Comparisons of guardianship laws and surrogate decision-making practices in China, Japan, Thailand and Australia: a review by the Asia Consortium, International Psychogeriatric Association (IPA) capacity taskforce

2015 ◽  
Vol 27 (6) ◽  
pp. 1029-1037 ◽  
Author(s):  
Joshua Tsoh ◽  
Carmelle Peisah ◽  
Jin Narumoto ◽  
Nahathai Wongpakaran ◽  
Tinakon Wongpakaran ◽  
...  
Keyword(s):  
Decision Making ◽  
Asia Pacific ◽  
Medical Decision ◽  
Ageing Population ◽  
Pacific Region ◽  
Surrogate Decision Making ◽  
Asia Pacific Region ◽  
Advanced Planning ◽  
Proxy Decision Making ◽  
Surrogate Decision

ABSTRACTBackground:The International Psychogeriatric Association (IPA) capacity taskforce was established to promote the autonomy, proper access to care, and dignity of persons with decision-making disabilities (DMDs) across nations. The Asia Consortium of the taskforce was established to pursue these goals in the Asia-Pacific region. This paper is part of the Asia Consortium's initiative to promote understanding and advocacy in regard to surrogate decision-making across the region.Method:The current guardianship laws are compared, and jurisdictional variations in the processes for proxy decision-making to support persons with DMDs and other health and social needs in China, Japan, Thailand, and Australia are explored.Results:The different Asia-Pacific countries have various proxy decision-making mechanisms in place for persons with DMDs, which are both formalized according to common law, civil law, and other legislation, and shaped by cultural practices. Various processes for guardianship and mechanisms for medical decision-making and asset management exist across the region. Processes that are still evolving across the region include those that facilitate advanced planning as a result of the paucity of legal structures for enduring powers of attorney (EPA) and guardianship in some regions, and the struggle to achieve consensual positions in regard to end-of-life decision-making. Formal processes for supporting decision-making are yet to be developed.Conclusions:The diverse legal approaches to guardianship and administration must be understood to meet the challenges of the rapidly ageing population in the Asia-Pacific region. Commonalities in the solutions and difficulties faced in encountering these challenges have global significance.

All things considered: Surrogate decision-making on behalf of patients in the minimally conscious state

2020 ◽  
Vol 15 (3) ◽  
pp. 111-119
Author(s):  
L Syd M Johnson ◽  
Kathy L Cerminara
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Medical Decision ◽  
Surrogate Decision Making ◽  
Surrogate Decision ◽  
Minimally Conscious

The minimally conscious state presents unique ethical, legal, and decision-making challenges because of the combination of diminished awareness, phenomenal experience, and diminished or absent communication. As medical expertise develops and technology advances, it is likely that more and more patients with disorders of consciousness will be recognized as being in the minimally conscious state, with minimal to no ability to participate in medical decision-making. Here we provide guidance useful for surrogates and medical professionals at any medical decision point, not merely for end-of-life decision-making. We first consider the legal landscape: precedent abounds regarding unconscious patients in coma or the vegetative state/Unresponsive Wakefulness Syndrome (VS/UWS), but there is little legal precedent involving patients in the minimally conscious state. Next we consider surrogates’ ethical authority to make medical decisions on behalf of patients with disorders of consciousness. In everyday medical decision-making, surrogates generally encounter few, if any, restrictions so long as they adhere to an idealized hierarchy of decision-making standards designed to honor patient autonomy as much as possible while ceding to the reality of what may or may not be known about a patient’s wishes. We conclude by proposing an ethically informed, practical guide for surrogate decision-making on behalf of patients in the minimally conscious state.

scholarly journals SURROGATES’ DECISION-MAKING CONFIDENCE AND COLLABORATIVE WILLINGNESS ON THE POST: THE ROLE OF SOCIAL NORMS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S138-S138
Author(s):  
Rachael Spalding ◽  
Jenna Wilson ◽  
Barry Edelstein
Keyword(s):  
Decision Making ◽  
Social Norms ◽  
Indirect Effect ◽  
Self Report ◽  
Medical Decision ◽  
Surrogate Decision Making ◽  
Consideration Of Future Consequences ◽  
Perceived Social Norms ◽  
Surrogate Decision ◽  
Future Consequences

Abstract When patients become incapacitated due to illness or frailty, “surrogates” work with patients’ providers to make medical decisions on their behalf. In surrogate decision-making situations, surrogates’ decision-making confidence predicts collaborative willingness, or the extent to which they are willing to work with the patient’s providers when making decisions (Spalding & Edelstein, under review). In an attempt to explain this finding, the current study examined whether perceived social norms for patient-physician collaboration and another psychological variable, consideration of future consequences, mediated the relation between decision-making confidence and collaborative willingness. Participants (n= 172) from Amazon’s Mechanical Turk completed self-report measures and a hypothetical surrogate decision-making task. A parallel multiple mediation analysis using 5000 bootstrapped samples with the PROCESS macro (Hayes, 2013) was conducted. The overall model explained 43.4% of the variance in collaborative willingness, F(4, 166) = 9.59, p< .001. There was a significant indirect effect of decision-making confidence on collaborative willingness through perceived social norms (b= .068, SE= .034, 95% CI [.014, .154]). There was not a significant indirect effect through consideration of future consequences. After including the significant indirect path through perceived social norms, the direct effect (b= .348, p< .001) of decision-making confidence on collaborative willingness was reduced (b= .243, p= .003). Thus, perceptions of social norms partially accounted for the relation between decision-making confidence and collaborative willingness. This finding illustrates how social perceptions of patient-provider collaboration can facilitate desirable medical decision-making behaviors, such as collaboration.

569 Surrogate Decision Making: Who Has the Ultimate Say in Patient Care?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S134-S135
Author(s):  
Todd F Huzar ◽  
Monica L Gerrek ◽  
Daniel J Freet
Keyword(s):  
Decision Making ◽  
The Other ◽  
Medical Decision ◽  
Surrogate Decision Making ◽  
Next Of Kin ◽  
Fourth Degree ◽  
Her Family ◽  
The Family ◽  
History Of ◽  
Surrogate Decision

Abstract Introduction Burn patients may present with an inability to communicate. In these cases, we need to rely on surrogates such as the Medical Power of Attorney (MPoA) or next of kin. A MPoA gives the agent the authority to participate in medical decision and in accordance with their wishes. The agent may consent to, refuse, withdraw, or withhold treatment, including life-sustaining interventions. At times, they may feel unable to participate in decision making without assistance (i.e. family members). The process can become more complicated and decision making can become “muddied” due to others influencing decisions. In our state, the MPoA is the proxy if the patient is unable to participate in decision making; however, there are cases when the patient doesn’t have an MPoA and the next of kin is the surrogate. In these cases, the next of kin would be consulted in the following order: spouse, adult children, parents, and nearest relatives. Some next of kin may not know the patient’s wishes complicating their care. Methods Two cases involving surrogates: #1: 60-year-old man with a history of HIV involved in a MVC and sustained 30% TBSA third and fourth degree burns to the face, torso, and extremities. The severity of his injuries and outcomes were discussed with his wife. She was not certain what her would want and she consulted her family because she did not know what to do; however, she knew that he would not want to live like this. After talking to the family, the kids “over-ruled” her. They wanted aggressive care despite the risks of complications and inability to perform ADLs because of his severe facial and hand burns. Case#2: 40 something year-old man with a history of schizophrenia that sustained 65% TBSA third and fourth degree burns to his face, neck, torso, and extremities due to self-immolation. The patient’s mother was identified, and it was explained to the patient’s mother that if he did survive his injury, he will not be able to perform any of his ADLs due his hand and facial burns. The patient’s mother wanted everything done for her son. Results Both patients were unable to perform ADLs due to their injuries. One patient was discharged for further inpatient care and the other was discharged home because his mother refused further care. The first patient was unable to communicate about his thoughts on his outcome. The other patient was discharged home. He was upset about what he looked like. He also told the staff that he will do his best to finish what he started. Conclusions Complex issues can arise when the patient cannot communicate their wishes and the next of kin plays the role of surrogate. The family may disagree and alter the decision-making process. After seeing this scenario play out and patients not being happy about their outcomes, the policies regarding surrogate decision making should be re-evaluated.

APEC Evolution and Prospects of Regional Integration Processes

2012 ◽  
pp. 40-50
Author(s):  
A. Fedorovskii
Keyword(s):  
Decision Making ◽  
Regional Integration ◽  
Economic Cooperation ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Regional Economic ◽  
Asia Pacific Economic Cooperation ◽  
Consensus Decision Making ◽  
Consensus Decision

The paper discusses the operational value of the key principles of the activities of the Asia-Pacific economic cooperation (APEC) that stand behind its creation. These include the consensus decision-making, the voluntary nature of the decisions’ implementation, the “open regionalism”. Also the author deals with the functioning of the APEC in the context of regional economic cooperation in the Asia-Pacific region at the end of the first decade of the XXI century.

What would people think? Perceived social norms, willingness to serve as a surrogate, and end-of-life treatment decisions

2020 ◽  
pp. 1-9
Author(s):  
Rachael Spalding ◽  
JoNell Strough ◽  
Barry Edelstein
Keyword(s):  
Decision Making ◽  
Mechanical Ventilation ◽  
End Of Life ◽  
Contextual Factors ◽  
Medical Decision ◽  
Decision Making Process ◽  
Surrogate Decision Making ◽  
Willingness To Serve ◽  
Surrogate Decision ◽  
End Of Life Treatment

Abstract Background Population aging has increased the prevalence of surrogate decision making in healthcare settings. However, little is known about factors contributing to the decision to become a surrogate and the surrogate medical decision-making process in general. We investigated how intrapersonal and social-contextual factors predicted two components of the surrogate decision-making process: individuals’ willingness to serve as a surrogate and their tendency to select various end-of-life treatments, including mechanical ventilation and palliative care options. Method An online sample (N = 172) of adults made hypothetical surrogate decisions about end-of-life treatments on behalf of an imagined person of their choice, such as a parent or spouse. Using self-report measures, we investigated key correlates of willingness to serve as surrogate (e.g., decision-making confidence, willingness to collaborate with healthcare providers) and choice of end-of-life treatments. Results Viewing service as a surrogate as a more typical practice in healthcare was associated with greater willingness to serve. Greater decision-making confidence, greater willingness to collaborate with patients’ physicians, and viewing intensive, life-sustaining end-of-life treatments (e.g., mechanical ventilation) as more widely accepted were associated with choosing more intensive end-of-life treatments. Significance of results The current study's consideration of both intrapersonal and social-contextual factors advances knowledge of two key aspects of surrogate decision making — the initial decision to serve as surrogate, and the surrogate's selection of various end-of-life treatment interventions. Providers can use information about the role of these factors to engage with surrogates in a manner that better facilitates their decision making. For instance, providers can be sensitive to potential cultural differences in surrogate decision-making tendencies or employing decision aids that bolster surrogates’ confidence in their decisions.

scholarly journals The bridging role of regional headquarters. Multinational companies in the Asia-Pacific region

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Bruno Amann ◽  
Jacques Jaussaud ◽  
Johannes Schaaper
Keyword(s):  
Decision Making ◽  
Structural Equation ◽  
Multinational Companies ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Content Type ◽  
Regional Headquarters ◽  
And Control ◽  
Coordination And Control

Purpose Large multinational companies (MNCs) are strongly formalized, often standardized and complex with multiple hierarchical levels. Over the past few decades, MNCs have strengthened their coordination and control systems by creating regional headquarters (RHQs). This study aims to investigate how MNCs rearticulate control dimensions at RHQs, to coordinate and exert control over subsidiaries in the Asia-Pacific region. Design/methodology/approach Based on a survey of 86 French MNCs in the Asia-Pacific region, this study applies a structural equation model to determine RHQs’ roles in the field of regional decision-making, coordination and control. Findings Large MNCs, with a significant presence in Asia, transfer coordination and control to RHQs, in a way that leads us to propose the use of the expression “regio-centralization.” RHQs become socialization hubs, where most regional decisions are taken and where international managers meet. MNCs mobilize at the same time expatriates, short-term assignees and local managers who intensively interact at RHQs. Thus, informal control at RHQs increases, partly substituting formal control by HQs. Smaller MNCs, without RHQs, on the contrary, base their control and coordination on the formalization of HQs-subsidiary relations, especially through strong reporting, in combination with centralized decision-making at HQs. Research limitations/implications This study is based on MNCs from one specific country, France, and focuses only on the dynamic Asia-Pacific host region. Coordination and control in less dynamic regions may reveal different results. Originality/value This study leads to a better understanding of how large MNCs reorganize dispersed activities in the Asia-Pacific region by creating RHQs, where important control and coordination functions are relocated.

scholarly journals Model-Informed Risk Assessment and Decision Making for an Emerging Infectious Disease in the Asia-Pacific Region

2016 ◽  
Vol 10 (9) ◽  
pp. e0005018 ◽  
Author(s):  
Robert Moss ◽  
Roslyn I. Hickson ◽  
Jodie McVernon ◽  
James M. McCaw ◽  
Krishna Hort ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Risk Assessment ◽  
Decision Making ◽  
Emerging Infectious Disease ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region
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