The Role of Informed Consent in Medical Decision Making

2001 ◽  
Author(s):  
Jessica W. Berg ◽  
Paul S. Appelbaum ◽  
Charles W. Lidz ◽  
Lisa S. Parker
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Process Model ◽  
Clinical Care ◽  
Single Point ◽  
Accurate Information ◽  
Course Of Action ◽  
Potential Benefits ◽  
Event Model ◽  
The Relationship

How can informed consent be integrated into the physician-patient relationship in a manner that is respectful of both the idea of informed consent and the imperatives of clinical care? A realistic answer to that question could, we believe, remove much of the resistance of many healthcare professionals to the idea of informed consent. This chapter’s goal is to offer a practical procedural framework within which clinicians can operate to facilitate patients’ decision making in a manner that meets both these desiderata. The interactions of physicians and patients in making decisions about medical treatment can be conceptualized in two ways. Decision making can be approached as an event that occurs at a single point in time (an “event model”), or it can be viewed as a continuous element of the relationship between patients and their caregivers (a “process model”). The implications of these different ways of conceptualizing decisions about treatment are quite profound, rooted as they are in distinct visions of the relationship between physicians and patients. The event model of informed consent is predicated on a relatively simple paradigm. A patient seeking medical care approaches a physician for assistance. After assessing the patient’s condition, the physician reaches a diagnosis and formulates a recommended plan of treatment. The physician’s conclusions and recommendations are presented to the patient, along with information concerning the risks and potential benefits of the proposed treatment, and possible alternatives and their risks and potential benefits. Weighing the available data, the patient reflects on the relative risks and benefits of each course of action and then selects the medically acceptable alternative that most closely fits the patient’s particular values. On the surface at least, the event model conforms well to the legal requirements for informed consent. The event model emphasizes the provision of full and accurate information to patients at the time of decision making. Consent forms are often used for this purpose; indeed, the consent form can be said to be the central symbol of the event model (see Chapter 9). Patients’ understanding, although desirable in the abstract, is less crucial to this model than is the provision of information.

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.

Common-Sense Epidemiology in the Age of Electronic Patient Records (EPR)

2020 ◽  
pp. 343-364
Author(s):  
Shirly Bar-Lev ◽  
Dizza Beimel
Keyword(s):  
Decision Making ◽  
Common Sense ◽  
Clinical Information ◽  
Active Role ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Professional Help ◽  
Course Of Action ◽  
The Relationship ◽  
Practical Recommendations

Encouraging patients to play a more active role in their health care is crucial for healthcare planning and for the design of services. This chapter shifts the scholarly focus from practitioners' decision making to that of laypersons' trying to make sense of the lab results available on their EPRs. The authors developed a methodology to capture the relationship between information formats (graph, numeric, or verbal), laypersons' assessment of the conditions' gravity, and their preferred course of action. Focusing on the effect of “not knowing” on laypersons' preferred courses of action, our findings show that formats that left respondents less able to understand the results—namely, the numeric and verbal formats—produced a lower sense of urgency, and correspondingly, less inclination to actively seek professional help. The chapter takes a step toward deriving practical recommendations as to how personal clinical information should be communicated, to improve laypersons' interpretation of the information's significance.

Ethics and law in paramedic practice: boundaries of capacity and interests

2020 ◽  
Vol 12 (10) ◽  
pp. 1-8
Author(s):  
Hamish Carver ◽  
Dominique Moritz ◽  
Phillip Ebbs
Keyword(s):  
Decision Making ◽  
End Of Life Care ◽  
Clinical Care ◽  
Relevant Information ◽  
Best Interests ◽  
Evidence Based ◽  
Ethical Standards ◽  
Healthcare Ethics ◽  
The Everyday ◽  
The Relationship

Decision-making is central to the everyday practice of paramedicine. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedics are required to make these decisions within settings that are often disordered, uncontrolled and unpredictable, where all the relevant information and circumstances are not fully known. Decision-making in this environment is intended to provide care and treatment in the best interests of the patient. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient's own wishes? More speci∼cally, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.

scholarly journals Applying cluster analysis to ranking the vulnerabilities of railway influence territory

2019 ◽  
Vol 265 ◽  
pp. 02018
Author(s):  
Viktor Katin ◽  
Vladimir Kosygin ◽  
Midkhat Akhtiamov ◽  
Andrey Lutsenko
Keyword(s):  
Decision Making ◽  
Cluster Analysis ◽  
Single Point ◽  
Rail Transport ◽  
Accurate Information ◽  
Decision Making Process ◽  
Cultural Significance ◽  
Ecological Economic ◽  
Vulnerability Ranking

The article considers the proprietary method of ranking the territory of the railway influence, based on the use of vulnerability matrices and application of cluster analysis, which allows optimizing the decision-making process for responding to emergencies associated with rail transport. The "point" ranking of vulnerabilities in the zone of railway influence was used for more accurate information on the events with applying the identity matrices of vulnerabilities. The partition cell is taken as a single "point". The method is based on the ranking of ecological, economic, environmental, bioresource and cultural significance of the territory by means of defining identical matrices of vulnerabilities that describe each point of the event. The partition cells were grouped into three clusters: moderately vulnerable territory, highly vulnerable territory and extremely vulnerable territory. The result of using the method was the compiling of vulnerability ranking maps.

scholarly journals Inappropriate Telemetry Use Is Increased during the COVID-19 Era

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1610
Author(s):  
Jean Kim ◽  
Kyle Miyazaki ◽  
Yoshito Nishimura ◽  
Ryan Honda
Keyword(s):  
Decision Making ◽  
Respiratory Failure ◽  
American Heart Association ◽  
Chart Review ◽  
American Heart ◽  
Clinical Care ◽  
Retrospective Chart Review ◽  
Heart Association ◽  
Academic Hospital ◽  
The Relationship

Due to the unprecedented COVID-19 pandemic, there may be overuse of telemetry monitoring compared to the pre-pandemic period. We compared the frequency of inappropriate telemetry use in the pre-COVID-19 period (1 November 2019 to 28 February 2020) versus the peri-COVID-19 period (1 March 2020 to 30 June 2020) at a major academic hospital in Honolulu, Hawaii, by a retrospective chart review to assess for the appropriateness of the telemetry orders during this period, based on the 2017 American College of Cardiology/American Heart Association guidelines. Compared to the pre-COVID-19 period, there was a significant increase in inappropriate telemetry use during the peri-COVID-19 period (X2 (1, N = 11,727) = 6.59, p = 0.0103). However, there was no increase in the proportions of respiratory failure (4.0%) or pneumonia (2.7%) during the peri-COVID-19 period. The increase in inappropriate telemetry use may be related to the uncertainty in clinical care and decision making amid the pandemic of the new virus. Appropriate utilization of telemetry monitoring is increasingly important during the pandemic due to the limited availability of resources. Further investigation is needed to clarify the relationship between the pandemic and trends in telemetry ordering.

scholarly journals 2191

2017 ◽  
Vol 1 (S1) ◽  
pp. 71-71
Author(s):  
Sarah Ronis ◽  
Kurt Stange ◽  
Lawrence Kleinman
Keyword(s):  
Decision Making ◽  
Family Relationships ◽  
Negative Impact ◽  
Clinical Care ◽  
Care Plan ◽  
Care Planning ◽  
Loop Model ◽  
The Impact ◽  
The Relationship ◽  
Parent Child

OBJECTIVES/SPECIFIC AIMS: (1) To propose an iterative decision-making model of care planning for CSHCN. (2) To identify targets warranting measurement in future studies of SDM in care planning for CSHCN. METHODS/STUDY POPULATION: Conceptual model developed by a multidisciplinary team iteratively considering the complex relationships among diverse factors affecting care planning for CSHCN, informed by clinical and implementation science experience and a scoping literature review of medical and cognitive sciences literature addressing interpersonal decision-making, communication, negotiation, and trust among children, their parents, and their clinicians. RESULTS/ANTICIPATED RESULTS: Decision-making interventions in pediatrics tend to focus narrowly on single acute decisions, providing minimal guidance for decisions related to chronic disease management over time. Few models account for the role of the child in the decision-making process, despite their ongoing development. Therefore, we propose a model of shared decision-making in the context of managing chronic illness in children that recognizes all actors and can support both the design of clinical care and research. This model—The SDM Learning Loop Model—highlights the dynamic iterative nature of exchanges between and among the clinical team and the parent-child dyad and recognizes the child as the center of each decision-making cycle. The model accounts for key practice, family, experiential, and emotional contexts influencing the decision-making encounter. In this model, change in child health status and developmental capacity resulting from a given cycle’s care plan will directly influence the relationship between clinician and parent-child dyad (eg, mutual trust, attunement) and impact each party’s engagement in the next round of decision-making. The relationship between experience and outcome stimulates learning. DISCUSSION/SIGNIFICANCE OF IMPACT: Our proposed SDM Learning Loop Model suggests that increasing the shared nature of decision making is not only likely to optimize care planning, but creates “buy-in” that can both reinforce the impact of positive outcomes, and moderate the negative impact on relationships when the outcome is other than desired. We hypothesize that this model can guide care planning and shape research to the benefit of both clinical outcomes and clinician-family relationships. Future work should focus on the development and validation of measures to account for the experiential and emotional contexts in which such decisions are made, and the outcomes of care in this population.

scholarly journals Mindfulness and decision-making: Sunk-costs or escalation of commitment?

2018 ◽  
Author(s):  
Neil Schmitzer-Torbert
Keyword(s):  
Decision Making ◽  
Sunk Costs ◽  
Escalation Of Commitment ◽  
Trait Mindfulness ◽  
Sunk Cost ◽  
Positive Health ◽  
Course Of Action ◽  
Cognitive Benefits ◽  
Positive Health Outcomes ◽  
The Relationship

Mindfulness is related to a number of positive health outcomes, such as decreased stress, anxiety and improved physical functioning. Recent studies have also identified a range cognitive benefits of mindfulness, including recent studies demonstrating that higher trait mindfulness and brief mindfulness inductions are associated with improved decision-making, and specifically to resistance to the influence of sunk-costs, where higher mindfulness is associated with increased willingness to discontinue a costly, but disadvantageous, course of action. However, some previous studies examining mindfulness and the sunk-cost bias have methodological limitations which make it difficult to determine if mindfulness is specifically related to sensitivity to the sunk-cost bias, or rather than to a general willingness to continue an unprofitable course of action (independent of the level of prior investment). The present study extends previous work by replicating the finding that trait mindfulness is positively related to resistance to the effects of sunk-costs, and also demonstrates that mindfulness is related to reduced escalation of commitment, an individual’s willingness to continue their commitment to a unprofitable course of action through the further investment of resources or time. Overall, trait mindfulness was most consistently related to reduced escalation of commitment, whereas the relationship between trait mindfulness and resistance to the effects of sunk-costs were less consistently observed

Healthcare Digitalized

2021 ◽  
pp. 60-78
Author(s):  
Miguel H. Kottow
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Precision Medicine ◽  
Biomedical Research ◽  
Clinical Medicine ◽  
Medical Services ◽  
Personal Care ◽  
Individual Decision ◽  
Individual Decision Making ◽  
The Relationship

Ever since medicine became a recognized profession, the relationship between patients and physicians was marked by authoritarian paternalism. With the advent of bioethics in the 1970s, patients' right to participate in decision making led to proclaim autonomy as the primary principle in clinical medicine and biomedical research, practically exercised as informed consent; yet, the issue remains contended and poorly regulated. Healthcare digitalization disassembles persons into clouds of data. Individual decision making is interfered with and replaced by dominant algorithms, supposedly delivering a P4 composite of precision medicine: personalized, preventive, predictive, participatory. Biomedicine develops into medicalization, marketization contractual client/provider relationship, and neglect of personal care for the ill and frail. These trends become dominant in digitalized healthcare as personal healthcare relationships, and ethically unsatisfactory medical services replace the psychosocial, existential elements of health/disease.

scholarly journals Article 5: The Role of Parents in the Proxy Informed Consent Process in Medical Research involving Children

2020 ◽  
Vol 28 (3) ◽  
pp. 521-546
Author(s):  
Sheila Varadan
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Research ◽  
Well Being ◽  
Ethical Challenges ◽  
Research Setting ◽  
Role Of Parents ◽  
Article 5 ◽  
The Relationship

Abstract Medical research involving child subjects has led to advances in medicine that have dramatically improved the lives, health and well-being of children. Yet, determining when and under what conditions a child should be enrolled in medical research remains an ethically vexing question in research ethics. At the crux of the issue is the free and informed consent of the child participant. A child, who is presumed legally incompetent, or lacks sufficient understanding to exercise autonomous decision-making, will not be able to express free and informed consent in the research setting. Rather than exclude all such children from medical research, a parent (or legal guardian) is designated as a proxy to consent on the child’s behalf. However, the concept of proxy informed consent and the framework for its implementation present practical and ethical challenges for researchers, particularly in navigating the relationship between proxy decision-makers and child subjects in the medical research setting. Article 5 of the uncrc may offer guidance on this point: (1) it places boundaries around how parental authority should be exercised; (2) it offers a model for parent-child decision-making that is participatory, collaborative and linked to the child’s enjoyment of rights under the uncrc; (3) it respects and supports the autonomy of child participants by recognising their evolving capacities to give informed consent. This paper concludes that greater consideration should be given to Article 5 as a complementary framework for researchers engaged in medical research involving children.

The association of specific neuropsychological deficits with capacity to consent to research or treatment

2007 ◽  
Vol 13 (6) ◽  
pp. 1047-1059 ◽  
Author(s):  
BARTON W. PALMER ◽  
GAURI N. SAVLA
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Empirical Studies ◽  
A Priori ◽  
Decisional Capacity ◽  
Capacity To Consent ◽  
Significant Relationships ◽  
Decision Making Processes ◽  
Relationship Of ◽  
The Relationship

Informed consent is key to ethical clinical research and treatment, but partially rests on the ability of individual patients or research participants to use disclosed information to make a meaningful choice. Although the construct of decisional capacity emerged from legal and philosophical traditions, several investigators have begun examining the relationship of specific neuropsychological abilities to decisional capacity. This line of research may foster development of better consent procedures, as well as aid in refining the construct of decisional capacity toward a form that better reflects the underlying neurocognitive processes. We conducted a systematic search of the published literature and thereby identified and reviewed 16 published reports of empirical studies that examined the relationship between specific neuropsychological abilities and capacity to consent to research or treatment. Significant relationships between neuropsychological scores and decisional capacity were present across all the reviewed studies. The degree to which specific neuropsychological abilities have particular relevance to decisional capacity remains uncertain, but the existing studies provide a solid basis for a priori hypotheses for future investigations. These ongoing efforts represent an important conceptual and empirical bridge between bioethical, legal, and neuropsychological approaches to understanding meaningful decision-making processes. (JINS, 2007, 13, 1047–1059.)

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