources
PubMed2006

A comparison of the Hooked on Nicotine Checklist and the Fagerström Test for Nicotine Dependence in adult smokers.

Diminished autonomy is a core feature common to all forms of dependence involving drugs or behaviors. The Hooked on Nicotine Checklist (HONC) is a reliable and valid measure of diminished autonomy over tobacco. It has not previously been compared with the Fagerström Test for Nicotine Dependence (FTND) in adult smokers. In the present study, 1,130 smokers (M age = 41; M cigs/day = 18.5) completed both measures. Factor analysis yielded one factor for both the HONC and the FTND. Mean HONC score was 7.0, and mean FTND score was 4.6; the measures correlated at r = .44. The HONC had higher internal consistency (alpha = .82) than the FTND (alpha = .61; z(1127) = 7.1, p < .001). The measures correlated similarly with age at smoking onset and days smoked per month, but the FTND correlated higher with cigarette consumption. Subjects who used nicotine replacement therapy or bupropion during an abstinence attempt scored higher on both measures, whereas those who maintained abstinence for at least 3 days scored lower. The HONC has several advantages: (a) It measures a clearly defined construct, and each item has face validity; and it has (b) better psychometric properties, (c) a logical cutpoint (zero symptoms), (d) greater sensitivity to the onset and low levels of dependence, and (e) easily interpretable scores. The HONC is uniquely suited for use with smokers whose cigarette consumption is low.

Adult↗
PubMedDate not supplied

The illusion of patient choice in end-of-life decisions.

After passage of the Patient Self-Determination Act and the Cruzan decision by the Supreme Court, honoring individual patient choice has become the primary means by which we have sought to improve the quality of life of the dying patient. However, the decision-making capacity of the dying patient is usually compromised, and advance directives have not consistently improved the dying process. We respect patient autonomy in order to respect the patient as a person; patient autonomy should be respected to the degree that it is intact. When autonomy is significantly diminished, as it usually is in dying patients, respecting autonomy reconstructed from documents or proxies may not be the best way to respect the dying person. We rather need to seek social consensus about when patients are dying, the nature of a "good death," and when it is preferable to a longer life.

Advance Directives↗
PubMed1990

The role of intimate others in medical decision making.

This paper shows how the present emphasis on patient autonomy overlooks ways in which intimate relations enable autonomy to function meaningfully and how traditional categories of competent and incompetent discount intimacy as a tool for accessing patients' subjective experiences. It is also urged that intimate associations mark moral boundaries for autonomy because they constitute a setting in which persons give and expend finite human resources.

Aged↗
PubMed1992

[Support provided by third parties and the reaction of close female caregivers in the care of elderly persons with loss of autonomy].

This article is about the relation between, on the one hand, support provided by third parties and, on the other, the burden and the depression experienced by the main female supporters who care for the elderly suffering from physical or cognitive problems. The authors examine the hypothesis that social support is not homogeneous across the board and that the different types of support are likely to have different effects on elders with adverse reactions to the caring process. Data originates from a study that was conducted in the Montréal area in 1990 with 159 female supporters living with an elder requiring care who requested support services from formal and informal networks. Hierarchical regression analyses show that the variables in connection with care dispensed by the network play a limited role in attempting to explain the depression and burden levels. Furthermore, these analyses confirm the hypothesis of the variables' narrow range of influence.

Activities of Daily Living↗
PubMed1998

Reconceptualizing advance care planning from the patient's perspective.

BACKGROUND: Traditional academic assumptions about advance care planning (ACP) include the following: (1) the purpose of ACP is preparing for incapacity; (2) ACP is based on the ethical principle of autonomy and the exercise of control; (3) the focus of ACP is completing written advance directive forms; and (4) ACP occurs within the context of the physician-patient relationship. These assumptions about ACP have never been empirically validated. OBJECTIVE: To examine the traditional academic assumptions by exploring ACP from the perspective of patients actively participating in the planning process. METHODS: Forty-eight patients (30 men and 18 women with a mean age of 48.3 years) who were undergoing hemodialysis were interviewed 6 months after receiving an advance directive form. Their experience of ACP was noted in interviews that were audiotaped, transcribed, and analyzed. RESULTS: The participants said that their purpose in ACP was to prepare for death and dying, and their underlying goals included the exercise of control and an attempt to relieve burdens placed on loved ones. Advance care planning was viewed as a social process, and completing a written advance directive form was often regarded as unnecessary. Participants often involved close loved ones, but physicians infrequently. CONCLUSIONS: The traditional academic assumptions are not fully supported from the perspective of patients involved in ACP. The patients we interviewed stated that (1) the purpose of ACP is not only preparing for incapacity but also preparing for death; (2) ACP is not based solely on autonomy and the exercise of control, but also on personal relationships and relieving burdens placed on others; (3) the focus of ACP is not only on completing written advance directive forms but also on the social process; and (4) ACP does not occur solely within the context of the physician-patient relationship but also within relationships with close loved ones.

Adult↗
PubMed2005

[Informed consent in the surgical patient. Reflections on the basic law of patient autonomy].

Informed consent is the final step in informing the surgical patient. The basic law of patient autonomy specifies the conditions in which patient authorization should be given with the aim of guaranteeing that a free decision is made. However, surgeons are sometimes faced with clinical situations in which it is difficult to obtain informed consent, whether because the patient is unable to provide consent or because of the need to intervene in a life-threatening situation, or because the informed consent document must specify the risks and consequences of the intervention. The present article aims to analyze what happens when the patient is unable to provide consent ("consent by representation") and the characteristics of the informed consent document according to the stipulations of the basic law of patient autonomy.

Humans↗
PubMed1992

Epidemiology and moral philosophy.

To an increasing extent ethical controversies affect and sometimes obstruct public health work and epidemiological research. In order to improve communication between the concerned parties a model for identification and analysis of ethical conflicts in individual-based research has been worked out in co-operation between epidemiologists and moral philosophers. The model has two dimensions. One dimension specifies relevant ethical principles (as beneficence, non-maleficence, autonomy and justice). The other dimension specifies the groups of persons involved in the conflict under consideration (for example: the study-population, individuals who may benefit from the results, the researchers and their personnel, the community at large). The model has been applied to the problem of legitimacy of case-register research and to problems in psychiatric health services research as well as epidemiological research.

Autopsy↗
PubMedDate not supplied

Reassessing autonomy in long-term care.

The realities of long-term care call for a refurbished, concrete concept of autonomy that systematically attends to the history and development of persons and takes account of the experiences of daily living.

Aged↗