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PubMed1997

The Model Physician-Assisted Suicide Act and the jurisprudence of death.

A Model Statute to Authorize and Regulate Physician-Assisted Suicide was published in 1996. This article describes the Act and some of its background and effects in detail, showing that it goes further than at first appears. Specifically, the article discusses the background and basic effect of the Act, the principal provisions of the Act and their effects, the morality and jurisprudence of the Act, the argument from autonomy, and the argument from utility. The authors conclude that by ignoring the moral traditions of Western culture, and focusing only on the ethics and anthropology of autonomy and utility, the drafters of the Act justify the dehumanization of the very people the Act is supposed to benefit.

Ethical Theory↗
PubMed2003

Discrepancies between patient and professionals recall and perception of an outpatient consultation.

AIMS: To explore the degree of agreement between patient and health care professional's perceptions of consultations. METHODS: Immediately after 141 dietitian/nurse specialist consultations, patients and professional's completed the Health Care Climate questionnaire (HCC), Medical Interview Satisfaction Scale (MISS) and the Treatment Self-Regulation Questionnaire (TSRQ) In addition, both parties were asked about any key points or issues discussed in the consultation; any decisions that were made about their diabetes treatment today; any goals that were set as a result of today's consultation. RESULTS: Patient and professional's scores on the HCC and MISS were not correlated (r=0.3 and 0.16). Patient and professionals disagreed on the issues discussed 19.6% of the time, on the decisions made 20.7% of the time and goals set 44.3% of the time. More autonomy support in the consultation was associated with greater autonomous motivation for self-care (r=0.31; P<0.001) more controlled motivation was associated with less agreement on issues discussed and goals set (r=-0.20; r= -0.24; P<0.05). CONCLUSION: There is significant disagreement between patients and professionals perceptions and recollection of the content of consultations. Professional's communications skills need to be developed to ensure these discrepancies are minimized. Skills to provide greater autonomy support in the consultation would help to enhance this process and improve outcomes.

Decision Making↗
PubMedDate not supplied

Ethical issues in the behavioral treatment of children and adolescents.

This article addresses a need to assess the acceptibility and evaluation of behavioral treatment as it is applied in child and adolescent inpatient settings. The choice of when and how to use behavioral interventions and the implications of these choices may present the nurse with certain ethical dilemmas related to ethical principles of autonomy, beneficence, and maleficence. In addition, the inpatient milieu structure is examined relative to possible ethical dilemmas.

Adolescent↗
PubMed1987

Informed consent and the psychiatric patient.

Informed consent is reviewed as it applies to psychiatric patients. Although new legislation, such as the Mental Health Act 1983, provides a useful safeguard for the protection of the civil rights of patients, it could actually reduce their humane care unless applied with sensitivity for the nature of their unique difficulties. In order to guard against this possibility, we suggest that legal requirements should be considered in light of the ethical principles which underlie them. Three principles are considered: those of autonomy (freedom); beneficence (paternalism); and the fiduciary principle (partnership). Psychotherapy is offered as a model for informed consent, which might be generalised to other clinical situations.

Beneficence↗
PubMed1998

Reaching targets in the national cervical screening programme: are current practices unethical?

The principle of informed consent is now well established within the National Health Service (NHS) in relation to any type of medical treatment. However, this ethical principle appears to be far less well established in relation to medical screening programmes such as Britain's national cervical screening programme. This article will critically examine the case for health care providers vigorously pursuing women to accept an invitation to be screened. It will discuss the type of information which women would need in order to make an informed decision about whether or not to be screened. The lack of such information in current patient leaflets on the "smear test" will then be documented. Finally, the article will explore possible ways of maximising women's autonomy in relation to the cervical screening programme without sacrificing any of its main benefits.

Adult↗
PubMedDate not supplied

Autonomy, privacy and informed consent 4: surgical perspective.

This is the fourth article in a four-part series that considers the issues of patient autonomy, privacy and informed consent. The article discusses these issues in the context of surgical patients and their nurses. There is an abundance of references to issues of autonomy and informed consent within the healthcare literature, although there are few empirical studies investigating these issues within practice. The issue of privacy has been somewhat less explored than that of autonomy or consent, particularly in the UK literature. This article reports the findings of a Scottish study that formed part of a multisite comparative study funded by the European Commission. A convenience sample of surgical patients (n = 282) and their nurses (n = 260) participated in the study. Data were collected by means of a self-completion questionnaire for both patients and nursing staff. Results indicated that there are significant differences in patient and staff perceptions on issues of patient autonomy, privacy and informed consent. However, the most marked difference in perceptions of patients and staff were found on the information-giving element of the autonomy subscale. Implications for nursing practice, education and research are highlighted.

Humans↗
PubMedDate not supplied

Cardiac retransplantation: determining limits.

OBJECTIVE: Cardiac transplantation has become an acceptable treatment option for end-stage congestive heart failure. Because of the increasing demand, there are not enough hearts to supply all patients in need of cardiac transplantation. This significant supply and demand imbalance necessitates that rationing decisions be made. This article will explore decisions made surrounding cardiac retransplantation. CONCLUSIONS: Early statistics suggest that survival for patients undergoing retransplantation is lower than first-time transplant recipients. In addition, the question of justice or fairness arises. Patients who are offered second and third heart transplants may deprive a significant number of patients who have not had their first chance at transplantation. The authors propose, based on medical suitability, respect for autonomy, and the principle of justice, that cardiac transplantation be a one-time treatment option. Retransplantation should not be allowed.

Beneficence↗
PubMed2002

The 'four principles of bioethics' as found in 13th century Muslim scholar Mawlana's teachings.

BACKGROUND: There have been different ethical approaches to the issues in the history of philosophy. Two American philosophers Beachump and Childress formulated some ethical principles namely 'respect to autonomy', 'justice', 'beneficence' and 'non-maleficence'. These 'four principles' were presented by the authors as universal and applicable to any culture and society. Mawlana, a great figure in Sufi tradition, had written many books which not only guide people how to worship God to be close to Him, but also advise people how to lead a good life to enrich their personality, as well as to create a harmonious society and a peaceful world. METHODS: In this study we examined the major works of Mawlana to find out which of these 'four principles of bioethics' exist in Mawlana's ethical understanding. RESULTS: We have found in our study that all these principles exist in Mawlana's writings and philosophy in one form or another. CONCLUSIONS: We have concluded that, further to Beachump and Childress' claim that these principles are universal and applicable to any culture and society, these principles have always existed in different moral traditions in different ways, of which Mawlana's teaching might be presented as a good example.

Beneficence↗
PubMed1992

Ethical dilemmas in dysphagia management and the right to a natural death.

Speech pathologists are at the forefront in dealing with the consequences of life-saving measures and the technological advances that promote survival. Many ethical dilemmas exist in the area of dysphagia management and these are often emphasized in the nursing home environment. A client's autonomy and ability to make informed decisions will invariably determine the role of the speech pathologist in making decisions or facilitating debate regarding eating and feeding status.

Decision Making↗
PubMed1989

Court-ordered cesarean section: an analysis of ethical concerns in compelling cases.

Two previously unreported cases are presented in which court-ordered cesarean sections were considered appropriate by physicians. An analysis of the factors that compel physicians to deem court-ordered intervention appropriate is presented. When the significance of a third-trimester fetal death or a lifetime physical or mental disability is balanced against the demand to uphold maternal autonomy at all costs, the recognized ethical principles of beneficence, nonmaleficence, justice, obstetric contract keeping, and acting in the patients' best interests combine, in rare situations, to override concerns for individual maternal autonomy and justify court-ordered intervention.

Adult↗
PubMed1986

Depression, self-love, time, and the "right" to suicide.

Elizabeth Bouvia, whose legal struggle to compel a psychiatric hospital to assist her in committing suicide ended with a decision that she could be force fed by the hospital, presented the psychiatric community with a host of ethical questions concerning the rights of a patient to choose death, and the obligations of the medical profession to promote life. What the courts did not decide is when a patient is incompetent to decide her own fate, and what is the duty of the hospital to intervene with a suicidal patient. The authors suggest that there is an ambiguity present whenever a patient presents herself to a hospital or therapist as suicidal, and that a time limited period, or cooling-off period, should exist that would allow an alliance to form between patient and care-giver, if possible, and then permit them to explore underlying issues of depression. The authors believe that there is a need to acknowledge the patient's ultimate right to choose death, but that autonomy should not be confused with impulsivity when anyone is faced with the irrevocability of the decision to die.

Adult↗
PubMed2006

The ethics of excluding women who become pregnant while participating in clinical trials of anti-epileptic medications.

INTRODUCTION: The bioethical principles of autonomy, beneficence, non-maleficence and justice, complemented by ethics committee evaluation, define conduct of clinical trials of anti-epileptic medications (AEM). BACKGROUND INFORMATION: Increased teratogenicity for offspring of women with epilepsy is presented in both lay and scientific literature. SPECIFIC DRUGS--OLDER GENERATION: Teratogenicity of phenobarbitone (PB), phenytoin (PHT), valproate (VPA) and carbamazepine (CBZ) is acknowledged, with drugs, such as trimethadione, being removed from the market because of teratogenicity. SPECIFIC DRUGS--NEW GENERATION: Insufficient data allowed definitive commentary concerning teratogenicity of newer AEM, such as lamotrigine (LTG), gabapentin (GBP), tiagabine (TGB) or levetiracetam (LEV). All those suggestions favour some over others with specific AEM combinations being questioned. PREGNANCY REGISTRIES: Lack of information sporn AEM-specific plus national and international birth registries which endorse VPA, CBZ and LTG dose related concerns. CONFLICT OF INTEREST: Competing influences of AEM and epilepsy-specific factors need delineation although appear more teratogenetic than does epilepsy alone. CLINICAL TRIALS: Most trials focus upon refractory epilepsy with potentially enhanced risks. Informed consent demands discussion of possible teratogenicity and exclusion of women unwilling to practice adequate contraception. DISCUSSION: Trials must respect legal and ethical dictates including the exclusion of women unwilling to practice reliable contraception. Automatic exclusion from a trial, subsequent to confirmed pregnancy, is unlikely to protect the foetus as potential for teratogenicity already has occurred. Autonomy should empower prospective parents to decide continued trial participation consequent to detailed informed consent without coercion. All options demand review, including responsibility to future AEM users.

Anticonvulsants↗
PubMedDate not supplied

Stroke patients' needs and experiences regarding autonomy at discharge from nursing home.

In this qualitative study stroke patients rehabilitating in nursing homes experienced an increase in their autonomy (particularly in self-determination, independence and self-care) in the last weeks before discharge. The change in autonomy was found to be related to regained abilities and self-confidence, and to patients' strategies (e.g. taking initiative, being assertive). The attitude of health professionals and family, and the nursing home could influence patient autonomy. Overprotection, paternalism, care routines and an inconsistent approach constrain autonomy. Conversely, attentiveness, tailored interventions and a respectful dialogue facilitate autonomy, like moderate instrumental and emotional support by the family. Nursing homes can enhance autonomy by minimizing care routines and by providing room for doing activities independently and privately. Attention to patient autonomy may improve patients' active participation in rehabilitation, quality of life, and autonomous living after discharge. Multidisciplinary guidelines based on the results may increase attention to the stroke patients' autonomy and stimulate a team approach.

Aged↗
PubMed2004

Reproductive autonomous choice--a cherished illusion? Reproductive autonomy examined in the context of preimplantation genetic diagnosis.

Enhancement of autonomous choice may be considered as an important reason for facilitating the use of genetic tests such as preimplantation genetic diagnosis. The principle of respect for autonomy is a crucial component not only of Western liberal traditions but also of Western bioethics. This is especially so in bioethical discussions and analyses of clinical encounters within medicine. On the basis of an analysis of qualitative research interviews performed with British, Italian and Swedish geneticists and gynaecologists on ethical aspects of preimplantation genetic diagnosis, the plausibility of the notion of autonomy within reproductive medicine is discussed. The analysis of interviews indicates not only that there is a gap between theoretical discussions and concrete practice, but also that an increase in choice--paradoxically--can hamper couples' choice.

Bioethics↗
PubMed2004

Assisted and surrogate decision making for pregnant patients who have schizophrenia.

Because of a dearth of literature, we developed preventive ethics strategies for managing the pregnancies of patients with schizophrenia. Schizophrenia can chronically and variably impair a woman's decisions concerning the management of pregnancy, including the decision about whether to continue the pregnancy through to viability and term. The psychiatrist must balance autonomy-based and beneficence-based obligations to the pregnant woman with schizophrenia, and both the psychiatrist and pregnant woman have beneficence-based obligations to the fetus when the fetus is a patient. We discuss the assessment of the decision-making capacity of pregnant patients with schizophrenia and describe the strategies of assisted decision making that aim to diminish chronically and variably impaired autonomy. When patients are severely impaired in decision-making capacity, as, for example, in psychotic denial of pregnancy, the standard of surrogate decision making applies. This should be guided by the substituted judgment standard. When patients' values are not known or have not been consistently held over time, surrogate decision making should be guided by the best interests standard. These strategies should substantially enhance patients' autonomy in the psychiatrist-patient relationship and contribute to the quality of their psychiatric and obstetric care.

Abortion, Induced↗
PubMed1997

Killing and caring: is euthanasia incompatible with care?

The issue of euthanasia continues to be surrounded by controversy, particularly in relation to its moral status and more recently, the significance that health professionals should attach to the principle of respect for patient autonomy. Increasing knowledge and expertise in the field of palliative care has also led to claims that the provision of effective palliative care services render discussion about the introduction of euthanasia unnecessary. By reviewing and analysing the arguments put forward in support of the continued ban on voluntary active euthanasia, this paper suggests that these arguments largely fail to address the notion of patient autonomy and concludes that even with provision and access to palliative care service, euthanasia could be considered a moral option which is not necessarily incompatible with care.

Beneficence↗