scholarly journals How should the ‘privilege’ in therapeutic privilege be conceived when considering the decision-making process for patients with borderline capacity?

2020 ◽  
Vol 47 (1) ◽  
pp. 47-50 ◽  
Author(s):  
Sumytra Menon ◽  
Vikki Entwistle ◽  
Alastair Vincent Campbell ◽  
Johannes J M van Delden
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Well Being ◽  
Relevant Information ◽  
Mental Capacity ◽  
Decision Making Process ◽  
The Novel ◽  
The Individual ◽  
Therapeutic Privilege ◽  
Court Of Appeal

Therapeutic privilege (TP) is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapore Court of Appeal introduced a novel interpretation of TP, identifying circumstances in which it might be used with patients who did not strictly lack capacity but might be inclined to refuse recommended treatments. In this paper, we explore the conceptual and practical challenges of this novel interpretation of TP. We propose that more emphasis should be placed on forms of shared and supported decision-making that foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being. The kind of privilege that doctors might need to invoke is one of time and supportive expertise to ensure a flexible, responsive approach calibrated to the individual patients’ needs. The provision of such service would extinguish the need for the novel TP proposed by the Singapore Court of Appeal.

Autonomy as a Goal of Psychotherapy

2019 ◽  
Author(s):  
Paul Biegler
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Personal Autonomy ◽  
Well Being ◽  
Psychological Disorder ◽  
Self Determination ◽  
Major Threat ◽  
Effective Decision ◽  
Effective Decision Making ◽  
Therapeutic Privilege

Personal autonomy describes the exercise of self-determination through informed and rational decisions that reflect an agent’s authentic values. The nexus between autonomy and psychotherapy is broad, with both respect for client autonomy through informed consent, and promotion of client autonomy through therapy itself representing key instances of the significance of autonomy in the consulting room. While inadequate disclosure of information poses a major threat to personal autonomy, so too do unjustified paternalism, coercion, and the injudicious use of therapeutic privilege. The capacity of psychotherapy to promote client autonomy, evidenced by more effective decision-making during periods where the risk of recurrent illness is high, is argued to be a key advantage of psychotherapy over treatment with medication alone. Ultimately, enhanced autonomy is a goal of treatment grounded in a more defensible conception of well-being for people with psychological disorder and, it is concluded, should be sought specifically through psychotherapy.

Sterilization of Women Who Are Mentally Handicapped

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 868-871
Author(s):  
Keyword(s):  
Decision Making ◽  
Mental Capacity ◽  
Future Research ◽  
Decision Making Process ◽  
Mentally Handicapped ◽  
Surgical Sterilization ◽  
Recent Statement ◽  
The Individual ◽  
Two Alternatives ◽  
Pharmacological Control

The recent statement of the American College of Obstetricians and Gynecologists on the sterilization of mentally handicapped women (REF) is comprehensive and is endorsed in principle and substance by this Committee. As pediatricians, we reinforce and reiterate the following: 1. With rare exception, there is no indication for sterilization of a child before menarche. An example is when sterilization is not intended, but is an unavoidable consequence of other surgery, such as surgery for a malignancy. 2. The primary or contributing indications for sterilization (particularly surgical sterilization) based on presumed or anticipated hardships to others must be viewed with great reservation and in light of acceptable alternate care arrangements which might be made for the mentally retarded individual. The judgment of "hardship" is extremely subjective and must not be simply a matter of inconvenience or a preference for the easier of two alternatives. 3. When sterilization or pharmacological control of menses is chosen after the appropriate informed deliberations and attempts at obtaining consent, the pediatrician should always advocate the least permanent and intrusive methodology consistent with lowest risk for the patient. Present and future research and clinical trials may very well make newer forms of chemical contraception or pharmacologic amenorrhea preferable to surgical sterilization. 4. Even if satisfactory informed consent cannot be provided by the patient, all efforts must be made to communicate the procedure and intent of the planned intervention to the patient; estimations of the patient's ability to comprehend and participate in the decision-making process should be done by personnel who are familiar with the individual patient and who are experienced in communication with persons with diminished mental capacity.

Relevant information and the Mental Capacity Act

2019 ◽  
Vol 24 (2) ◽  
pp. 71-75 ◽  
Author(s):  
Oluwatoyin A Sorinmade
Keyword(s):  
Decision Making ◽  
Relevant Information ◽  
Decision Making Process ◽  
Patient Needs ◽  
Decisional Capacity ◽  
Correct Determination ◽  
Mental Capacity Act ◽  
The Individual

Implicit in the assertion that an individual has consented to/has capacity to decide, is the concept that the individual has understood that which needed to be understood, retained the same and used/weighed this information as part of their decision-making process and thereafter communicated their wishes in whatever way possible. What invariably underpins the decision-making process is the information available to the individual (relevant information) and how this information is influenced by the functioning of their mind/brain. Consent given without an individual having processed the information relevant to the decision at hand is arguably invalid. This paper seeks to draw attention to the underpinning role of “what the patient needs to know” – (relevant information) in the correct determination of an individual's decisional capacity.

The transformation of the decision-making process on the part of economic agents influenced by social constraints

2020 ◽  
Vol 16 (7) ◽  
pp. 1202-1222
Author(s):  
M.V. Grechko ◽  
L.A. Kobina ◽  
S.A. Goncharenko
Keyword(s):  
Decision Making ◽  
Consumer Choice ◽  
Social Constraints ◽  
Decision Making Process ◽  
Economic Knowledge ◽  
Economic Agents ◽  
The Individual ◽  
Contextual Environment ◽  
Economic Constraints ◽  
External Signals

Subject. The article focuses on the decision-making mechanism used by economic agents given the existing social constraints. Objectives. We devise applied toolkit to study how socio-economic constraints transform the decision-making mechanism used by economic agents. Methods. The study involves means of the expert survey, the method that streamlines economic knowledge. Results. Social constraints are illustrated to influence the decision-making mechanism used by economic agents, assuming that the individual mind relies on specific mechanisms to make judgments and decisions. Generally, the mechanisms are very useful, however they may generate serious errors during the decision-making process. Given the social constraints, economic agents were found to follow four mental models to make their decisions in case of the full or partial uncertainty, i.e. the representative relevance, accessibility, relations, heuristics (modeling). Conclusions and Relevance. The scientific ideas herein show that the inner architecture of a choice an individual makes determines his or her decisions. The decisions often depend on the contextual environment that gives external signals perceived by the individual while evaluating alternative ways. The findings can possibly be used as a mechanism to manage the consumer choice.

scholarly journals HESR innovation in analysis that supports decision making and action

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B Barr
Keyword(s):  
Decision Making ◽  
Health Equity ◽  
Social Protection ◽  
Well Being ◽  
Status Report ◽  
Policy Performance ◽  
European Health ◽  
The Individual ◽  
Health And Well Being ◽  
Inform Decision Making

Abstract The European Health Equity Status Report makes innovative use of microdata, at the level of the individual, to decompose the relative contributions of five essential underlying conditions to inequities in health and well-being. These essential conditions comprise: (1) Health services (2) Income security and social protection (3) Living conditions (4) Social and human capital (5) Employment and working conditions. Combining microdata across over twenty sources, the work of HESRi has also produced disaggregated indicators in health, well-being, and each of the five essential conditions. In conjunction with indicators of policy performance and investment, the HESRi Health Equity Dataset of over 100 indicators is the first of its kind, as a resource for monitoring and analysing inequities across the essential conditions and policies to inform decision making and action to reduce gaps in health and well-being.

Exploring ethical aspects of elective surgery patients’ decision-making experiences

2012 ◽  
Vol 20 (6) ◽  
pp. 672-683 ◽  
Author(s):  
Mei-Ling Lin ◽  
Chuen-Teng Huang ◽  
Hsien-Hsien Chiang ◽  
Ching-Huey Chen
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Healthcare Professionals ◽  
Elective Surgery ◽  
Phenomenological Approach ◽  
Healthcare Personnel ◽  
Decision Making Process ◽  
Ethical Aspects ◽  
Southern Taiwan ◽  
Colaizzi's Method

The practice of respecting patients’ autonomy is rooted in the healthcare professionals’ empathy for patients’ situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients’ experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi’s method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes emerged from the analyses: (a) a voluntary yet necessary alternative—to undergo a surgery and (b) alternatives compelled by the unalterable decision—the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel.

scholarly journals Studi tentang Motivasi ARMY Jakarta dalam Membeli Merchandise Idola (Studi Kasus Kaos Uniqlo X BT21)

Prologia ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. 128
Author(s):  
Johanna Ruthllianie ◽  
Diah Ayu Candraningrum
Keyword(s):  
Decision Making ◽  
Parasocial Interaction ◽  
Decision Making Process ◽  
Consumer Decision Making ◽  
Consumer Decision ◽  
Consumer Motivation ◽  
Individual Motivation ◽  
Public Figures ◽  
The Individual

This research attempts to adopt the individual motivation behind the decision in purchasing an idol merchandise. In addition the resources focused on the concept of consumer motivation and the consumer decision making process. The concept of motivation includes sources of motivation, divided into motivational intrinsic and motivation extrinsic. While the consumer decision-making process is divided into five steps which are recognized the need, looking for information, evaluation of decision, buying decision, and the consumer behavior after purchasing. The researcher uses a case study of the shirt Uniqlo X BT21 with qualitative method. The results of the research which is the consumer motivation lead to purchasing a Uniqlo X BT21 shirt. Parasocial interaction in fact can influence consumers to purchase merchandise. The more closely the relation between society can lead to higher motivation to purchase the needs. The collaboration between Uniqlo and BTS succeeds in attracting the fans. The results of collaboration between brand and public figures now is a strategy for creating promotional products. Entrepreneurs, who also use this strategy need to see the opportunity by using this phenomenon. Penelitian ini mengangkat tentang motivasi individu dalam keputusan pembelian merchandise idola. Konsep yang digunakan yaitu motivasi dan keputusan pembelian. Konsep motivasi meliputi sumber motivasi, yaitu melalui motivasi intrinsik dan motivasi ekstrinsik. Sedangkan untuk keputusan pembelian melalui lima tahapan yaitu, mengenali kebutuhan, pencarian informasi, evaluasi alternatif, keputusan pembelian dan perilaku pasca pembelian. Penelitian ini menggunakan studi kasus terhadap kaos Uniqlo X BT21 dengan metodologi kualitatif. Hasil penelitian ini yaitu motivasi yang menyebabkan pembelian kaos Uniqlo X BT21. Interaksi parasosial terbukti mampu untuk mempengaruhi pembelian merchandise. Semakin lekat sebuah hubungan parasosial, maka akan semakin tinggi motivasi minat beli. Kolaborasi yang diadakan Uniqlo dengan BTS dapat dikatakan berhasil menarik minat penggemar. Sehingga kolaborasi merek dan public figure kini merupakan sebuah strategi yang dapat dilakukan untuk mempromosikan produk. Pebisnis perlu melihat peluang yang hadir dalam fenomena tersebut.

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