The Impact of the Patient Self-Determination Act's Requirement That States Describe Law concerning Patients' Rights

1993 ◽  
Vol 21 (1) ◽  
pp. 102-108 ◽  
Author(s):  
Joan M. Teno ◽  
Charles Sabatino ◽  
Lauren Parisier ◽  
Fenella Rouse ◽  
Joanne Lynn
Keyword(s):  
Advance Directives ◽  
Medical Decision Making ◽  
The State ◽  
Self Determination ◽  
State Agency ◽  
Medical Decision ◽  
Patients Rights ◽  
Written Information ◽  
The Impact ◽  
Written Description

As of December 1991, the Patient Self-Determination Act (PSDA) mandated that health care institutions which receive funding from Medicare or Medicaid provide written information about persons rights to participate in medical decision-making and formulate advance directives. The PSDA required each state…acting through a State agency, association, or other private nonprofit entity develop a written description of the law of the State (whether statutory or as recognized by the courts of the State) concerning advance directives that would be distributed by providers or organizations under the requirements of [the Act].

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.

Evaluating the Differential Impact of Interventions to Promote Self-Determination and Goal Attainment for Transition-Age Youth with Intellectual Disability

2018 ◽  
Vol 43 (3) ◽  
pp. 165-180 ◽  
Author(s):  
Karrie A. Shogren ◽  
Kathryn M. Burke ◽  
Mark H. Anderson ◽  
Anthony A. Antosh ◽  
Michael L. Wehmeyer ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Rhode Island ◽  
Goal Attainment ◽  
Transition Planning ◽  
School Context ◽  
Transition Services ◽  
The State ◽  
Self Determination ◽  
Differential Impact ◽  
The Impact

This study examined the differential impact of implementing the Self-Determined Learning Model of Instruction (SDLMI) alone with implementing the SDLMI combined with Whose Future Is It? with transition aged students with intellectual disability in a cluster randomized trial in the state of Rhode Island. The state of Rhode Island is implementing systemic change in transition services and supports under the auspices of a Consent Decree entered into by the state with the U.S. Department of Justice. One area of focus is promoting self-determination during transition planning in the school context as a means to affect employment trajectories. This study focused on the impact of self-determination instruction on self-determination outcomes while youth were still in school, given research establishing a relationship between self-determination and employment outcomes. Latent mediation models suggested that students in the SDLMI-only group reported significant increases in their self-determination scores from baseline to the end of the year, and teachers of students in the SDLMI-only group saw students’ goal attainment as predicting change in self-determination over the course of the year. Teachers reported significant changes in student self-determination in the SDLMI + Whose Future Is It? group. Implications for individualizing interventions to teach skills associated with self-determination in the context of planning and setting goals for the transition to integrated employment are discussed.

Informed Consent and Advance Directives

2004 ◽  
Vol 94 (2) ◽  
pp. 198-205
Author(s):  
Jay M. Baruch
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
End Of Life ◽  
Advance Directives ◽  
Medical Decision Making ◽  
Informed Decision ◽  
Ethical Framework ◽  
Medical Decision ◽  
Informed Decision Making ◽  
Popular Belief

Contrary to popular belief, a patient’s signature on a piece of paper does not constitute informed consent. This article describes the ethical framework of consent in the context of the larger process of informed decision making. The elements of informed consent are examined in practical terms. Common pitfalls are addressed, with strategies to help anticipate and resolve possible dilemmas. These important tools are integral to all levels of medical decision making, including those at the end of life. (J Am Podiatr Med Assoc 94(2): 198-205, 2004)

Implications of the patient self-determination act: Guidelines for involving adolescents in medical decision making

1996 ◽  
Vol 19 (5) ◽  
pp. 319-324 ◽  
Author(s):  
Mary Ann McCabe ◽  
Cynthia H. Rushton ◽  
Jacqueline Glover ◽  
Melinda G. Murray ◽  
Sanford Leikin
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Self Determination ◽  
Medical Decision ◽  
Patient Self Determination Act

The impact of “significant others” on breast cancer patients’ treatment decision making.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 20-20
Author(s):  
Suepattra G. May ◽  
Katharine Rendle ◽  
Meghan Halley ◽  
Nicole Ventre ◽  
Allison W. Kurian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Patients ◽  
Medical Decision Making ◽  
Treatment Decision ◽  
Significant Others ◽  
Medical Decision ◽  
Breast Cancer Patients ◽  
Treatment Decision Making ◽  
The Impact

20 Background: Shared medical decision making (SDM) has been lauded by advocates for its potential to democratize the patient-physician relationship. However, the practice of SDM is still conceived of as largely a dyadic moment that exists between the patient and the physician. Few studies have looked at the role of significant others (spouses, partners, family members and friends) in decision making or considered how discussions and actions outside the consultation room affect a patient’s medical decisions. This prospective study investigated the impact of significant others on the decision making deliberations of newly diagnosed breast cancer patients. Methods: Forty-one newly diagnosed breast cancer patients were interviewed at four critical time points throughout treatment to explore how they deliberated decisions with both care providers and significant others. Surveys assessing HRQOL, role preferences and treatment satisfaction along with EHR abstraction augmented interview data. Grounded theory analysis was used to identify recurrent themes in the qualitative data, and survey data were analyzed using IBM SPSS Statistics 20. Results: Emergent themes from our analysis identified several factors that patients consider when faced with cancer treatment decisions, including 1) presentation of treatment options 2) patient or significant other conflict/concordance with care team recommendations 3) perceived risk of recurrence and 4) short and long term impact of treatment on daily life. Participants stressed the need for clinicians to view patients beyond diagnosis and recognize their larger care network as influential factors in their decision making. Conclusions: Our interviews highlight how the current healthcare delivery structure rarely acknowledges the circles of care that can exert influence on decision making. Lack of attention to non-clinical others can lead to sub-optimal medical decision making because these influences are not adequately understood by clinicians. Findings from this study suggest the need to enhance clinicians’ and researchers’ understanding of the influence of others in patients’ treatment decision making, enabling them to intervene in these practices.

scholarly journals Implementing Triage Standing Orders in the Emergency Department Leads to Reduced Physician-to-Disposition Times

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Charles W. Hwang ◽  
Thomas Payton ◽  
Emily Weeks ◽  
Michelle Plourde
Keyword(s):  
Emergency Department ◽  
Retrospective Cohort ◽  
Medical Decision Making ◽  
Medical Director ◽  
Diagnostic Assessment ◽  
Medical Decision ◽  
Ed Crowding ◽  
Assessment Strategies ◽  
The Impact ◽  
Disposition Time

Emergency departments (EDs) throughout USA have improvised various processes to curb the “national epidemic” termed ED “crowding.” Standing orders (SOs), one such process, are medical orders approved by the medical director and entered by nurses when patients cannot be seen expeditiously, expediting medical decision-making and decreasing length of stay (LOS) and time to disposition. This retrospective cohort study evaluates the impact of SOs on ED LOS and disposition time at a large university ED. Results indicate that SOs significantly improve ED throughput by reducing disposition time by up to 16.9% (p=0.04), which is especially significant in busy ED settings. SOs by themselves are not sufficient for a complete diagnostic assessment. Strategies such as having a provider in the waiting area may help make key decisions earlier.

Strategic identity

Thesis Eleven ◽  
2018 ◽  
Vol 145 (1) ◽  
pp. 38-57 ◽  
Author(s):  
Albert E. Alejo
Keyword(s):  
Indigenous Peoples ◽  
Local Community ◽  
The State ◽  
Self Determination ◽  
The Many ◽  
The Impact

This article introduces the concept of ‘strategic identity’ as a bridge between the indigenous peoples’ struggle for self-determination and their search for solidarity in the context of globalization, with a focus on the Lumads, or indigenous peoples in southern Philippines. The paper begins with an encounter with a global actor affecting a local community. We realize the impact of powerful, well-networked forces that challenge even the operation of the state. Without trivializing the threats associated with this model of globalization, we also insist that a realistic and hopeful approach may emerge if we acknowledge the many ‘selves’ in the indigenous peoples’ self-determination. At the heart of this proposal is a matrix that unpacks the complex ways that local, national, sectoral, and global actors can engage in conflict or solidarity with these strategic identity assertions. Solidarity work, then, becomes diversified and strategized in response to the evolving multiple indigenous identities that modernity paradoxically both endangers and engenders.

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