Patient Autonomy, Capacity, and Consent

2020 ◽  
Author(s):  
Jessica Berg ◽  
Emma Cave
Keyword(s):  
Patient Autonomy ◽  
Medical Decision Making ◽  
The United States ◽  
Best Interests ◽  
Medical Decision ◽  
Human Rights Law ◽  
Federal Law ◽  
Medical Decisions ◽  
General Overview ◽  
Best Interests Standard

This chapter discusses patient autonomy, capacity, and consent involving children. It first provides a general overview of children’s rights with respect to making medical decisions in both the United States and Europe. The chapter then discusses the best interests standard (which is usually applied in cases of minors) and how to consider capacity in the context of children. In the discussions of European approaches, the chapter covers relevant international and regional human rights law. The jurisdiction of England and Wales are used as examples. The chapter also provides a general overview of US state approaches and federal law. The chapter concludes by noting some new areas of medical decision-making which challenge the traditional models.

Informed Consent: Physician Inexperience is a Material Risk for Patients

2007 ◽  
Vol 35 (3) ◽  
pp. 478-485 ◽  
Author(s):  
Richard J. Veerapen
Keyword(s):  
United States ◽  
Decision Making ◽  
Informed Consent ◽  
Information Disclosure ◽  
Patient Autonomy ◽  
Medical Decision Making ◽  
The United States ◽  
Positive Influence ◽  
Medical Decision ◽  
Canadian Law

The Canadian law governing informed consent was significantly influenced by the decision of its Supreme Court in Reibl v. Hughes, a case that involved a physician’s failure to warn the patient about the risk of stroke after carotid endarterectomy. Even though most Canadian plaintiffs after Reibl have continued to lose informed consent cases, it is likely that the judgement in this case has significantly influenced the manner in which physicians now approach the discussion of risk while obtaining consent not only in Canada but also in several other jurisdictions.The development of informed consent law in the United States similarly became one of the drivers for change in physicians’ practices of information disclosure to their patients. The effect of Reibl on clinical practice is an outstanding example of the law’s positive influence on medical practice, especially in protecting patient autonomy during collaborative medical decision-making.

scholarly journals Decisional autonomy undermines advisees’ judgments of experts in medicine and in life

2020 ◽  
Vol 117 (21) ◽  
pp. 11368-11378
Author(s):  
Samantha Kassirer ◽  
Emma E. Levine ◽  
Celia Gaertig
Keyword(s):  
Patient Autonomy ◽  
Medical Decision Making ◽  
The United States ◽  
Medical System ◽  
Decision Makers ◽  
Medical Decision ◽  
Positive Trend ◽  
The Past ◽  
Before And After ◽  
To Come

Over the past several decades, the United States medical system has increasingly prioritized patient autonomy. Physicians routinely encourage patients to come to their own decisions about their medical care rather than providing patients with clearer yet more paternalistic advice. Although political theorists, bioethicists, and philosophers generally see this as a positive trend, the present research examines the important question of how patients and advisees in general react to full decisional autonomy when making difficult decisions under uncertainty. Across six experiments (N= 3,867), we find that advisers who give advisees decisional autonomy rather than offering paternalistic advice are judged to be less competent and less helpful. As a result, advisees are less likely to return to and recommend these advisers and pay them lower wages. Importantly, we also demonstrate that advisers do not anticipate these effects. We document these results both inside and outside the medical domain, suggesting that the preference for paternalism is not unique to medicine but rather is a feature of situations in which there are adviser–advisee asymmetries in expertise. We find that the preference for paternalism holds when advice is solicited or unsolicited, when both paternalism and autonomy are accompanied by expert guidance, and it persists both before and after the outcomes of paternalistic advice are realized. Lastly, we see that the preference for paternalism only occurs when decision makers perceive their decision to be difficult. These results challenge the benefits of recently adopted practices in medical decision making that prioritize full decisional autonomy.

scholarly journals Medical Decision Making for Youth in the Foster Care System

2016 ◽  
Author(s):  
Zachary Strassburger
Keyword(s):  
Foster Care ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Medical Decisions ◽  
Foster Care System ◽  
Birth Parents ◽  
Birth Parent ◽  
Laws And Policies ◽  
Do So ◽  
Care System

Youth in the foster care system often have no one person who isclearly authorized to make medical decisions for them. From acaseworker insisting upon a vaccine to a birth parent refusingpermission for psychotropic medication, this paper argues that thequestion of who makes these decisions matters for children’s rights.This paper reports the results of a survey of 132 stakeholdersrepresenting all U.S. states, 17 qualitative interviews, and a reviewof relevant laws and policies. The stakeholders and legal researchrevealed that in sixteen states, common practice disagreed with thewritten laws and policies about who should be making medical decisionsfor youth in the foster care system. Most often, foster parents aremaking medical decisions despite note having legal authority to do so,and birth parents are rarely making decisions even when they arelegally allowed to do so. This paper proposes that following federallaw about promoting family reunification, birth parents should be incharge of medical decision making for the first 12-24 months. Afterthat time, the foster parent, if one is available and has showncommitment to the child, should become the medical decision maker.Such a policy would promote birth parent involvement and familyreunification while acknowledging the need of young people in care fordecision makers who can make long-term commitments to their care.

Support for management medical decisions and the nature of uncertainty in them

2021 ◽  
Author(s):  
S.Yu. Zhuleva ◽  
A.V. Kroshilin ◽  
S.V. Kroshilina
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Information ◽  
General Scheme ◽  
The Body ◽  
Medical Decision ◽  
Problem Situation ◽  
Medical Decisions ◽  
Inaccurate Information ◽  
Individual Decisions

The process of making a medical decision is characterized by a lack of knowledge and inconsistency of the available information, the lack of the possibility of attracting competent medical experts, limited time resources, incomplete or inaccurate information about the patient's condition. These aspects may be the causes of medical errors, which lead to further aggravation of the problem situation. Purpose – it is necessary to define and justify managerial medical decisions and types of medical information in conditions of uncertainty, when each variant of the sets of outcomes of the situation (recommendations) has its own unique set of values. The fundamental difference between this process for medical use is the concept of the "best medical solution", in which the key role is given to the patient's state of health in obtaining and evaluating alternatives, as well as the need to take into account the time, adverse reactions of the body and the costs of implementing this solution. In the medical field, support for medical decision-making can be classified as organizational-managerial and therapeutic-diagnostic, but both are determined by the position of the person making the medical decision and are aimed at effective management of the medical institution as a whole. The article describes the causes and factors of the nature of uncertainty in the tasks of supporting medical decision-making in medical-diagnostic and organizational-managerial areas. The analysis of the features of supporting medical decision-making in conditions of uncertainty is carried out. Approaches and directions in this area, as well as the concept of “solution”, are considered. The essence of the management medical decision is reflected. The classification of management medical decisions is given, the requirements that are imposed on them are highlighted. The features of the development of management medical solutions in the conditions of incompleteness and uncertainty, the problems that arise when they are implemented in information systems are presented. The general scheme of the process of creating a management medical solution is shown. The features of making group and individual decisions are reflected. The algorithm of actions of the person making the medical decision in the conditions of uncertainty, incompleteness and risk in medical subject areas is presented.

Bioethics in the field of pediatric surgery

2020 ◽  
Vol 69 (4) ◽  
pp. 483-492
Author(s):  
Marko Bašković ◽  
Dora Škrljak Šoša
Keyword(s):  
Decision Making ◽  
Legal System ◽  
Pediatric Surgery ◽  
Medical Decision Making ◽  
Treatment Strategies ◽  
Moral Dilemmas ◽  
The State ◽  
Best Interests ◽  
Medical Decision ◽  
Team Members

It is the professional responsibility of pediatric surgeons to follow the principles of maintaining life and alleviating suffering, often by questioning whether they have acted correctly. Apart from the moral dilemmas of choosing the best treatment strategies, they are often in dilemmas with the parents, who also involve their own “strategy” in the whole story, which they think is the most optimal treatment for their child, despite the contrary recommendations of the profession. Children, and especially adolescents, may be somewhat involved in medical decision making. Mostly the parent-physician-child / adolescent triangle agrees, but this is not always the case, which is why pediatric surgeons encounter problems. Ethical committees, composed of competent people, supported by the legal system of the state, who are able by consensus of team members to advocate and ensure the best interests of patients, must be activated for the full scope of the solution.

scholarly journals The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis

2020 ◽  
Vol 5 (2) ◽  
pp. 238146832094070
Author(s):  
Andrea Meisman ◽  
Nancy M. Daraiseh ◽  
Phil Minar ◽  
Marlee Saxe ◽  
Ellen A. Lipstein
Keyword(s):  
Ulcerative Colitis ◽  
Decision Making ◽  
Decision Support ◽  
Focus Groups ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Support Needs ◽  
Final Decision ◽  
Care Providers ◽  
Medical Decisions

Purpose. To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs’ preferences. Methods. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic’s peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs’ roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. Results. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as “final decision makers.” Knowledge and experience were facilitators identified to participating in medical decision making. Conclusions. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.

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