Disputes about the Withdrawal of Treatment: The Role of the Courts

2004 ◽  
Vol 32 (4) ◽  
pp. 701-707 ◽  
Author(s):  
Loane Skene
Keyword(s):  
Decision Making ◽  
Human Rights ◽  
Medical Advice ◽  
Treatment Regime ◽  
Best Interests ◽  
Against Medical Advice ◽  
Turn On ◽  
Limited Success ◽  
Withdrawal Of Treatment

It is commonly said that patients (or their representatives) have no right to demand that treatment must be continued when medical carers believe it is “futile” to continue it. There are certainly many judicial statements to this effect, some of which are quoted in this paper. However, there are various ways that courts can intervene, even if they do not order directly that treatment must be provided or continued. First, patients or their representatives may argue the process of decision making was unfair or that they were unfairly discriminated against when treatment has been refused. To date, these arguments have met with limited success so far as enabling patients to have treatment provided or continued against medical advice. More recently, however, some patients have challenged the lawfulness of a proposed treatment regime by advancing human rights arguments, based in turn on a broader aspect of patients’ “best interests” than best medical interests.

scholarly journals Discharge against medical advice (DAMA) in paediatrics: An approach to promote safety and ethics

2019 ◽  
Vol 25 (1) ◽  
pp. 12-15
Author(s):  
Aifric Kavanagh ◽  
Olivia Ostrow ◽  
Randi Zlotnik Shaul
Keyword(s):  
Decision Making ◽  
Medical Advice ◽  
Informed Decision ◽  
Best Interests ◽  
Informed Decision Making ◽  
Process Map ◽  
Against Medical Advice ◽  
Professional Obligations ◽  
Discharge Against Medical Advice ◽  
Reference Tool

Abstract Requests for discharge against medical advice are often challenging for clinicians to navigate, especially when the patient is a child. An informed, standardized approach to managing situations where children and their families are requesting to leave against medical advice is essential to maximizing safety and ethics for patients and staff, yet such situations are often not handled this way. Paediatric discharge against medical advice (DAMA) requests are best managed when clinicians ensure the patient’s best interests are met, understand and act upon their professional obligations, and engage in guided discussion with patients and families that involves both shared and informed decision-making strategies. A process map can capture these criteria and readily provide clinicians with a bedside reference tool when managing paediatric DAMA requests.

Working Toward Recognition of the Rights of Migrant and Refugee Children

2020 ◽  
pp. 674-695
Author(s):  
Sarah Paoletti
Keyword(s):  
Human Rights ◽  
Civil War ◽  
Best Interests ◽  
Refugee Children ◽  
Next Generation ◽  
Rights Of The Child

This chapter addresses the rights of migrant and refugee children who increasingly are forced into migration, either alone or with members of their family, due to violence, civil war, poverty, economic degradation, and other often-intersecting factors. While addressing the rights and obligations set forth in the Convention on the Rights of the Child and other international and regional human rights instruments, the chapter further seeks to bring attention to the complexity and fluidity of migration and the motives that spurn migration; the role of family in serving the child’s best interests; and the scope of considerations that must be accounted for in seeking to ensure that the next generation of immigrants is positioned to thrive.

The role of patient-provider interactions: Using an accounts framework to explain hospital discharges against medical advice

2016 ◽  
Vol 156 ◽  
pp. 106-113 ◽  
Author(s):  
Helen-Maria Lekas ◽  
David Alfandre ◽  
Peter Gordon ◽  
Katherine Harwood ◽  
Michael T. Yin
Keyword(s):  
Medical Advice ◽  
Hospital Discharges ◽  
Against Medical Advice

scholarly journals The judgment of crimes against humanity in Brazil: Analysis through the critical criminological lens of lola aniyar

2021 ◽  
pp. 47135-47145
Keyword(s):  
Decision Making ◽  
Human Rights ◽  
Supreme Court ◽  
Ad Hoc ◽  
Lewis Carroll ◽  
Crimes Against Humanity ◽  
Military Dictatorship ◽  
Criminal Control ◽  
Decision Making Rule

In this article we discuss two recent Brazilian Supreme Court judgments about crimes committed during the civil-military dictatorship: Allegation of Disobedience of Fundamental Precept suit n. 153 (constitutionality of the 1979 amnesty law), and Extradition suit n. 1362, that discussed the extradition of an Argentine citizen who was convicted of committing crimes against humanity during the Argentine dictatorship). We analyze the role of the Brazilian Supreme Court in the (re) construction of the “criminal problem” and “criminal control” in relation to crimes against humanity perpetrated during the periods of the Argentine (1978-1983) and Brazilian (1964-1985) dictatorship. We take Lola Aniyar de Castro Thought’s, seeking some inspiration, for whom the criminology of the 21st Century is the “criminology of human rights”, and criminal control would be the thermometer of human rights. In the last part of this article, we discussed what seems to have been “the triumph of Lewis Carroll”, in the metaphor of reversing meanings: when protecting human rights is not to protect human rights, by creating an ad hoc decision-making rule from which “remembering is to forget”, and “forgetting is to remember”, provided that, from the peculiar Rule n. 42, the investigation and accountability for crimes against humanity are not allowed.

scholarly journals Epistemic and ethical responsibility during the pandemic

2021 ◽  
Vol 11 (3-4) ◽  
pp. 117-125
Author(s):  
Andrea Klimková
Keyword(s):  
Decision Making ◽  
Human Rights ◽  
Moral Philosophy ◽  
Ethical Responsibility ◽  
Policy Makers ◽  
Moral Principles ◽  
Policy Responses ◽  
Actual Content ◽  
Political Decisions

Abstract Intellectual (specialised) knowledge is omnipresent in human lives and decisions. We are constantly trying to make good and correct decisions. However, responsible decision-making is characterised by rather difficult epistemic conditions. It applies all the more during the pandemic when decisions require not only specialised knowledge in a number of disciplines, scientific consensus, and participants from different fields, but also responsibility and respect for moral principles in order to ensure that the human rights of all groups are observed. Pandemic measures are created by politicians, healthcare policy-makers, and epidemiologists. However, what is the role of ethics as a moral philosophy and experts in ethics? Experts in ethics and philosophy are carefully scrutinising political decisions. Levy and Savulescu (2020) have claimed that Ethicists and philosophers are not epistemically arrogant if they question policy responses. They played an important role in the creation of a reliable consensus. This study analyses epistemic and moral responsibility, their similarities, analogies, and differences. Are they interconnected? What is their relationship and how can they be filled with actual content during the pandemic?

scholarly journals European Court of Human Rights and right to respect for family life: the role of the best interests of the child in establishing equality between divorced parents

2017 ◽  
Vol 4 (1) ◽  
pp. 48-70
Author(s):  
Kyriaki Patsianta
Keyword(s):  
Human Rights ◽  
Sexual Orientation ◽  
Family Life ◽  
Best Interests ◽  
Parental Rights ◽  
Member States ◽  
European Court ◽  
Methods Of Evaluation

This article discusses the European concept of the best interests of the child forged by the European Court of Human Rights in cases concerning family life. The Strasbourg Court does not determine in a detailed way all the aspects of the child’s best interests in a case presented before it. It forges its minimum content while the Member States are free to complete its construction.This European minimum content contains two branches: the conceptual principles and the methods of evaluation. An analysis on specific judgments of the Court regarding equality between divorced parents in parental rights allocation provides a concrete example of how these two branches are constructed by it. The alleged discriminatory treatment relates to issues like religion, sexual orientation, transsexualism.

Role of Aboriginal Health Workers and Liaison Officers in quality care in the Australian acute care setting: a systematic review

2020 ◽  
Vol 44 (3) ◽  
pp. 427 ◽  
Author(s):  
Tamara Mackean ◽  
Elizabeth Withall ◽  
Judith Dwyer ◽  
Annabelle Wilson
Keyword(s):  
Acute Care ◽  
Continuity Of Care ◽  
Care Setting ◽  
Health Workers ◽  
Quality Care ◽  
Medical Advice ◽  
Acute Care Setting ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice

ObjectiveThe aim of this study was to identify the contribution of Aboriginal Health Workers and Liaison Officers (AHWLOs) to quality of care in the acute health care setting in Australia. MethodsA systematic review of peer-reviewed literature focused on the role of AHWLOs and quality processed and quality outcomes. Authors undertook study selection based on inclusion criteria and performed quality assessment using critical appraisal tools from the Joanna Briggs Institute. ResultsThe search revealed limited literature that met the inclusion criteria, namely four quantitative studies and one mixed-methods study. The settings of the included studies were mental health and cardiac care units within various hospitals. The studies indicated that AHWLOs may have a positive effect on communication between healthcare professionals and patients, rates of discharge against medical advice and continuity of care. Methodological constraints among the included studies made it difficult to establish specific contributions of AHWLOs to quality care markers across acute care units. ConclusionsThe role of AHWLOs in providing quality care in the acute care setting has received minimal research. The limited existing research highlights the importance of the AHWLO role. For example, AHWLOs may influence patient communication, discharge against medical advice and continuity of care within mental health and cardiac care units. Further, because of methodological constraints among the limited studies, research into the role of AHWLOs in these and other acute care settings is needed to assess effects on a range of specific clinical quality markers. What is known about the topic?Aboriginal and Torres Strait Islander people experience unacceptable health inequities. AHWLOs are a unique workforce introduced to increase access to culturally safe care and, ultimately, help to address these inequities. What does this paper add?This review explores the current evidence for the contribution of AHWLOs to quality care in the acute care setting. The findings suggest that these professionals may improve communication between patients and medical staff, improve continuity of care and reduce patient discharge against medical advice. However, these findings highlight that the use of quality care markers across acute care settings is needed to generate tangible evidence to help establish the legitimacy of these health professionals. What are the implications for practitioners?AHWLOs have a place in the acute care team. Although further research is required to expand the preliminary evidence base of their effect on quality acute care, this workforce should be supported at the individual, organisational and policy levels to enhance the health and well-being of one the most vulnerable communities in Australia.

scholarly journals The Politics of Hate Speech: A Case Comment on Warman v Lemire

2012 ◽  
Vol 19 (1, 2 & 3) ◽  
pp. 2011
Author(s):  
Ranjan K. Agarwal
Keyword(s):  
Decision Making ◽  
Human Rights ◽  
Supreme Court ◽  
Hate Speech ◽  
Freedom Of Expression ◽  
Court Ruling ◽  
Supreme Court Ruling ◽  
Teleological Reasoning ◽  
Academic Debate

In September 2009, the Canadian Human Rights Tribunal waded into a highly public and acrimonious debate about the role of human rights tribunals and commissions, especially in policing hate speech. In Warman v Lemire,1 the Tribunal held that section 13(1) of the Canadian Human Rights Act2 (CHRA), which prohibits the communication of hate messages, infringed the constitutional guarantee of freedom of expression, section 2(b) of the Charter of Rights and Freedoms.3 The decision added to a firestorm of media, political and academic debate about whether anti-discrimination statutes should prohibit hate speech. The Warman decision is complicated by a twenty-year-old Supreme Court ruling, in a 4–3 decision, that a predecessor provision in the CHRA is constitutional. In this article, I argue that the Tribunal’s decision is logically unsound and likely the result of ends-based or teleological reasoning. In my view, ends-based reasoning does not assist in Charter analysis as it produces decisions that call into question the legitimacy of the courts. This article first outlines the facts in Warman and the Tribunal’s holding on the constitutional issues. It goes on to survey the legal and constitutional background to the Warman decision and discuss the Taylor precedent. It then describes the Tribunal’s reasoning on constitutional issues, including the Taylor decision and amendments to the CHRA after Taylor. Finally, it criticizes the Tribunal’s ends-based reasoning and argues that this type of reasoning is illegitimate in constitutional decision-making.

Surrogate Decision-making for Incompetent Elderly Patients: The Role of Informal Representatives

2012 ◽  
Vol 19 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Sjef Gevers ◽  
Joseph Dute ◽  
Herman Nys
Keyword(s):  
Decision Making ◽  
Best Interests ◽  
Surrogate Decision Making ◽  
Next Of Kin ◽  
Incompetent Patient ◽  
The Law ◽  
European Standards ◽  
Surrogate Decision ◽  
Informal Approach

Abstract Informal or unofficial representation refers to the practice (more common in some European jurisdictions than in others), that persons not designed by a court or by the patient himself, make medical decisions on the patient’s behalf in case of their incompetence. If the law provides for this, it is usually next of kin (spouse, children, brothers and sisters, etc.) who are allowed to act in such a capacity. Informal representation raises several questions. Are family members always familiar with what their relative would have wished, ready to take responsibility, and not too much reigned by their emotions? The basic legal concern is whether there are sufficient procedural and other safeguards to protect the incompetent patient from representatives who do not serve their best interests. In addressing these issues, after a brief survey of the law in the Netherlands as compared with that in Belgium, Germany and England/Wales, we will argue that informal representation as such is not at variance with international and European standards. However, an ‘informal’ approach to surrogate decision-making should always go together with sufficient protection of the incompetent patient, including procedural safeguards with regard to the decision that the patient is incompetent, limits to the decision-making power of informal representatives and effective forms of conflict resolution.

scholarly journals “Thinking Too Much”: A Clash of Legitimate Values in Clinical Practice Calls for an Indaba Guided by African Values-Based Practice

2020 ◽  
pp. 179-187
Author(s):  
Werdie Van Staden
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
General Practitioner ◽  
Antipsychotic Medication ◽  
Common Ground ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Difficult Decision ◽  
Decision Points ◽  
Major Decision

AbstractThis chapter applies African value-based practice (A-VBP) to the story of Akanya at two major decision points when values clashed: first between the general practitioner and Akanya’s parents when Akanya was acutely psychotic and required hospitalisation and second 8 years later, when Akanya wanted to discontinue his antipsychotic medication against medical advice. For both rather difficult decision points, the story illustrates how an indaba within A-VBP served as a practical process to take seriously and account for values that were clashing (i.e., uncommon ground), framed by values that were shared (i.e., common ground). The story underscores that dissensual decision-making affords more than default responses such as “I offer only what is medically best—take it or leave it” or alternatively “whatever the patient wants.”

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