Documentation of Decision-Making Capacity, Informed Consent, and Health Care Proxies: A Study of Surrogate Consent

2011 ◽  
Vol 52 (6) ◽  
pp. 521-529 ◽  
Author(s):  
Anna Glezer ◽  
Theodore A. Stern ◽  
Elizabeth A. Mort ◽  
Susan Atamian ◽  
Joshua L. Abrams ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Informed Consent ◽  
Decision Making Capacity ◽  
Surrogate Consent ◽  
Health Care Proxies

scholarly journals Autonomy, Rationality, and Contemporary Bioethics

2020 ◽  
Author(s):  
Jonathan Pugh
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Personal Autonomy ◽  
Rational Beliefs ◽  
Philosophical Work ◽  
Decision Making Capacity ◽  
Important Relationship ◽  
Legal Judgments ◽  
The Relationship ◽  
New Framework

Personal autonomy is often lauded as a key value in contemporary Western bioethics, and the claim that there is an important relationship between autonomy and rationality is often treated as an uncontroversial claim in this sphere. Yet, there is also considerable disagreement about how we should cash out the relationship between rationality and autonomy. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient’s right to refuse medical treatment, regardless of whether ‘… the reasons for making the choice are rational, irrational, unknown or even non-existent’. This book brings recent philosophical work on the nature of rationality to bear on the question of how we should understand autonomy in contemporary bioethics. In doing so, the author develops a new framework for thinking about the concept, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in personal autonomy. Furthermore, the account outlined here allows for a deeper understanding of different forms of controlling influence, and the relationship between our freedom to act, and our capacity to decide autonomously. The author contrasts his rationalist account with other prominent accounts of autonomy in bioethics, and outlines the revisionary implications it has for various practical questions in bioethics in which autonomy is a salient concern, including questions about the nature of informed consent and decision-making capacity.

Informed Consent for Epidural Analgesia at the Time of Labor Pain, Seems Too Late!

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Bastanhagh E ◽  
◽  
Behseresht A ◽  
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Pain Management ◽  
Epidural Analgesia ◽  
Pain Treatment ◽  
Decision Aids ◽  
Treatment Options ◽  
Labor Pain ◽  
Lumbar Epidural Analgesia ◽  
Decision Making Capacity

Pain in the process of childbirth is the phenomenon mostly feared by every woman in her pregnancy, and is a major cause of dissatisfaction and embarrassing memories of labor. Usage of lumbar epidural analgesia as a very effective pain management option has solved this problem to a great extent, and its utilization has turned to common practice in most of the women hospitals worldwide. The use of lumbar epidural analgesia in labor is widespread due to its benefits in terms of effective pain relief in comparison with other labor pain treatment options [1]. Vaginal delivery is an extremely painful process accompanied with great emotional disturbance, which may not be possible for the laboring mother to focus and concentrate to understand the anesthetist explanations at that moment and sign the epidural analgesia informed consent properly. On one hand, the laboring mother expresses doubts because of uncertainty on her decision and on the other hand she desperately wants to get rid of the excruciating labor pain by any means possible. Therefore, the decision to have a neuraxial analgesia (epidural, combined spinal epidural) sounds obligatory on this condition. Each of these analgesic methods beside desirable effectiveness in pain management may have some side effects and it is obvious that each complication takes lots of time and patiently concentration for the mother to be precisely understood and the decision making is even beyond of it. Decision making process cannot get precisely completed just in labor time, so free of any upcoming complication, informed consent may not be ethically verified on labor time. Decision making capacity is a complex mental process involving both cognitive and emotional components. Sometimes this complex action is reduced to “understanding” alone. There are uncertainties about decision-making capacity (mental competence) of women in labor in relation to giving informed consent to neuraxial analgesia. Considering these parameters, sufficient information about pain management methods (advantages, side effects, the way each procedure is conducted) should be provided as part of prenatal education and the consent process must be carefully conducted to enhance mothers’ autonomy [2]. To utilize effective methods for presenting the mothers with (like multimedia modules, recorded video of the sample procedure and so on) in late pregnancy should be considered to achieve better understanding and right decision. Patient decision aids are beneficial in clinical anesthesia and studies have shown that patients feel better informed, have better knowledge, and have less anxiety, depression and decisional conflicts after using this method [3]. It has been demonstrated that using decision aids prior to the procedure can significantly reduce the decision conflict, and improve both autonomy and outcome as a united benefit in favor of laboring mothers [4]. It seems that pain-relieving methods (neuraxial and other treatment options) should be described in details at the second and third trimester of pregnancy by a team consist of midwife, anesthesia provider and obstetrician. The more time is spent on this process; the better informed consent is achieved finally. Also high quality decision aids can increase women’s familiarity with medical terminology, options for care, and an insight into personal values, thereby decreasing decisional conflicts and increase knowledge [5]. Factors like parity, pain threshold, and estimated length of labor should be considered together in the decision process to individualize the best pain treatment option for mother [6].

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2018 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

scholarly journals INFORMED CONSENT IN CLINICAL TRIALS FOR PERSONS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S28-S28 ◽  
Author(s):  
Joan G Carpenter
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Clinical Trials ◽  
Informed Consent ◽  
Nursing Homes ◽  
Decision Maker ◽  
Surrogate Decision Maker ◽  
Decision Making Capacity ◽  
Consent Document ◽  
Surrogate Decision

Abstract Informed consent is one of the most important processes during the implementation of a clinical trial; special attention must be given to meeting the needs of persons with dementia in nursing homes who have impaired decision making capacity. We overcame several challenges during enrollment and consent of potential participants in a pilot clinical trial including: (1) the consent document was designed for legally authorized representatives however some potential participants were capable of making their own decisions; (2) the written document was lengthy yet all seven pages were required by the IRB; (3) the required legal wording was difficult to understand and deterred potential participants; and (4) the primary mode of communication was via phone. We tailored assent and informed consent procedures to persons with dementia and their legally authorized representative/surrogate decision maker to avoid risking an incomplete trial and to improve generalizability of trial results to all persons with dementia.

Truth telling and consent

2015 ◽  
Author(s):  
Linda L. Emanuel ◽  
Rebecca Johnson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Informed Consent ◽  
End Of Life ◽  
Health Care Systems ◽  
Truth Telling ◽  
Care Systems ◽  
Ethical Norms ◽  
The Impact ◽  
Selection Of

Truth telling and informed consent are relatively recently established legal and ethical norms in end-of-life health care. This chapter provides an exploratory guide to the evolution of both norms, highlighting some of the benefits, problems, and issues associated with both terms. It also presents a selection of the stepwise protocols and practices which Western medicine has developed in order to deliver patient-centred palliative care which comforts and relieves. In addition, the chapter discusses the impact that constant adjustment to loss can have on patient psychology and decision-making in end-of-life care scenarios and the value of framing that experience in terms of continuous reintegration. Finally, the chapter discusses the lessons which can be learned from the contested place of family within health-care systems where decision-making depends on truth telling and informed consent, and the lessons which can be learned from familism across the globe.

scholarly journals Temporising and respect for patient self-determination

2018 ◽  
Vol 45 (3) ◽  
pp. 161-167
Author(s):  
Jenny Lindberg ◽  
Mats Johansson ◽  
Linus Broström
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Professional ◽  
Real World ◽  
Clinical Ethics ◽  
Crucial Role ◽  
Self Determination ◽  
Academic Literature ◽  
Decision Making Capacity

The principle of self-determination plays a crucial role in contemporary clinical ethics. Somewhat simplified, it states that it is ultimately the patient who should decide whether or not to accept suggested treatment or care. Although the principle is much discussed in the academic literature, one important aspect has been neglected, namely the fact that real-world decision making is temporally extended, in the sense that it generally takes some time from the point at which the physician (or other health care professional) determines that there is a decision to be made and that the patient is capable of making it, to the point at which the patient is actually asked for his or her view. This article asks under what circumstances, if any, temporising—waiting to pose a certain treatment question to a patient judged to have decision-making capacity—is compatible with the principle of self-determination.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2016 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

Ethics

Oncology ◽  
2017 ◽  
pp. 728-738
Author(s):  
Natalia S. Ivascu ◽  
Sheida Tabaie ◽  
Ellen C. Meltzer
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Informed Consent ◽  
Ethical Issues ◽  
Surrogate Decision Making ◽  
Ethical Problems ◽  
Decision Making Capacity ◽  
Surgical Critical Care ◽  
Surrogate Decision ◽  
Special Circumstances

In all areas of medicine physicians are confronted with a myriad ethical problems. It is important that intensivists are well versed on ethical issues that commonly arise in the critical care setting. This chapter will serve to provide a review of common topics, including informed consent, decision-making capacity, and surrogate decision-making. It will also highlight special circumstances related to cardiac surgical critical care, including ethical concerns associated with emerging technologies in cardiac care.

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