Parents As Decision-Makers — Do the Attitudes of Norwegian Doctors Conform to Law?

2011 ◽  
Vol 18 (5) ◽  
pp. 531-547 ◽  
Author(s):  
Marianne K. Bahus ◽  
Reidun Føerde
Keyword(s):  
End Of Life ◽  
Decision Makers ◽  
Best Interests ◽  
Final Decision ◽  
End Of Life Decisions ◽  
Legal Rules ◽  
Hypothetical Scenario ◽  
The Supreme Court ◽  
Surrogate Decision ◽  
The Right

AbstractThis article studies whether the attitudes of Norwegian doctors regarding surrogate decision power in end-of-life care conform to legal rules, particularly as they apply to the protection of children. The article is based on a hypothetical scenario concerning a critically ill child, believed to be dying, presented to 406 doctors. The study indicates that doctors may permit parental/surrogate decision-making to a greater extent than justified by law, sometimes in contravention of the child’s best interests, which should be a fundamental guideline in all decisions that concern children. This article suggests a need to improve knowledge of doctors concerning parents’/surrogates’ right to participate in life-or-death decisions. We conclude that Norway needs a precedent decision from the Supreme Court that confirms the right of judicial review of end-of-life decisions, and which applies the principle of the child’s best interests as a fundamental guideline in the final decision.

scholarly journals The Association of Surrogate Decision Makers' Religious and Spiritual Beliefs With End-of-Life Decisions

2020 ◽  
Vol 59 (2) ◽  
pp. 261-269 ◽  
Author(s):  
Alexia M. Torke ◽  
George Fitchett ◽  
Saneta Maiko ◽  
Emily S. Burke ◽  
James E. Slaven ◽  
...  
Keyword(s):  
End Of Life ◽  
Decision Makers ◽  
Spiritual Beliefs ◽  
End Of Life Decisions ◽  
Surrogate Decision Makers ◽  
Life Decisions ◽  
Surrogate Decision

Medical treatment and best interests: judicial interpretation of values, wishes and beliefs under the Mental Capacity Act 2005

2020 ◽  
Vol 22 (3) ◽  
pp. 165-173
Author(s):  
Owen P. O'Sullivan
Keyword(s):  
Medical Treatment ◽  
Clinical Decision ◽  
Case Law ◽  
Decision Makers ◽  
Best Interests ◽  
Content Type ◽  
The Supreme Court ◽  
Mental Capacity Act 2005 ◽  
Mental Capacity Act ◽  
The Uk

Purpose The prominence of the best interests principle in the Mental Capacity Act 2005 represented an important transition to a more resolutely patient-centred model regarding decision-making for incapable adults (“P”). This paper aims to examine the courts’ consideration of P’s values, wishes and beliefs in the context of medical treatment, reflect on whether this has resulted in a wide interpretation of the best interests standard and consider how this impacts clinical decision makers. Design/methodology/approach A particular focus will be on case law from the Court of Protection of England and Wales and the Supreme Court of the UK. Cases have been selected for discussion on the basis of the significance of their judgements for the field, the range of issues they illustrate and the extent of commentary and attention they have received in the literature. They are presented as a narrative review and are non-exhaustive. Findings With respect to values, wishes and beliefs, the best interests standard’s interpretation in the courts has been widely varied. Opposing tensions and thematic conflicts have emerged from this case law and were analysed from the perspective of the clinical decision maker. Originality/value This review illustrates the complexity and gravity of decisions of the clinical decision makers and the courts have considered in the context of best interests determinations for incapacitated adults undergoing medical treatment. Subsequent to the first such case before the Supreme Court of the UK, emerging case law trends relating to capacity legislation are considered.

Beyond Willpower: Strategies for Reducing Failures of Self-Control

2018 ◽  
Vol 19 (3) ◽  
pp. 102-129 ◽  
Author(s):  
Angela L. Duckworth ◽  
Katherine L. Milkman ◽  
David Laibson
Keyword(s):  
Cognitive Intervention ◽  
Decision Makers ◽  
Self Control ◽  
Best Interests ◽  
Psychological Science ◽  
Contemporary Research ◽  
The Right ◽  
Do The Right Thing

Almost everyone struggles to act in their individual and collective best interests, particularly when doing so requires forgoing a more immediately enjoyable alternative. Other than exhorting decision makers to “do the right thing,” what can policymakers do to reduce overeating, undersaving, procrastination, and other self-defeating behaviors that feel good now but generate larger delayed costs? In this review, we synthesize contemporary research on approaches to reducing failures of self-control. We distinguish between self-deployed and other-deployed strategies and, in addition, between situational and cognitive intervention targets. Collectively, the evidence from both psychological science and economics recommends psychologically informed policies for reducing failures of self-control.

scholarly journals Treatment choice when faced with high risk of poor outcome – and response to decisions made by surrogates on their behalf

2020 ◽  
Vol 8 (11) ◽  
Author(s):  
Charlie Corke ◽  
Stella-May Gwini ◽  
Sharyn Milnes ◽  
Ben Jong ◽  
Neil Orford
Keyword(s):  
Online Survey ◽  
Treatment Choice ◽  
Decision Makers ◽  
Care Plan ◽  
Poor Outcome ◽  
Advance Care Plan ◽  
Hypothetical Scenario ◽  
Surrogate Decision Makers ◽  
Advance Care ◽  
Surrogate Decision

Faced with a high likelihood of poor outcome treatment choice is difficult and few people are certain about what they would, or would not, want. Recognising this we sought to explore how individuals react to hypothetical choices made on their behalf by surrogate decision-makers. We used an online survey, using a hypothetical scenario involving a 95% chance of poor outcome and 5% chance of good outcome. There were 510 participants. Most (63%) expressed uncertainty regarding preference for treatment. 37% expressed certainty (12% certainly wanting treatment and 25% certainly not wanting treatment). Seventy seven percent indicated they would be understanding or pleased if the surrogate chose to treat, while 92% were understanding or pleased with a decision not to treat by a surrogate decision maker. Patients who had expressed ‘certain’ wishes when presented with the scenario (either certainly wanting or certainly not wanting treatment) were more likely to be angry/upset when surrogates made the opposite decision. Those who had completed an Advance Care Plan (ACP) were more likely to be angry/upset when these wishes were not followed. This finding suggests it may be unrealistic to expect surrogate decision-makers to identify ‘what the patient would want’ as a binary choice between consenting to treatment or refusing treatment when chances are poor and the decision is difficult. Asking surrogates to identify choices that they believe would be likely to make the person angry or upset might be more appropriate and more effective. Most people were understanding of decisions made by surrogates (whether these matched their preference or not). This finding should be used to reassure surrogates who are required to make difficult decisions. Additionally, factors associated with patient upset/anger at surrogate treatment decisions were identified. This most commonly included those patients who had documented wishes in an Advance Care Plan that was not followed.

scholarly journals On the Likelihood of Surrogates Conforming to the Substituted Judgment Standard When Making End-of-Life Decisions for Their Partner

2019 ◽  
Vol 39 (6) ◽  
pp. 651-660 ◽  
Author(s):  
Eleonore Batteux ◽  
Eamonn Ferguson ◽  
Richard J. Tunney
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Real Life ◽  
Considerable Proportion ◽  
Next Of Kin ◽  
Substituted Judgment ◽  
End Of Life Decisions ◽  
Life Decisions ◽  
The Right ◽  
Substituted Judgment Standard

A considerable proportion of end-of-life decisions are made by the patient’s next-of-kin, who can be asked to follow the substituted judgment standard and decide based on the patient’s wishes. The question of whether these surrogate decision makers are actually able to do so has become an important issue. In this study, we examined how the likelihood of surrogates conforming to the substituted judgment standard varies with individual differences in mortality acceptance and confidence in their decision making. We recruited 153 participants in romantic relationships between 18 and 80 years old from the general population. We asked them to make hypothetical end-of-life decisions for themselves and on behalf of their partner, as well as predict what their partner would do, and complete a series of questionnaires. Participants predicted that their partner would make similar decisions to their own but were more likely to accept a life-saving treatment that could result in reduced quality of life on their partner’s behalf than for themselves. Decisions made by older adults were more likely to conform to the substituted judgment standard, which is encouraging given that they are more likely to be confronted with these decisions in real life, although this was not due to differences in mortality acceptance. Older adults were also more likely to have had previous discussions with their partner and thereby know that person’s wishes and feel confident that they made the right decision, but these factors did not affect their likelihood of conforming to the substituted judgment standard. This shows that encouraging discussions about end of life among families would ease the decision process, but more work is needed to ensure that surrogates can adhere to the substituted judgment standard.

Patient Confidentiality and the Surrogate's Right to Know

2000 ◽  
Vol 28 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Lynn A. Jansen ◽  
Lainie Friedman Ross
Keyword(s):  
Treatment Decisions ◽  
Decision Makers ◽  
Best Interests ◽  
Right To Know ◽  
Patient Confidentiality ◽  
Surrogate Decision Makers ◽  
Incapacitated Patients ◽  
Surrogate Decision

Physicians treating newly incapacitated patients often must navigate surrogate decision-makers through a difficult course of treatment decisions. Such a process can be complex. Physicians must not only explain the medical facts and prognosis to the surrogate, but also attempt to ensure that the surrogate arrives at decisions that are consistent with the patient's own values and wishes. Where these values and wishes are unknown, physicians must help surrogates make decisions that reflect the patient's best interests.

scholarly journals Development and effectiveness of advance care planning protocol for heart failure outpatients

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
AH Higashitsuji ◽  
SO Okada ◽  
YF Fujisawa ◽  
MS Sano ◽  
NT Taguchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
End Of Life Care ◽  
Home Visit ◽  
Decision Makers ◽  
Care Planning ◽  
Life Care ◽  
Patients With Heart Failure ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Heart failure has a poor prognosis, and the number of patients continues to increase. Moreover, since it is a disease that causes various sufferings, substantial end-of-life care is needed. Advanced care planning (ACP) is a part of end-of-life care for patients with heart failure. ACP provides patient decision-making opportunities, documenting end-of-life preferences, and increasing end-of-life conversation. However, the ACP intervention for patients with heart failure is not integrated, and studies are insufficient. In addition, Japan follows a non-Western culture, in which participation in the medical decision-making is reluctant and considered to be less prepared for ACP. Clarifying the effects of systematic ACP on patients with heart failure in Japan can be used to determine effective interventions in Japan and may provide effective ACP intervention for patients who have no preparedness worldwide. Purpose This study aimed to identify the effect of protocol-based intervention on the outcomes of ACP in Japanese outpatients with heart failure. Methods This is a single-center retrospective observational study. Data on patient attributes, conversation records, and document information from medical records of patients who have undergone intervention using the predeveloped ACP protocol were collected. Numerical data were statistically analyzed. ACP results were evaluated by performing deductive content analysis on the basis of existing frameworks. A subgroup analysis was performed on differences in ACP outcomes based on patient attributes. Results Data were collected from 13 patients who underwent ACP intervention. The median age was 69 years. Moreover, 76% were male, 84% were married, 76% were living with family, and 46% were receiving home-visit nursing care. New York Heart Association functional classification II was the most common in the severity classification of heart failure, and ischemic cardiomyopathy was the most common etiology. Documenting patient’s wishes, recording patient’s wishes in medical record, and identifying what brings value to patient"s life were achieved in 76% of the participants. Deciding surrogate decision makers, discussing values and care preferences with the surrogate, and discussing values and care preferences with health care professionals were achieved in 69% of the participants. Differences in patient attributes, such as age and presence or absence of home-visit nursing, did not affect ACP outcomes. Conclusion Protocol-based ACP allows patients with heart failure to determine surrogate decision makers and discuss care preferences with healthcare professionals, identify what they value, and record their wishes. The protocol-based ACP had a positive impact on ACP outcomes, without being restricted by patient attributes.

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