scholarly journals Rational Decision-Making Capacity in End of Life Decision-Making

2020 ◽  
pp. 211-233
Author(s):  
Jonathan Pugh
Keyword(s):  
Decision Making ◽  
Anorexia Nervosa ◽  
Blood Transfusion ◽  
Blood Transfusions ◽  
Rational Decision ◽  
The Third ◽  
Decision Making Capacity ◽  
Life Saving ◽  
End Of Life Decision ◽  
Life Decision

This chapter brings the rationalist account of decision-making capacity to bear on three case studies. The first concerns a patient who ‘unwisely’ refuses treatment for a condition that can be treated straightforwardly, but which will otherwise be fatal. The second concerns a Jehovah’s Witness who refuses a life-saving blood transfusion. The third concerns an individual suffering from anorexia nervosa, who recognizes that she is dangerously underweight, but who nonetheless refuses to consume food. The author argues that a rationalist approach can accommodate the thought that an individual’s decision-making capacity is not precluded by their making an ‘unwise’ decision. It can also accommodate both the thought that Jehovah’s Witnesses can have decision-making capacity to refuse blood transfusions, and that some sufferers of anorexia nervosa may lack decision-making capacity. The author argues that his account is better equipped to investigate the nuances of these hard cases than the standard account.

End-of-Life Decision Making across Cultures

2011 ◽  
Vol 39 (2) ◽  
pp. 201-214 ◽  
Author(s):  
Robert H. Blank
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Ethical Issues ◽  
The United States ◽  
Special Issue ◽  
The Past ◽  
Life Saving ◽  
Demographic Patterns ◽  
End Of Life Decision ◽  
Life Decision

As is evident from the other articles in this special issue, end-of-life treatment has engendered a vigorous dialogue in the United States over the past few decades because decision making at the end of life raises broad and difficult ethical issues that touch on health professionals, patients, and their families. This concern is exacerbated by the high cost related to the end of life in the U.S. Moreover, in light of demographic patterns, progressively scarce health care resources, and an expanding array of life-saving technologies, decisions at the end of life are becoming problematic matters of public and, thus, scholarly concern in most countries. Issues at the end of life are central not only to bioethics but also raise important ancillary policy dimensions.

scholarly journals End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

2021 ◽  
Vol 12 ◽  
Author(s):  
Carla Kotzé ◽  
Johannes Lodewikus Roos ◽  
René Ehlers
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Older People ◽  
End Of Life ◽  
Serious Mental Illness ◽  
Decision Making Capacity ◽  
Consent To Treatment ◽  
Advance Care ◽  
End Of Life Decision ◽  
Life Decision

Background: The study's main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Methods: A cross-sectional, observational study, was done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness. The Mini-Cog and a semi-structured clinical assessment of end-of-life decision-making capacity was done before a standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardized instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results: The Assessment of Capacity to Consent to Treatment scores correlated (p < 0.001) with the outcomes of the semi-structured decision-making capacity evaluation. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p < 0.001); a duration of serious mental illness of 30–39 years (p = 0025); having a diagnosis of schizophrenia spectrum disorders (p = 0.0007); and being admitted involuntarily (p < 0.0001). A main finding was that 65% of participants had decision-making capacity for end-of-life decisions, were able to express their values and engage in advance care discussions.Discussion and Conclusion: Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Many older patients with serious mental illness can engage in end-of-life discussions and can make autonomous decisions about preferred end-of-life care. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

scholarly journals Reflecting on ‘Hannah’s Choice’: Using the Ethics of Care to Justify Child Participation in End of Life Decision-Making

2019 ◽  
Author(s):  
Kirsty L Moreton
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Holistic Approach ◽  
Ethics Of Care ◽  
The Past ◽  
Law And Policy ◽  
Life Saving ◽  
End Of Life Decision ◽  
Narrative Account ◽  
Life Decision

Abstract It has been ten years since the case of Hannah Jones—the 12-year-old girl who was permitted to refuse a potentially life-saving heart transplant. In the past decade, there has been some progress within law and policy in respect of children’s participatory rights (UNCRC—Article 12), and a greater understanding of family-centred decision-making. However, the courts still largely maintain their traditional reluctance to find children Gillick competent to refuse medical treatment. In this article, I revisit Hannah’s case through the narrative account provided by Hannah and her mother, to ascertain what lessons can be learnt. I use an Ethics of Care framework specially developed for children in mid-childhood, such as Hannah, to argue for more a creative and holistic approach to child decision-making in healthcare. I conclude that using traditional paradigms is untenable in the context of palliative care and at the end of life, and that the law should be able to accommodate greater, and even determinative, participation of children who are facing their own deaths.

scholarly journals 214 - End-of-life decision-making capacity in older people with serious mental illness

2021 ◽  
Vol 33 (S1) ◽  
pp. 15-16
Author(s):  
Carla Kotzé ◽  
Louw Roos ◽  
René Ehlers
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Older People ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Decision Making Capacity ◽  
Consent To Treatment ◽  
End Of Life Decision ◽  
Life Decision

ABSTRACTObjectives:The study’s main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Design, Setting, and Participants:This was a cross-sectional, observational study, done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness.Measurements:Socio-demographic, diagnostic, and treatment data were collected before administration of the Mini- Cog and a semi-structured clinical assessment of end-of-life decision-making capacity. Finally, the standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardised instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results:According to the semi-structured decision-making capacity assessment, 65% of participants had decision-making capacity for end-of-life decisions. The Assessment of Capacity to Consent to Treatment scores were significant (p<0.001) when compared to decision-making capacity. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p<0.001); a duration of serious mental illness of 30-39 years (p=0025); having a diagnosis of schizophrenia spectrum disorders (p=0.0007); and being admitted involuntarily (p<0.0001).Conclusions:Two thirds of older people with serious mental illness had decision-making capacity and were able to engage in end-of-life care discussions. Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

End-of-Life Decision-Making in Canada: The Report by the Royal Society of Canada Expert Panel on End-of-Life Decision-Making

2011 ◽  
Author(s):  
Udo Schuklenk ◽  
Johannes J. M. van Delden ◽  
Jocelyn Downie ◽  
Sheila McLean ◽  
Ross Upshur ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Royal Society ◽  
Expert Panel ◽  
End Of Life Decision ◽  
Life Decision

scholarly journals “What Would You Do?”: How Cat Owners Make End-of-Life Decisions and Implications for Veterinary-Client Interactions

Animals ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 1114
Author(s):  
Katherine Littlewood ◽  
Ngaio Beausoleil ◽  
Kevin Stafford ◽  
Christine Stephens
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
End Of Life ◽  
Companion Animals ◽  
Chronically Ill ◽  
Future Research ◽  
End Of Life Decisions ◽  
Life Decisions ◽  
End Of Life Decision ◽  
Life Decision

Cats are the most common companion animals in New Zealand. Advances in veterinary care means that cats are living longer and there are many older cats. End-of-life decisions about cats are complicated by owner–cat relationships and other psychosocial factors. Our study explored the ways in which end-of-life decisions were being made by owners of older and chronically ill cats in New Zealand and the role of their veterinarian in the process. Qualitative data were gathered via retrospective semi-structured interviews with 14 cat owners using open-ended questions. Transcripts of these interviews were explored for themes using template analysis and nine themes were identified. Four were animal-centered themes: cat behavior change, pain was a bad sign, signs of ageing are not good, and the benefits of having other people see what owners often could not. Five were human-centered themes: veterinarians understanding owners’ relationships with their cat, normalizing death, the need for a good veterinarian to manage end of life, veterinary validation that owners were doing the right thing, and a strong desire to predict the time course and outcome for their cat. End-of-life decision making is complex, and the veterinarian’s role is often poorly defined. Our owners appreciated the expertise and validation that their veterinarian provided but continuity of care was important. Future research aimed at exploring the veterinarian’s perspective during end-of-life decision making for cats would be a valuable addition to the topic.

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