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PubMed2003

Women empowerment and marital fertility in Oman.

International studies have the inverse relationship of women education and empowerment on fertility. Our aim is to study the association of women education and empowerment with some of fertility indicators or determinants namely; total number of children ever-born, age of women at her first birth and the last closed birth interval length in a community based survey (National Health Survey, 2000) A cross-sectional survey of the health status of Omani community was designed. Face to face interview to 2037 ever married women including demographic data, fertility patterns, family planning, two women empowerment indices (decision making and freedom of movement), and other reproductive health modules. About 31% of the sample was considered highly empowered in decision- making and the mean number of decisions taken in the household was 4.46 for the overall sample. For freedom of movement, 29% of the sample was highly empowered with a mean number of 3.88 for the overall sample. The mean values of both indices varied significantly according to age, residence, level of education and work status. Higher freedom of movement score women was more likely to have less number of children in the first 20 years of marriage. Women of 'higher score of decision making index were more likely to have longer closed birth interval. Those scored low in the decision making index were more likely to get a child at an earlier age. In developing countries where fertility limitation depend on "modern" methods, women's education and autonomy are considered as strong tools to make changes in demographic transition.

Adolescent↗
PubMedDate not supplied

What about the family?

The prevalent ethic of patient autonomy ignores family interests in medical treatment decisions. Acknowledging these interests as legitimate forces basic changes in ethical theory and the moral practice of medicine.

Beneficence↗
PubMed1991

A new myth about families of older people?

Are gerontologists creating a new myth about families by emphasizing individual autonomy as independence without family interdependence, by advocating advance directives instead of supporting a rebuttable presumption of family surrogates, and following the lead of the U.S. Supreme Court in the Cruzan case (Cruzan v. Director, 1990), by ignoring intergenerational interdependencies in surrogate decision making? This paper argues that another antifamily trend is developing despite empirical evidence showing that elderly persons themselves prefer family members to represent them in surrogate decision making. Research and public policy suggestions are offered for protecting the elderly's preferences.

Advance Directives↗
PubMed2006

[Girl or boy?--Parents' preferences, choice of sex, and sex reassignment surgery for children with disorders of sex development].

DEFINITION OF THE PROBLEM: Ethical guidelines for the treatment of newborns with disorders of sex development have come under critical discussion. Former patients urgently demand a reassessment of surgical genital corrections, arguing that modern societies are more willing to tolerate sexual ambiguity and that clear-cut gender differences are becoming less and less important. ARGUMENTS: The growing children's rights movement has stressed the fact that children are not just objects of their parents and society's expectations. The limits of parental decision making in case of sexual ambiguity are an object of ongoing controversies. We discuss the relative authority of parents' wishes in the determination of the newborn child's sex. CONCLUSION: We reject a purely autonomy based approach. Our arguments are based on a relational ethics of parenthood.

Adolescent↗
PubMed2006

Triage in medicine, part II: Underlying values and principles.

Part I of this 2-article series reviewed the concept and history of triage and the settings in which triage is commonly practiced. We now examine the moral foundations of the practice of triage. We begin by recognizing the moral significance of triage decisions. We then note that triage systems tend to promote the values of human life, health, efficient use of resources, and fairness, and tend to disregard the values of autonomy, fidelity, and ownership of resources. We conclude with an analysis of three principles of distributive justice that have been proposed to guide triage decisions.

Decision Making↗
PubMed1996

Withdrawal from dialysis: the role of autonomy and community-based values.

By examining the ethical features of dialysis withdrawal as well as tr transcultural differences in attitudes toward withdrawal, one can have a better understanding of the role of autonomy and community-based values on medical decision-making. Three distinctive patterns of withdrawal are described herein. The first concerns patients suffering from an advanced state of physical or mental decline. When a patient or health care surrogate decision maker requests cessation of therapy because it fails to be beneficial for the patient in his or her totality, the physician should be prepared to cooperate, in accord with beneficence and nonmaleficence as well as autonomy. The second pattern occurs when the patient loses decisional capacity, and the surrogate decision maker makes unreasonable requests for nonbeneficial care. At issue is what constitutes nonmaleficence and beneficence in this setting, the provider and surrogate differing on whether continuing dialysis constitutes beneficence. Such a dilemma can alleviated by community-based consensus guidelines with consent of the patient before losing capacity. The dialysis network is potentially a unit of patient and professional community. In third pattern, the patient's decision to withdraw appears to be inappropriate to their potential for benefit from continued therapy. The nephrologist and patient are conflicted on what constitutes beneficence, with the former holding that continuation is morally superior. In such cases, the physician must mediate the situation in a beneficent fashion not solely dictated by a constraining view of patient autonomy.

Beneficence↗
PubMed2005

[Respect for autonomy of "incompetent" patients?--the ethical problem of advanced directives].

In addressing the ethical and legal problems of advanced directives, the article discusses whether respect for the autonomy of the so-called "incompetent" patients is possible and morally required. Starting with a critique of how modern medicine threatens patient autonomy and care (2.), the author goes on to highlight the mutual interdependence between respect for autonomy and patient care as two moral requirements arising from respect for human dignity (3.). Finally; the article elucidates the practical consequences as they relate to a treatment approach for each patient that is simultaneously caring and respectful of their autonomy, commenting on the ramifications for a sensitive and conscientious approach to advanced medical directives and for the special -role of nursing in this context.

Advance Directives↗
PubMed2006

Autonomy and autonomy competencies: a practical and relational approach.

This essay will address a general philosophical concern about autonomy, namely, that a conception of autonomy focused on freedom of the will alone is inadequate, once we consider the effects of oppressive forms of socialization on individuals' formation of choices. In response to this problem, I will present a brief overview of Diana Meyers's account of autonomy as relational and practical. On this view, autonomy consists in a set of socially acquired practical competencies in self-discovery, self-definition, self-knowledge, and self-direction. This account provides a distinction between choices that express unreflectively internalized social norms and those that are the result of a critical 'self-reading'. I conclude that this practical conception of autonomy makes much higher demands upon nurses (and patients) than has previously been thought. In fact, if nurses are to be expected to genuinely promote autonomy, they are going to need specific training in counselling-type communication skills.

Choice Behavior↗
PubMed2006

Discharge planning with older adults: toward a negotiated model of decision making.

BACKGROUND: Occupational therapists are frequently involved in discharge accommodation decision making with older adults. PURPOSE: The literature regarding this process is reviewed. The ways in which risk avoidance and autonomy promotion philosophies influence decisions are examined and a new approach is proposed. SUMMARY: One approach is based on risk avoidance, where decisional control rests with professionals, but the client is left out of the process. Another is that of autonomy promotion, in which decisional control rests with the client. When risks are high, this can result in ethical dilemmas. The importance of the environment, its relationship to occupational performance, and differing interpretations of client-centred processes are important considerations. PRACTICE IMPLICATIONS: In response to the inadequacy of models grounded in risk avoidance or autonomy promotion, occupational therapists are challenged to move toward a balanced approach to decision making with older people, grounded in partnership, shared power, and negotiation.

Aged↗
PubMed2003

In the company of women: enacting autonomy within the perinatal nursing relationship.

An understanding of autonomy has important significance in North American health care. Although a respect for autonomy is necessary to protect the self-determination and agency of birthing women in hospital settings, I suggest that enactments of autonomy that are independent of relationships offer only an incomplete interpretation of such a vital concept. In this article I explore an understanding of autonomy situated within the context of a relational birthing narrative. In so doing, autonomy becomes conceptualized as contextual and concrete, giving rise to an embodied view of the birthing woman.

Decision Making↗
PubMed2001

Patient autonomy naturalized.

Traditional informed consent often promotes passive acquiescence rather than active exercise of autonomy. A more natural biologically based model of autonomy is needed, a model that both recognizes the biological roots and therapeutic benefits of active confident choices among real alternatives, and offers substantive guidelines for promoting patient autonomy. A biological model of patient autonomy explains the value of information to patients, outlines the circumstances under which patients make effective choices, and suggests complementary roles for patients and professional caregivers.

Ethics, Medical↗
PubMed1992

A survey method for investigating ethical decision making in family practice.

BACKGROUND: The tension between respect for patient autonomy versus concern for patient welfare is a challenging ethical issue for physicians. The purpose of this research was to describe a method for analyzing ethical decisions and to report the results of a survey of ethical decision making among family physicians. METHODS: We developed a survey instrument that used simulated case scenarios, each of which posed an ethical dilemma. The ethical problems on the survey included the extent to which diagnostic information should be revealed to patients, the extent to which physicians should become involved in patients' life-style issues, and how to deal with patients' family problems. We mailed the questionnaire to 1,300 US family physicians. RESULTS: Six hundred seventy-four physicians responded. Respondents did not deal with the simulated ethical problems in a uniform manner and often tended to respond more to specific details of a case rather than the overall ethical dilemma posed. Physicians who chose a course of action giving patients more control were motivated by factors that showed respect for patient autonomy. On the other hand, physicians who chose a course of action giving patients less control were not motivated by factors suggesting a concern for patient welfare. CONCLUSIONS: Based on responses to simulated case scenarios, family physicians did not demonstrate a uniform approach but rather a more contextual one. Respect for patient autonomy was linked to family physicians' reported courses of action.

Adult↗
PubMed2004

[Are legal measures for the protection of patients with Alzheimer disease useful for the caregivers?].

Formal and informal caregivers for patients with Alzheimer's disease are faced with the individual's loss of autonomy and ability to manage daily life activities. They could be helped by legal measures aimed to protect the patient and his\her possessions as well as to protect themselves. Study from individual reports showed the shortcomings for the caregivers of legal measures such as the guardianship and their limitation with regard to the consideration of the patient as a person.

Activities of Daily Living↗
PubMed2006

[Ethical aspects of resuscitation].

The former typically paternalistic physician-patient relationship has changed gradually toward an autonomy based one in the second half of the 20th century. Patient's autonomy includes the right to refuse life-saving therapy in modern constitutional states. Hungarian law assures the right to refuse life-saving treatment as well. However to our knowledge no such therapy refusal has occurred since the law coming into force likely because of the rather strict regulations. Forgoing resuscitation is basically determined by two factors: autonomy of the patient, and medical futility. The alteration of the law's form can facilitate the lawful Do Not Resuscitate (DNR)orders for the sake of patient's autonomy. Qualitative futility is characterized by quality of life, which only the patient has the right to judge. Resuscitation protocols based on results of controlled studies can significantly improve both the success rate of resuscitations and the quality of life. Education plays a prominent role in this process as it was demonstrated in our prospective comparative study. According to author's study Hungarian DNR orders are paternalistic and patient autonomy plays a secondary role. It was also established that patient's autonomy significantly improved in the subgroup trained according to international standards. Hungarian results were compared to the results of a highly educated group in the second study. The results confirmed the presumption: the education of resuscitation according to international standards improves both the representation of patient's autonomy in DNR decisions, survival rate and quality of life.

Advance Directives↗
PubMed1991

Support of patient autonomy in the do not resuscitate decision.

In this study we examined critical care nurses' beliefs concerning the support of patient autonomy in the do not resuscitate (DNR) decision. The study sample consisted of 251 members of the American Association of Critical-Care Nurses (AACN). Subjects were asked to examine four hypothetical cases and select the agent (patient, family member, physician, or nurse) (1) most appropriate to support patient autonomy in the DNR decision and (2) who would actually make the DNR decision, if these hypothetical cases were to occur on the clinical units where the subjects were employed. The nurses' answers concerning the agent best able to support patient autonomy in the DNR decision were in general agreement with the do not resuscitate decision model developed by the principal investigator (B.B.O.) to demonstrate support for patient autonomy in the DNR decision. However, when asked who would actually make the DNR decision on their units, the nurses frequently responded that the physician would make the decision, regardless of the agent selected as best able to support patient autonomy in the case situation. An ethical conflict concerning the DNR decision appeared to exist for the majority of the subjects in this study.

Attitude of Health Personnel↗