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PubMed2006

Care with dignity: a concept analysis.

The attribute of dignity depends on the perspective of the individual and can be affected by interactions with others. Dignity involves the day-to-day choices by which individuals create who they will become and how they will be perceived in the context of human culture. Dignified care requires a caregiver-patient relationship that values autonomy, individual diversity, truth, justice, rights, and responsibilities. Because authoritative practice does not acknowledge the rights and dignity of others, those who have power must constrain themselves and use caution in applying judgement.

Aged↗

PubMed1992

Ethical dilemmas of cervical cancer screening.

Cervical screening presents several ethical dilemmas to family physicians. The author reviews the risks associated with screening, costs versus benefits of running a screening program, and the issues surrounding patient autonomy and patient coercion. Is saving one life worthwhile, and at what cost? Cervical screening programs are imperative in family practice, but only if harm to the patient is minimized and ethical objections are addressed.

Coercion↗

PubMed2003

Who makes the decision? Patient's autonomy vs paternalism in a Confucian society.

Through the ages health professionals have depended on patients' co-operation and obedience as essential aspects of cure. The Code of Ethics of the American Medical Association in 1848, section 6, stated that "the obedience of a patient to the prescription of his physician should be prompt and implicit..." But A Patient's Bill of Rights published by the American Hospital Association in 1973 said that "the patient has the right to refuse treatment to the extent permitted by law..." At a quick glance, these two statements seem to put these two parties in conflict. The situation could even be more complicated when cultural elements are added to the consideration of who makes the final decision. A survey taken in the summer of 2002 in Taiwan showed that in a Confucian society, the family element often determines the course of decision and the patient's autonomy is overlooked. The head of the family, not the patient himself or herself, usually makes the decision, especially when the medical decision has something to do with a life or death situation.

Confucianism↗

PubMed2005

Respecting end-of-life treatment preferences.

Most patients eventually must face the process of planning for their future medical care. However, few Americans have a living will or a durable power of attorney for health care. Although advance directives provide a legal basis for physicians to carry out treatment using a health care proxy or a living will, they also should reflect the patient's values and preferences. Family physicians are in a position to integrate medical knowledge, individual values, and cultural influences into end-of-life care. Family physicians can best respect the autonomy of patients by allowing the patient and family to prospectively identify relevant health care preferences, by sustaining an ongoing discussion about end-of-life preferences, and by abiding by the decisions their patients have made.

Advance Care Planning↗

PubMedDate not supplied

Ethical and juridical foundations of conscientious objection for health care workers.

In front of the evolution of medicine and biotechnology, health care workers are called upon to take part within new biomedical practices, that may overcome the limit of acceptability, as it is perceived by their moral conscience. Issues as abortion, euthanasia, assisted suicide, artificial fertilisation, experimentation on human embryos and prescription of contraceptives and abortifacients call into play the right to conscientious objection of health care personnel, and in some cases, perhaps of physicians and pharmacists too. This recall--already present in many codes of professional conduct and medical ethics--sounds today as a necessity, which asks for a serious deepening of the content, the applicability and the new hypothesis of conscientious objection, in the light of bioethics and law. In particular, the self-determination and often exasperated autonomy of the patient within these practices makes a new principle of professional integrity arise, to protect the physician's conscientious convictions, if the request of the patient or society seem to violate some fundamental human values.

Bioethical Issues↗

PubMed2006

Will "no blood" kill Jehovah Witnesses?

A 46-year-old Indonesian woman presented with signs and symptoms suggestive of an ovarian tumour and was advised to have surgery with exploratory laparotomy and removal of the mass. She agreed but refused blood transfusion any time in the course of her treatment or procedure, as she was a Jehovah Witness. As there was a high risk of intraoperative haemorrhage, steps were taken to reduce any consequent complications due to the surgery. The ethical conflict is between respecting patient autonomy and compromising standards of care, arising from the refusal of a standard therapy. The latest developments in the blood transfusion doctrine policy for the Jehovah Witnesses are also discussed in this case study.

Advance Directives↗

PubMed1986

Resuscitation decisions.

Some of the considerations that go into resuscitation decision making and the withdrawal of life support are discussed. These considerations include: ethical principles (benevolence, autonomy, and informed consent); surrogate decision making (the principles of substituted judgment, patients' best interests, and reason); medical decisions concerning resuscitation; and guiding principles for the individual care giver.

Adult↗

PubMed1977

Ethical concerns in community mental health.

With growing emphasis for ethical behavior of professionals in contemporary American society, those mental health specialists involved in the community must focus on their own behavior. This becomes a difficult task, since it is apparent that current ethical guidelines for community psychologists are not comprehensive enough to be adequately helpful. Nine areas of conflicting values and ethical concerns are considered in an effort to begin formulation of a blueprint for community mental health workers. These areas include community participation, continuity of services, politics, planning, autonomy versus manipulation, overism, minority groups, training, and consultation. Ethical principles generic to each area are put forth as proposed guidelines for professional activities and as propagators of discussion and debate.

Attitude of Health Personnel↗

PubMed2005

The adult patient, informed consent and the emergency care setting.

How much information does a practitioner of emergency care give to an adult patient of sound mind in order for that patient to make a choice? This paper examines legal and professional perspectives and the challenges for the practitioner of emergency care in the process of information giving. Autonomy and human rights are significant themes in any health care context, and this paper argues that practitioners must discharge their duty of care, and facilitate an environment in which patients are informed despite the need for timely decisions about care and treatment.

Adult↗

PubMed2005

Maternal structure and autonomy support in conversations about the past: contributions to children's autobiographical memory.

The authors examined the contributions of maternal structure and autonomy support to children's collaborative and independent reminiscing. Fifty mother-child dyads discussed past experiences when the children were 40 and 65 months old. Children also discussed past events with an experimenter at each age. Maternal structure and autonomy support appeared as 2 distinct and separable components of mothers' reminiscing style and acted in an additive fashion to predict children's memory. Children whose mothers demonstrated both high structure and high autonomy support provided the greatest memory in these conversations, whereas children whose mothers were low on both dimensions provided minimal memory. The authors discuss the implications of these effects for children's autobiographical memory development.

Autobiographies as Topic↗

PubMed2005

Measuring adults' loss of autonomy over nicotine use: the Hooked on Nicotine Checklist.

The Hooked on Nicotine Checklist (HONC) is a 10-item screening tool originally developed to assess loss of autonomy over tobacco in adolescent smokers. A smoker's endorsement of any item indicates some loss of autonomy, and the sum of endorsed items indicates the degree to which autonomy has been lost. This study extends the HONC to adult smokers. Self-administered questionnaires were completed by a convenience sample of 1,102 adults who were recruited in their natural environments while observed smoking. Subjects were mostly experienced smokers who consumed a mean of 17.5 cigarettes per day and had smoked an average of 20.9 years. HONC scores ranged from 0 to 10, with a mean of 7.1. The HONC appears to measure a single dimension. Internal HONC consistency was high (alpha = .83), and interitem correlations were low to moderate. HONC scores correlated positively with levels of current and peak lifetime cigarette consumption. The HONC scores of heavy, moderate, and light smokers differed significantly in the expected direction. Subjects with higher HONC scores were more likely to report a shorter duration of abstinence and greater use of pharmacological aids when quitting. The HONC appears to be psychometrically sound in both adolescents and adults. It is a reliable and valid measure of lost autonomy for both novice and experienced smokers, and it allows for comparisons between these populations.

Adolescent↗

PubMed2005

The value of empathy in dietetic consultations. A pilot study to investigate its effect on satisfaction, autonomy and agreement.

Forty individuals with diabetes and three dietitians completed a questionnaire concerning their consultation. Empathy was examined using the Empathic Communication Coding System (ECCS) (Bylund & Makoul, 2002). The more empathic the professionals' response to emotional opportunities, the more satisfied patients were with their consultations (r = 0.41, d.f. = 15, P = 0.05). There was a nonsignificant trend that the more empathic opportunities that arise during a consultation, the higher the agreement between patient and dietitian on what was discussed (r = 0.28, P = 0.07). The data also suggest that patients reported more autonomy support when they created more empathic opportunities during their consultation (r = -0.29, P = 0.07). This preliminary study suggests that professionals' responses to empathic opportunities may be a useful component of dietetic consultations.

Attitude of Health Personnel↗

PubMed2004

Organising services for influenza vaccination for older people.

OBJECTIVES: To follow up a trial of home-administered influenza vaccination of older people to explore reasons for their immunisation behaviour, including their views on the organisation of services. METHODS: Follow-up of original trial using analysis of records of 1865 older people and semi-structured interviews of 25 older people. RESULTS: A once-off home visit does not appear to result in sustained changes in immunisation behaviour. Older people's behaviour appears to be largely explained by their beliefs about immunisation; the organisation of services may exert only small effects. Older people can be characterised as belonging to one of four groups in their orientation towards influenza vaccination: the 'faithful', who are keen to have vaccination; the 'converts', who have been persuaded of the benefits of vaccination and are likely to self-initiate appointments for vaccination; the 'easy-going', who require prompting for vaccination; and the 'sceptics', who perceive influenza vaccination to be ineffective or to be irrelevant for them because of their perceived inherent resistance to influenza. The last group sees vaccination as a form of interference and may be resistant to home visits to administer the vaccine. CONCLUSIONS: Targets for immunising older people require more debate because of the delicate balance between achieving herd immunity and preserving autonomy and choice for older people.

Aged↗

PubMed1998

Advance directives for psychiatric treatment: a view from the trenches.

Medical advance directives for end-of-life decisions at times that patients cannot express their preferences have become a major trend in recent state and federal legislation. The author argues that an extension of directives to cover future psychiatric treatment are fraught with both practical and ethical dilemmas. Although the potential for increasing patient autonomy is certainly positive, the potential for implementing covert ideological agendas has been present from the beginning, and the significant differences between medical end-of-life decisions and ongoing treatment of psychiatric patients must weigh against psychiatric advance directives unless major changes are made in existing procedures.

Advance Directives↗

PubMedDate not supplied

Professional and ethical considerations in the use of high-tech pain management.

Pain management, a primary focus of the oncology nurse, is undergoing a technologic boom. Assessment of high-tech treatments in medicine is an underdeveloped and controversial area. This paper is intended to promote critical thinking about methods of high-tech pain relief such as subcutaneous, IV, and intraspinal analgesia and anesthesia delivered by ambulatory, implanted, or patient-controlled devices. These issues are described within an ethical framework that focuses on the principles of autonomy, beneficence, nonmaleficence, and justice. Application of these principles to the clinical practice setting and recommendations for practice conclude this paper.

Aged↗

PubMed1989

Justified paternalism in adolescent health care. Cases of anorexia nervosa and substance abuse.

This essay on the limits of adolescent autonomy espouses justified paternalism in adolescent medicine as a 1980s alternative to the "antipaternalistic" rights position of the 1970s. Thus, it proposes that the harm principle be a basis for justified limitations of liberty. In turn, justified paternalism should be both testable and severely limited because by definition it always involves treating someone in a way that violates a moral rule (e.g., coercive deprivation of freedom, invasion of privacy). Therefore, paternalism can only be justified when the evil prevented from occurring to the person is greater than the wrong caused by the violation of the moral rule and, more importantly, if it can be universally justified under relevantly similar circumstances always to treat persons in this way.

Adolescent↗

PubMed2002

Responsiveness of the Impact on Participation and Autonomy questionnaire.

OBJECTIVE: To evaluate the responsiveness of a newly developed generic questionnaire, the Impact on Participation and Autonomy (IPA), which focuses on 2 aspects of participation: perceived participation and the experience of problems. DESIGN: Preliminary study of questionnaire responsiveness compared with transition indices. Participants completed 2 assessments, 3 months apart. To measure change, they completed 9 transition indices at the second assessment. One transition index assessed perceived change in general, the other 8 addressed 1 of the specific problem experience items in the IPA. SETTING: Outpatient clinic of the rehabilitation department of an academic hospital. PARTICIPANTS: Fifty-seven consecutive persons admitted for multidisciplinary rehabilitation treatment, with various diagnoses, were enrolled in the study; 49 persons completed both assessments. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Standardized response mean (SRM) and area under the receiver operating characteristic curve (AUC) for participation domain scores and problem scores. RESULTS: SRMs and AUCs for the participation domains ranged from 0.1 to 1.3 and from 50% to 92%, respectively. The SRMs of the items on the experience of problems ranged from 0.4 to 1.5, whereas their AUCs ranged from 56% to 74%. CONCLUSIONS: The IPA detected within-person improvement over time, but its responsiveness must be confirmed in a larger study sample.

Activities of Daily Living↗

PubMed1996

The ethics of randomised controlled trials: a matter of statistical belief?

This paper outlines the approaches of two apparently competing schools of statistics. The criticisms made by supporters of Bayesian statistics about conventional Frequentist statistics are explained, and the Bayesian claim that their method enables research into new treatments without the need for clinical trials is examined in detail. Several further important issues are considered, including: the use of historical controls and data routinely collected on patients; balance in randomised trials; the possibility of giving information to patients; patient choice and patient autonomy; and how widely the results of clinical trials can be used. It is concluded that good statistical techniques in the design and analysis of medical studies are essential, but the statistical school used in developing such techniques is relatively unimportant.

Bayes Theorem↗