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At least 1,081 records · Page 60Linked to original sources
PubMed2006

Ethically justified clinical strategies for promoting geriatric assent.

OBJECTIVE: To develop ethically justified clinical strategies for promoting geriatric assent with a focus on the application of professional virtues. METHOD: The concept of geriatric assent was extended to all geriatric patients incapacitated by cognitive impairments, including dementias, and practical clinical steps for promoting geriatric assent were developed. RESULTS: A four step-process for promoting geriatric assent is proposed by balancing the principles of beneficence and respect for autonomy within the context of the psychiatrist's virtues. These four steps include identifying the patient's long-standing values and preferences; assessing plans of care in terms of biopsychosocial safety and independence along with the patient's values and preferences; protecting remaining autonomy; and cultivating the professional virtues of steadiness, self-effacement, and self-sacrifice when making decisions that risk the patient's future health and safety. CONCLUSIONS: In promoting geriatric assent, psychiatrists are obligated to support and directively counsel the patient's surrogate to adopt care plans that promote the patient's values and preferences to the extent possible. These clinical strategies for promoting geriatric assent should serve to enhance the patient's remaining sense of integrity and dignity. These strategies should also protect remaining health status and therefore protect remaining autonomy.

Aged↗
PubMed2001

Confidentiality, consent and autonomy in the physician-patient relationship.

In the practice of medicine there has long been a conflict between patient management and respect for patient autonomy. In recent years this conflict has taken on a new form as patient management has increasingly been shifted from physicians to insurers, employers, and health care bureaucracies. The consequence has been a diminishment of both physician and patient autonomy and a parallel diminishment of medical record confidentiality. Although the new managers pay lip service to the rights of patients to confidentiality of their records, in fact they advocate very liberal medical records access policies. They argue that a wide range of parties has a need to know the contents of individually identifiable medical records in order to control costs, promote quality of care, and undertake research in the public interest. Broad interpretations of the need to know, however, are at odds with strict interpretations of the right to confidentiality. Strict confidentiality policies require that, with few exceptions, patient consent be obtained whenever a patient's record is used outside the treatment context. The traditional criterion for overriding the consent requirement has been that without the override some harm would directly result. This rule is now challenged by the claim that patients have a duty to make their records available for a wide range of research and public health purposes. The longstanding tension between physician responsibility for patient welfare and respect for patient autonomy is being replaced by a debatable requirement that both physician and patient autonomy be subordinated to the goals of data collection and analysis.

Access to Information↗
PubMed1992

The medical exception: physicians, euthanasia and the Dutch criminal law.

The legalization of euthanasia, both in the Netherlands and in other countries is usually justified in reference to the right to autonomy of patients. Utilizing recent Dutch jurisprudence, this article intends to show that the judicial proceedings on euthanasia in the Netherlands have not so much enhanced the autonomy of patients, as the autonomy of the medical profession.

Advisory Committees↗
PubMed1995

A desperate solution: individual autonomy and the double-blind controlled experiment.

The randomization ingredient in double-blind controlled experiments may be objectionable to patients who, in their desperation, come to such trials seeking a last chance of cure. Minogue et al., who view such a situation as inherently exploitive and undermining of patient autonomy, propose that such "desperate volunteers" instead be enrolled in the active arm, while other patients, less desperate and more committed to medical progress, continue to be randomized. Their view is critiqued as destructive of medical progress, inappropriate in its lack of clinical response to such patients, and fatally flawed by unrealistic notions of autonomy and voluntariness.

Control Groups↗
PubMedDate not supplied

The challenge of autonomy. Respecting the patient's wishes.

Issues surrounding patient autonomy frequently occur in the critical care setting. To deal effectively with the complex issues of autonomy, the critical care nurse needs to identify the threats to autonomy and respond as a patient advocate. The authors present a patient case that demonstrates the autonomy issues that confront many critical care patients.

Aged↗
PubMed2005

A longitudinal study of the relationship of maternal autonomy support to children's adjustment and achievement in school.

A longitudinal study examined the relations of maternal autonomy support to children's school adjustment. Autonomy support and other parenting dimensions were measured when children were 5 years old. School measures were teacher-rated academic and social adjustment and achievement in reading and math in grade 3. Regression analyses controlling for age 5 family and child factors (e.g., socioeconomic status [SES], kindergarten adjustment, IQ) revealed that autonomy support was positively related to grade 3 adjustment (social and academic) and reading achievement. Maternal emphasis on school performance was positively related to achievement measures but negatively related to social adjustment. Maternal use of rewards and praise was unrelated to grade 3 school measures. Finally, supplemental analyses revealed that autonomy support was associated with greater consistency in children's adjustment across social and academic domains as well as higher overall adjustment. These results highlight the developmental significance of parental autonomy support in early childhood.

Achievement↗
PubMed2007

Truth telling, autonomy and the role of metaphor.

This paper examines the potential role of metaphors in helping healthcare professionals to communicate honestly with patients and in helping patients gain a richer and more nuanced understanding of what is being explained. One of the ways in which doctors and nurses may intentionally, or unintentionally, avoid telling the truth to patients is either by using metaphors that obscure the truth or by failing to deploy appropriately powerful and revealing metaphors in their discussions. This failure to tell the truth may partly account for the observation by clinicians that patients sometimes make decisions that, from the perspective of their clinician, and given all that the clinician knows, seem unwise. For example, patients with advanced cancer may choose to undergo further, aggressive, treatment despite the fact that they are likely to accrue little or no benefit as a result. While acknowledging that the immediate task of telling patients the truth can be difficult for all those concerned, I argue that the long-term consequences of denying patients autonomy at the end of life can be harmful to patients and can leave doctors and nurses distressed and confused.

Decision Making↗
PubMed2006

Survey of the general public's attitudes toward advance directives in Japan: how to respect patients' preferences.

BACKGROUND: Japanese people have become increasingly interested in the expression and enhancement of their individual autonomy in medical decisions made regarding medical treatment at and toward the end of life. However, while many Western countries have implemented legislation that deals with patient autonomy in the case of terminal illness, no such legislation exists in Japan. The rationale for this research is based on the need to investigate patient's preferences regarding treatment at the end of life in order to re-evaluate advance directives policy and practice. METHODS: We conducted a cross-sectional survey with 418 members of the general middle-aged and senior adults (aged between 40 and 65) in Tokyo, Japan. Respondents were asked about their attitudes toward advance directives, and preferences toward treatment options. RESULTS: Over 60% of respondents agreed that it is better to express their wishes regarding advance directives (treatment preferences in writing, appointment of proxy for care decision making, appointment of legal administrator of property, stating preferences regarding disposal of one's property and funeral arrangements) but less than 10% of them had already done so. About 60% of respondents in this study preferred to indicate treatment preferences in broad rather than concrete terms. Over 80% would like to decide treatment preferences in consultation with others (22.2% with their proxy, 11.0% with the doctor, and 47.8% with both their proxy and the doctor). CONCLUSION: This study revealed that many Japanese people indicate an interest in undertaking advance directives. This study found that there is a range of preferences regarding how advance directives are undertaken, thus it is important to recognize that any processes put into place should allow flexibility in order to best respect patients' wishes and autonomy.

Advance Directives↗
PubMed1991

Hide-and-seek or show-and-tell? Emerging issues of informed consent.

This article reviews key philosophical and legal underpinnings of mental health professionals' obligation to obtain informed consent from consumers of their services. The basic components of informed consent are described, and strategies for clinically and ethically appropriate methods of obtaining informed consent are discussed. Emerging issues in informed consent involving duty to assess and protect against client dangerousness, obligations to third parties, and issues of deception are considered as well. The article proposes that part of the process of obtaining informed consent is the cultivation of a treatment environment that emphasizes beneficence and client autonomy.

Altruism↗
PubMed2003

No more kidding around: restructuring non-medical childhood immunization exemptions to ensure public health protection.

Professor Silverman's article examines the complex challenges faced by U.S. policymakers attempting to balance the public health protections of mandatory childhood immunization programs with the legal, religious, philosophical, and practical concerns raised by permitting non-medical exemptions under the programs. The article begins with a discussion of the history of childhood immunization programs, and continues by describing the inconsistency of enforcement of state immunization laws and exemptions. The author analyzes recent cases from New York, Wyoming, and Arkansas, and discusses how these decisions both pose threats to these programs' public health protections, while also offering insight into potential problems for other state vaccination programs. Professor Silverman concludes by advocating that states adopt an "informed refusal" approach to vaccination exemption as a way of improving immunity protections, while respecting the autonomy rights of those who wish to opt out of the program.

Child↗
PubMedDate not supplied

The noncompliant patient in search of autonomy.

From a medical perspective, patients who do not comply with the doctor's orders are usually seen as deviant, and deviance requires correction. But many chronically ill people view their behavior differently, as a matter of self-regulation. In this light noncompliance supports people's desires for independence and autonomy, desires that align closely with the therapeutic goals of caregivers.

Attitude to Health↗
PubMedDate not supplied

Autonomy and assisted suicide. The execution of freedom.

Proponents of assisted suicide who base their arguments on autonomy err in ways that are little attended to. In the absence of a substantive theory of the good, in neither a descriptive nor an ascriptive sense can the concept of autonomy distinguish those acts that should be morally prohibited from those that may be permitted. And to impose a particular theory of the good, whether individual liberty or the sanctity of life, violates the autonomy of those who do not share a commitment to that theory.

Beneficence↗
PubMed1985

Paternalism modernised.

The practice of paternalism has changed along with developments in medicine, philosophy, law, sociology and psychology. Physicians have learned that a patient's values are a factor in determining what is best for that patient. Modern paternalism continues to be guided by the principle that the physician decides what is best for the patient and pursues that course of action, taking into account the values and interests of the patient. In the autonomy model of the doctor-patient relationship, patient values are decisive. In the paternalistic model, they are but one among several factors the physician must consider in making a medical decision. Although difficult to practise because of limitations in empathising with another person, modern paternalism remains a way to achieve maximum patient benefit.

Beneficence↗