scholarly journals A Moment in Human Development: Legal Protection, Ethical Standards and Social Policy on the Selective Non-Treatment of Handicapped Neonates

1985 ◽  
Vol 11 (1) ◽  
pp. 31-78
Author(s):  
Larry Gostin
Keyword(s):  
Legal Protection ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Critical Examination ◽  
Ethical Standards ◽  
Federal Law ◽  
Severely Handicapped ◽  
Legislative Initiative ◽  
Constitutional Right ◽  
Personal Interests

AbstractSelective non-treatment decisions involving severely handicapped neonates have recently come under renewed judicial and legislative scrutiny. In this Article, the Author examines the legal, ethical and social considerations attendant to the non-treatment decision. In Part II of this Article the Author discusses the predominant ethical viewpoints relating to this issue and proposes a new moral standard based on personal interests. Part III presents a survey of the jurisprudence relating to selective non-treatment decisions. Parts IV and V of this Article provide a critical examination of the recently enacted Child Abuse Amendments of 1984, a federal legislative initiative designed to regulate treatment decisions relating to handicapped infants. The Author suggests that the ethical standards and treatment criteria proposed in this Article may prove useful to courts seeking to balance the handicapped neonate's constitutional right to privacy with the requirements of the new federal law.

Information Behavior Factors Related to Satisfaction with Treatment Decisions in Parents of Children with Cancer (Preprint)

2018 ◽  
Author(s):  
Makiko Watanabe
Keyword(s):  
Health Literacy ◽  
Information Sources ◽  
Information Behavior ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Medical Institution ◽  
Information Utilization ◽  
Critical Health Literacy ◽  
Satisfaction With Treatment ◽  
Attending Physician

BACKGROUND Information behavior studies in modern medicine are indispensable not only for medical professionals but also in considering health outcomes for patients and health consumers. However, quantitative surveys do not provide sufficient information, and the medical information available on the Internet has not been analyzed in detail. OBJECTIVE The purpose of this study was to examine the relationship between information behavior and satisfaction with treatment decisions in patients and their family members and explore the characteristics of information behavior involved in treatment decisions. METHODS A retrospective, cross-sectional survey was conducted using a questionnaire (58 respondents, response rate 59.2%) for 105 parents of children with cancer at a children’s hospital in Japan. Multiple regression analysis was performed to determine whether information behavior influenced satisfaction with treatment decisions, and correlation analysis was performed to examine the relationships between information behaviors. The analysis included 15 information sources and information behavior measured as the communicative health literacy, critical health literacy, and Shared Decision Making measured using the Functional, Communicative and Critical Health Literacy Scale and the Treatment Decision Satisfaction Scale consisting of 6 items. RESULTS The results regarding the RQ1 showed that the attending physician (P = .044), medical institution websites (P = .038), medical books/scientific papers (including those published in English; P = .020), and communicative health literacy (which reflects information utilization capability; P = .048), influenced satisfaction with treatment decisions. The results regarding the RQ2 showed that parents who used the attending physician as an information source did not receive information from other sources apart from a hospital medical professional. On the other hand, parents who used medical institution websites as information sources received various descriptive information. CONCLUSIONS We identified Internet-based information sources that influenced satisfaction with treatment decisions. We identified that the parent's information behavior tended to have a positive influence on the treatment decision when the attending physician and the medical institution’s Health Practitioner, HP, were the information sources, or when they recognized that there was a high communicative HL and utilized the information. Furthermore, the variables used to measure information behavior were divided into several groups based on association. Regarding satisfaction with treatment decisions correlating with each other, information behavior reflected the possibility of establishing links with information sources with direct influence, related information sources, and information utilization capability.

scholarly journals Decision Making for Treatment After ACL Injury From an Orthopaedic Surgeon and Patient Perspective: Results From the NACOX Study

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110050
Author(s):  
Hanna Tigerstrand Grevnerts ◽  
Sofi Sonesson ◽  
Håkan Gauffin ◽  
Clare L. Ardern ◽  
Anders Stålman ◽  
...  
Keyword(s):  
Decision Making ◽  
High Activity ◽  
Treatment Decision ◽  
Acl Injury ◽  
Treatment Decisions ◽  
Activity Level ◽  
Knee Instability ◽  
Acl Injuries ◽  
Patient Reported ◽  
And Function

Background: In the treatment of anterior cruciate ligament (ACL) injuries, there is little evidence of when and why a decision for ACL reconstruction (ACLR) or nonoperative treatment (non-ACLR) is made. Purpose: To (1) describe the key characteristics of ACL injury treatment decisions and (2) compare patient-reported knee instability, function, and preinjury activity level between patients with non-ACLR and ACLR treatment decisions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 216 patients with acute ACL injury were evaluated during the first year after injury. The treatment decision was non-ACLR in 73 patients and ACLR in 143. Reasons guiding treatment decision were obtained from medical charts and questionnaires to patients and orthopaedic surgeons. Patient-reported instability and function were obtained via questionnaires and compared between patients with non-ACLR and ACLR treatment decisions. The ACLR treatment group was classified retrospectively by decision phase: acute phase (decision made between injury day and 31 days after injury), subacute phase (decision made between 32 days and up to 5 months after injury), and late phase (decision made 5-12 months after injury). Data were evaluated using descriptive statistics, and group comparisons were made using parametric or nonparametric tests as appropriate. Results: The main reasons for a non-ACLR treatment decision were no knee instability and no problems with knee function. The main reasons for an ACLR treatment decision were high activity demands and knee instability. Patients in the non-ACLR group were significantly older ( P = .031) and had a lower preinjury activity level than did those in the acute-phase ( P < .01) and subacute-phase ( P = .006) ACLR decision groups. There were no differences in patient-reported instability and function between treatment decision groups at baseline, 4 weeks after injury, or 3 months after injury. Conclusion: Activity demands, not patient-reported knee instability, may be the most important factor in the decision-making process for treatment after ACL injury. We suggest a decision-making algorithm for patients with ACL injuries and no high activity demands; waiting for >3 months can help distinguish those who need surgical intervention from those who can undergo nonoperative management. Registration: NCT02931084 ( ClinicalTrials.gov identifier).

scholarly journals Authorities and Officials of the Prosecutor’s Office as Subjects of Protection and Subjects of Violation of the Constitutional Right of Citizens to Petition

Lex Russica ◽  
2021 ◽  
pp. 33-43
Author(s):  
I. V. Timoshenko
Keyword(s):  
Russian Federation ◽  
Legal Protection ◽  
Public Power ◽  
The Status ◽  
Effective Instrument ◽  
The Russian Federation ◽  
Constitutional Right ◽  
Objective Side ◽  
Administrative Code ◽  
The Right

The paper analyzes the status of bodies and officials of the prosecutor’s office as subjects of protection and subjects of violation of the constitutional right of citizens of Russia to petition as bodies exercising public power, whereas the very norm-principle of the basic Russian law on the right of citizens to petition is considered both as a constitutional right and as a constitutional safeguard. The author identifies the main practical problems, legal gaps and conflicts of law when citizens implement their constitutional right to petition and their reasons. The author proposes options for their elimination at the law-making and law-enforcement levels. It is noted that article 5.59 of the Code of the Russian Federation on Administrative Offences from 2011 providing administrative liability for violation of established procedure of consideration of citizens’ petitions, despite being a very effective instrument for the legal protection of the right under consideration, needs to be adjusted because its discretionary part contains only general language and does not reveal the objective side of this administrative offence. At the same time, prosecutor’s offices have long developed a certain practice concerning the application of Art. 5.59 of the Administrative Code of the Russian Federation as a means of public and legal protection of the violated right of citizens to petition. However, what should be done if the right of citizens to petition is violated by the prosecutors themselves with their special status as subjects of the offense, whereas it is the exclusive competence of prosecutors by operation of law to initiate cases under Art. 5.59 of the Administrative Code of the Russian Federation? The paper is devoted to the search for the answer to this question.

Achieving shared treatment decisions

2017 ◽  
Author(s):  
Martin H.N. Tattersall ◽  
David W. Kissane
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Shared Decision ◽  
Similar Treatment ◽  
Treatment Benefits ◽  
Patient Values

The respect of a patient’s autonomous rights within the model of patient-centred care has led to shared decision-making, rather than more paternalistic care. Understanding patient needs, preferences, and lifestyle choices are central to developing shared treatment decisions. Patients can be prepared through the use of question prompt sheets and other decision aids. Audio-recording of informative consultations further helps. A variety of factors like the patient’s age, tumour type and stage of disease, an available range of similar treatment options, and their risk-benefit ratios will impact on the use of shared decision-making. Modifiable barriers to shared decision-making can be identified. Teaching shared decision-making includes the practice of agenda setting, use of partnership statements, clarification of patient preferences, varied approaches to explaining potential treatment benefits and risks, review of patient values and lifestyle factors, and checking patient understanding–this sequence helps both clinicians and patients to optimally reach a shared treatment decision.

Physicians' views on the influence of patient participation on treatment decisions - an explorative study

2007 ◽  
Vol 20 (3) ◽  
pp. 174-182 ◽  
Author(s):  
Elina Jaakkola
Keyword(s):  
Decision Making ◽  
Patient Participation ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Role Expectations ◽  
Customer Participation ◽  
Health Care Managers ◽  
Treatment Decision Making ◽  
Explorative Study ◽  
Significant Difference

While patient participation in treatment decisions is increasingly advocated in medical literature, patient demand has been considered to cause unnecessary prescribing. Using the concept of customer participation as discussed in services marketing and management literature as a theoretical base, the paper analyses the influence of patient participation on the medical service process and treatment decision-making. A qualitative, explorative study was conducted to investigate American and British physicians' views on patient participation in the treatment of osteoporosis and schizophrenia. It became evident that in the cases of both osteoporosis and schizophrenia, patients influence prescribing decisions despite the significant difference in their willingness and ability to participate. The manifestations of patient participation were divided into three groups: (1) resources, such as the patient's condition and information about it, and his/her preconceived notions and preferences, (2) actions, such as preparing for the service, negotiating decisions and implementing the treatment, and (3) the patient's role expectations and inclination to participate. The influence of such manifestations on prescribing decision-making is discussed in detail, and differences between the studied illnesses are explained. Implications to health-care managers and practitioners are discussed.

HSR19-089: Misperceptions Regarding Palliative and Hospice Care Among Cancer Patients: What Can We Learn from Patient-Reported Treatment Decision Making

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-089
Author(s):  
Sara Hayes ◽  
Brian M. Green ◽  
Shayna Yeates ◽  
Amrita Bhowmick ◽  
Kaitlyn McNamara ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Cancer Care ◽  
Hospice Care ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Treatment Decision Making ◽  
Diagnosis Of Cancer

Background: Despite NCCN Guidelines and clear definition of palliative care, patients often carry misperceptions about palliative care and how it can be beneficially integrated into a patient’s care plan. In order to better understand the misinformation about palliative and hospice care, this study aims to assess patient-healthcare provider (HCP) communication regarding treatment decisions. Methods: An online survey was conducted with individuals who have had a diagnosis of cancer (n=1,517) to better understand their healthcare experiences as well as the impact their cancer diagnosis had on their quality of life. Measures included agreement scale questions assessing patient information needs surrounding treatment decision making. Open-ended questions where respondents were prompted to provide a written response allowed researchers to further assess patients’ understanding of palliative and hospice care. Responses to agreement-scale questions were evaluated using descriptive statistics. Openended question responses were analyzed using Dedoose qualitative data analysis software. Results: Among patients with a diagnosis of cancer, there were a broad range of patient misperceptions regarding palliative care, hospice care, and how they are used in cancer care. The majority of respondents (81%) stated that their HCP played a role when deciding on their treatment plan. Despite this, only 46% were confident they knew about the treatment’s impact on their daily life, 56% were confident they knew about the potential side effects of treatment, and 57% felt they had all of the information they needed. Themes identified through qualitative analysis include: patient conflation of palliative and hospice care, belief that palliative and hospice care are only relevant to end-of-life decision-making, and uncertainty about whether quality of life can actually be improved. Conclusions: Institutions and HCPs are recommended to integrate palliative care into cancer care. However, as this research shows, oncology patients are often misinformed about the benefits of palliative care. This follows a parallel concern of patients making treatment decisions without optimal information. A potential factor behind this unmet need may be lack of effective communication between patient and HCP. Palliative care may be mentioned by the HCP, but not discussed with enough empathy or depth, leading to patient misunderstanding and lack of inclusion in treatment plans.

Criminal Law Interpretation of Victimization Aspect of Domestic Violence

2016 ◽  
Vol 4 (4) ◽  
pp. 0-0
Author(s):  
Valentin Kharlamov
Keyword(s):  
Domestic Violence ◽  
Criminal Law ◽  
Legal Status ◽  
Legal Protection ◽  
Public Law ◽  
Rights And Interests ◽  
Definition Of ◽  
Criminal Legislation ◽  
Procedure Codes ◽  
Personal Interests

The article examines criminal-legal features of victimization aspect of domestic violence, presents the analysis of the use in legislation of such terms as “victim” and “injured person”, their legal specifics, reflects debate in criminal law theory about characteristics of victimization aspect. The author provides classification for victims of criminal assault, reveals gaps of the Russian criminal legislation in the sphere of family protection, puts forward proposals for improving the criminal law aimed at harsher punishment for the violation of rights and interests of a family and its members. The author sees a wider scope of persons recognized as victims to be one of the possible ways of improving legal protection of personal interests, accompanied by enshrining relevant public-law mechanisms of protecting rights and interests of “other persons” as victims in the Criminal and Criminal Procedure Codes of Russia. In order to extend the definition of “victim”, the author proposes to differentiate the legal status of the abovementioned category of persons, talking into account the specifics of each of those persons.

The influence of age plus standard clinical approach with or without comprehensive geriatric assessment (CGA) on treatment decisions in older cancer patients: Final results.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9035-9035
Author(s):  
Lore Decoster ◽  
Cindy Kenis ◽  
Katrien Van Puyvelde ◽  
Jacques De Greve ◽  
Godelieve Conings ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Prospective Trial ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Clinical Approach ◽  
University Hospitals ◽  
Oncological Treatment ◽  
Treatment Regimens ◽  
Reduced Dose ◽  
Older Cancer Patients

9035 Background: The aim of this prospective study was to examine how age and standard clinical approach with and without CGA results determine treatment decisions in older cancer patients (pts). Methods: This study,conducted in 2 Belgian university hospitals, included pts ≥ 70 years with a malignant tumor (breast, colorectal, ovarian, lung, prostate and hematological) if a new cancer therapy was considered. All pts underwent a uniform CGA. Results were communicated to the treating physician. After the treatment decision, an interview with the treating physician was performed, using a predefined questionnaire: 1/ What would be your oncological treatment proposal in case the pt was 55y without other comorbidity? 2/ Is this different from your treatment proposal for this pt according to age and standard clinical approach without CGA results? 3/ Is this different from your treatment proposal for this pt with CGA results? Results: From October 2009 till July 2011, 937 pts were included in the study. Median age was 76y (range 70-95) and 63.5% was female. A total of 902 (96.3%) questionnaires were completed and 56.2% of the physicians were aware of the CGA results at treatment decision. In 381 pts (42.2%; 95%CI 39.0-45.5) age and standard clinical approach led to a different treatment decision compared to younger pts without comorbidity. This influence was most prominent for chemotherapy decisions: 309 patients did not receive standard chemotherapy (reduced dose (13), less toxic regimen (163), less toxic regimen at reduced dose (5) or no chemotherapy (128)). When the physician was aware of the CGA, these results influenced their treatment in 6.7% (95%CI: 4.5-8.9), mostly concerning chemotherapy. In 8 pts CGA results encouraged the treating physician to choose a more aggressive chemotherapy regimen and in 11 pts CGA results led to a decision of palliative care. Conclusions: Based on this prospective trial, we conclude that physicians use adapted treatment regimens in older versus younger pts, only based on age and standard clinical approach. CGA results change the treatment decision in 6.7% and sometimes trigger the use of a more aggressive treatment.

Size and influence of the decision support networks of women newly diagnosed with breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18012-e18012
Author(s):  
Lauren P. Wallner ◽  
Yun Li ◽  
Chandler McLeod ◽  
Ann S Hamilton ◽  
Kevin C. Ward ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Decision Support ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Breast Cancer Treatment ◽  
Network Size ◽  
Support Networks ◽  
Newly Diagnosed ◽  
Treatment Decision Making

e18012 Background: Little is known about the size and characteristics of informal decision support networks of women diagnosed with breast cancer and whether involvement of informal decision supporters (DSP) influences breast cancer treatment decisions. Methods: A population-based sample of newly diagnosed breast cancer patients reported to the Georgia and Los Angeles SEER registries in 2014-15 were surveyed approximately 6 months after diagnosis (N = 2,502, 68% response rate). Network size was estimated by asking women to list up to 3 of the most important DSPs who helped them with locoregional therapy decisions. For each individual DSP listed, respondents reported how important each DSP’s opinion was in treatment decision making, and how satisfied they were with their involvement (5 pt. scales, “not at all” to “very”). Decision deliberation was measured using 5-items assessing degree patients thought through the decision, with higher scores reflecting more deliberative treatment decisions. We compared network size (0-3 or more) across patient-level characteristics and estimated the association between network size and deliberation using multivariable linear regression. Results: Of the 2,502 women in this analysis, 51% reported having 3 or more DSPs, 20% reported 2, 18% reported 1, and 11% reported not having any DSPs. Married/partnered women, those younger than 45 years old, and black women were all more likely to report larger networks (all p < 0.001). Partnered women most often reported their partner as their main DSP (37.9%), whereas not partnered/unmarried women most often reported children (38.4%). The majority of women were highly satisfied with their DSP being involved in their decisions (76.5%) and 68.6% felt their DSP was very important in their decision making. Larger support networks were associated with more deliberative surgical treatment decision-making (p < 0.001). Conclusions: Most women engaged multiple DSPs in their treatment decision making, including spouses, children, and friends. Involving more DSPs was associated with more deliberative treatment decisions. Future initiatives to improve breast cancer treatment decision making should acknowledge and engage informal DSPs.

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