scholarly journals Temporising and respect for patient self-determination

2018 ◽  
Vol 45 (3) ◽  
pp. 161-167
Author(s):  
Jenny Lindberg ◽  
Mats Johansson ◽  
Linus Broström
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Professional ◽  
Real World ◽  
Clinical Ethics ◽  
Crucial Role ◽  
Self Determination ◽  
Academic Literature ◽  
Decision Making Capacity

The principle of self-determination plays a crucial role in contemporary clinical ethics. Somewhat simplified, it states that it is ultimately the patient who should decide whether or not to accept suggested treatment or care. Although the principle is much discussed in the academic literature, one important aspect has been neglected, namely the fact that real-world decision making is temporally extended, in the sense that it generally takes some time from the point at which the physician (or other health care professional) determines that there is a decision to be made and that the patient is capable of making it, to the point at which the patient is actually asked for his or her view. This article asks under what circumstances, if any, temporising—waiting to pose a certain treatment question to a patient judged to have decision-making capacity—is compatible with the principle of self-determination.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2018 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

“The Right to Make Choices”: The National Resource Center for Supported Decision-Making

Inclusion ◽  
2015 ◽  
Vol 3 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Peter Blanck ◽  
Jonathan G. Martinis
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Decision Making ◽  
Daily Life ◽  
Self Determination ◽  
Life Choices ◽  
Resource Center ◽  
Independent Life ◽  
The Right ◽  
National Resource

Abstract Research shows that self-determination and the right to make life choices are key elements for a meaningful and independent life. Yet, older adults and people with disabilities are often placed in overly broad and restrictive guardianships, denying them their right to make daily life choices about where they live and who they interact with, their finances, and their health care. Supported decision-making (SDM)—where people use trusted friends, family members, and professionals to help them understand the situations and choices they face, so they may make their own decisions—is a means for increasing self-determination by encouraging and empowering people to make decisions about their lives to the maximum extent possible. This article examines the implications of overly broad guardianship and the potential for supported decision-making to address such circumstances. It introduces the National Resource Center for Supported Decision-Making as one means to advance the use of supported decision-making and increase self-determination.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2016 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

Information System for Management of Organisation and Its Activity

2010 ◽  
pp. 511-532
Author(s):  
Lorenzo Ros McDonnell ◽  
Salvador Guillen Salazar
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Information System ◽  
Real World ◽  
Health Care Organization ◽  
Care Organization ◽  
Organization Model ◽  
Organization Management ◽  
Computer Based ◽  
Operation Control

Health care organization management needs modeling techniques that allows to explain and manage it as the real world it self. This similarity between real world and model represents the key of success. A model characteristic represents the guide lines to manage it, and if this model is represented with a data model and an Information system it makes possible to be implemented in a computer based system. This chapter offers a hierarchical representation model and with different model views of the health care organizations, allowing being applied the business integration architecture, it is a way to transfer the organization approaches from the Industrial world to the Health Care world. To reach it is necessary to represent all the activities performed by a health care organization with the process map, linking the map with the structures of the organization that connects the different map points (resource-operation), developing the organization model. It is necessary that the decision making rules are implemented in the organization model to include in it the “intelligence”. The decision making rules to reach the organization rules are the Planning and Operation control system, and though it can be integrated the goals, activity and resources.

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