Ethics of the Psychotherapeutic Alliance, Shared Decision Making and Consensus on Therapy Goals

2019 ◽  
Author(s):  
Stella Reiter-Theil ◽  
Charlotte Wetterauer
Keyword(s):  
Decision Making ◽  
Problem Solving ◽  
Shared Decision Making ◽  
Assisted Suicide ◽  
Ethical Issues ◽  
Medical Patient ◽  
Shared Decision ◽  
Ethical Challenges ◽  
Therapy Goals ◽  
Psychotherapeutic Alliance

The ethics of the psychotherapeutic alliance (a), shared decision making (b), and consensus on therapy goals (c) is discussed in the context of a legal overview in three German-speaking countries. Particular ethical challenges are identified in different settings. Clinical Ethics Support (CES) has gained importance beyond acute medical patient care, but is still new in psychotherapy. Three examples present ethical issues underlying the basic concepts of psychotherapy (a, b, and c) that often go unnoticed or remain implicit. Addressing ethical questions in a practical psychotherapy context may lead to acknowledging more complexity than expected. At the same time, meta-level ethical reflection can help to coordinate previously diverging interests and efforts and remove obstacles towards problem-solving. Complexity as well as problem solving will be illustrated by referring to problems with confidentiality concerning sexual abuse, coercion in treating dependency disorders, and responding to wishes of assisted suicide.

scholarly journals Computer knows best? The need for value-flexibility in medical AI

2018 ◽  
Vol 45 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Rosalind J McDougall
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Treatment Decision ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Value Judgements ◽  
The Relationship

Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system creates both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making.

scholarly journals Ethical Issues in Dysphagia Management

2020 ◽  
Vol 41 (03) ◽  
pp. 257-265
Author(s):  
Paula Leslie ◽  
Dominika Lisiecka
Keyword(s):  
Decision Making ◽  
Family Caregivers ◽  
Clinical Judgment ◽  
Information Disclosure ◽  
Ethical Issues ◽  
Shared Decision ◽  
Ethical Reflection ◽  
Ethical Challenges ◽  
Swallowing Problems

AbstractDysphagia management is complex and requires balancing individuals' preferences, quality of life, and medical consequences. Ethical challenges are not uncommon given the complexity of dysphagia. Professionals must engage in ethical reflection and shared decision-making when managing dysphagia. Recognizing one's own presuppositions and beliefs may be fundamental to ensuring an ethical approach. The goal of this article is to apply principles of ethics using hypothetical case studies of dysphagia. To this end, we will describe the challenges of working with the disorder of dysphagia; the influence of culture on decision-making about eating and feeding; the importance of information disclosure and respect for individuals' refusal of recommendations; and the interplay of ethical reflection, evidence, and clinical judgment when making complex dysphagia management decisions. These concepts should be kept in mind to ensure compassionate and competent care of the person with eating, drinking, or swallowing problems and their family caregivers.

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behavior Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Treatment Information ◽  
Centered Care ◽  
Potential Risks ◽  
Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

On the evaluation of shared decision making: The Decision Evaluation Scales

2004 ◽  
Author(s):  
P. F. M. Stalmeier ◽  
M. S. Roosmalen ◽  
L. C. G. Josette Verhoef ◽  
E. H. M. Hoekstra-Weebers ◽  
J. C. Oosterwijk ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision

Shared Decision Making to Increase Family Involvement in the Care of Consumers With SMI

2013 ◽  
Author(s):  
Shirley M. Glynn ◽  
Lisa Dixon ◽  
Amy Cohen ◽  
Amy Drapalski ◽  
Deborah Medoff ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Family Involvement ◽  
Shared Decision

Shared-Decision-Making

2018 ◽  
Vol 09 (06) ◽  
pp. 250-252
Author(s):  
Rainer Bubenzer
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Partizipative Entscheidungsfindung ◽  
Shared Decision ◽  
Sich Eine

Auch in der Onkologie hat das Thema Patientenbeteiligung zunehmend an Bedeutung gewonnen. Ein häufig genanntes Mantra dazu lautet: Viele Patienten wünschen sich eine aktivere Rolle bei der eigenen Gesundheitsversorgung, am besten auf „Augenhöhe“. Ein Ansatz, der solche Wünsche berücksichtigt, ist die partizipative Entscheidungsfindung (PEF, shared-decision-making). Auch auf gesundheitspolitischer Ebene spielt PEF eine wachsende Rolle, wird z. B. im Rahmen des Nationalen Krebsplans spezifisch gefördert (►siehe Kasten). Ob und wieweit diese ambitionierten Ziele in der Onkologie in der Versorgungswirklichkeit angekommen sind, war eines der Themen beim 17. Deutschen Kongress für Versorgungsforschung in Berlin. Es zeigte sich: PEF ist in vielen Bereichen der Onkologie noch längst nicht angekommen.

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