Implicit Decision-Making in Family Caregiving

2001 ◽  
Vol 18 (2) ◽  
pp. 219-237 ◽  
Author(s):  
Loretta L. Pecchioni
2015 ◽  
Vol 32 (2) ◽  
pp. 91 ◽  
Author(s):  
Eniola Salami ◽  
Bonnie Lashewicz

In Canadian law, the concept of autonomy is individualistic in nature, manifest as the capacity, or legal ability of an individual to actively understand the purpose and consequences of their actions according to whether they have faculties to comprehend and weigh risks and benefits.  Feminist scholars critique such conceptualizations of autonomy and, instead, argue the importance of “relational autonomy” which is predicated on the view that actions result from one’s own volition in combination with the influence of one’s social and relational connections. In this paper, we examine the dynamics and implications of relational autonomy in decision-making by adults with developmental disabilities by studying adults with developmental disabilities in interaction with their caregiving family members.  Our purpose is to contribute understandings of how and in what ways family caregiving relational contexts both support and hinder decision-making by adults with developmental disabilities.  We begin with an overview of conceptualizations and applications of autonomy, then illustrate relational autonomy dynamics through comparative analysis of data from two women with developmental disabilities who were interviewed together with their family caregivers about successes and struggles in giving and receiving care and making decisions. These two women, and their family caregivers (N=9) are selected from a larger sample of adults with developmental disabilities and their family caregivers (N = 26) because the contrasts, as well as the similarities, between their family care situations are striking, and taken together, illustrate a range of ways in which decision-making is supported and hindered.  We conclude by upholding the importance of relational autonomy for legal understandings of decision-making, yet we caution that critical examination of relationship dynamics is vital. En droit canadien, le concept de l’autonomie est un concept individualiste de par sa nature et est perçu comme l’aptitude, physique ou juridique, d’une personne à comprendre activement l’objet et les conséquences de ses actes en fonction de la question de savoir si elle possède les facultés voulues pour apprécier et soupeser les risques et les avantages en jeu. Des universitaires féministes critiquent ces conceptualisations de l’autonomie et mettent plutôt l’accent sur l’importance de l’« autonomie relationnelle », qui repose sur l’interaction entre la volonté de la personne et l’influence de ses contacts sociaux et relationnels. Dans le présent document, nous nous penchons sur la dynamique et sur les incidences de l’autonomie relationnelle dans les décisions que prennent les adultes handicapés en étudiant l’interaction d’adultes handicapés avec leurs aidants familiaux. Notre but est de favoriser une meilleure compréhension de la mesure dans laquelle les contextes relationnels dans lesquels se trouvent les aidants familiaux peuvent à la fois appuyer et entraver le processus de prise de décisions chez les adultes handicapés. Après avoir présenté un bref aperçu des conceptualisations et des applications de l’autonomie, nous illustrons la dynamique de l’autonomie relationnelle au moyen d’une analyse comparative de données provenant de deux femmes handicapées qui ont été interrogées ainsi que leurs aidants familiaux au sujet des défis et des réussites liés à la prestation et à la réception de soins et à la prise de décisions. Ces deux femmes et leurs aidants familiaux (N=9) ont été choisis à partir d’un plus grand échantillon d’adultes handicapés et de leurs aidants familiaux (N=26), parce que les contrastes, tout comme les similitudes, entre leurs situations sont frappants et que, examinées ensemble, ces données illustrent différentes façons dont la prise de décisions est appuyée et entravée. Nous concluons en insistant sur l’importance de l’autonomie relationnelle pour la compréhension des aspects juridiques de la prise de décisions, tout en soulignant qu’un examen critique de la dynamique des relations est vital.


2000 ◽  
Vol 21 ◽  
pp. 269 ◽  
Author(s):  
Suzanne M. Narayan ◽  
Kenneth W. Hepburn ◽  
Marsha L. Lewis ◽  
Sheila A. Corcoran-Perry

2020 ◽  
pp. 073346482091153 ◽  
Author(s):  
Jun Miyashita ◽  
Ayako Kohno ◽  
Yosuke Yamamoto ◽  
Sayaka Shimizu ◽  
Teruhisa Azuma ◽  
...  

Objectives: This study aimed to reveal the features of older adults’ advance care planning (ACP) discussions by identifying psychosocial factors related to their discussions in Japan, where people value family-centered decision making. Methods: A qualitative study using in-depth interviews was conducted with 39 participants (aged ≥65 years) recruited from the outpatient department of a community hospital in Fukushima, Japan. Data were analyzed using the grounded theory approach. Results: Through experiences of family caregiving, participants became aware of their own feelings about the end of life. Equal relationship with family members was important for lowering the threshold for having discussions. Some participants and their families in the same generation reached agreements on ACP; however, they were willing to yield to children’s decision making despite these discussions. Discussions: These findings provide insights into the psychosocial factors in relation to ACP discussions and support for the role of ACP discussions in the family-centered decision-making culture.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 653-654
Author(s):  
Ivana Alexander

Abstract Informal family caregivers of older adults are the life’s blood of the long-term services and supports (LTSS) system in the United States, providing an estimated $470 billion in unpaid care each year. This care is disproportionately provided by racial and ethnic minority families, where systemic economic disparities make it impossible to afford formal care in many cases. Adding to this are the cultural expectations or familism values that often influence attitudes and beliefs about caregiving. These expectations and values contribute to the emotional, psychological, financial, and professional strain experienced by caregivers. They also impact the caregiver-healthcare provider dyad as well as the caregiver-patient-healthcare provider triad, where shared decision-making is an essential component of providing LTSS for family members. This presentation applies an auto-enthographic lens to the author’s personal experiences as a younger African-American female caregiver of an elderly, terminally ill family member and as a medical social worker to highlight the gaps that exist between familism values, the shifting reality of family caregiving, and available resources and addresses related implications for the future of long-term care in a family-centered context.


Author(s):  
Elaine Wittenberg ◽  
Joy V. Goldsmith ◽  
Sandra L. Ragan ◽  
Terri Ann Parnell

The majority of adults will develop or contract one or more chronic illnesses in the latter third of their lives. They will live protractedly with illness for years before death. About one in six Americans (adult aged, as there are no reliable numbers on caregivers under the age of 18) provide an estimated 37 billion hours of unpaid care to family or friends. This population of caregivers shoulders a heavy load with little support, putting their own health in peril. A description of the caregiving population, their tasks, and financial costs are detailed. The four most common chronic illnesses of dementia, cancer, diabetes, and heart disease are specifically examined from a caregiving perspective. An argument is presented that situates the patient and caregiver as one unit of care, prioritizing family communication as a key part of health communication and decision-making. The summative force of perceived, experienced, and anticipated communication for the caregiver with patient, providers, family, and system is described. Caregiver effectiveness and well-being can be improved through better communication and improved health literacy, which also improves patient outcomes. The integration of family illness narratives that situate the informal caregiver’s experiences are presented. Four featured caregiver stories are detailed and set the stage for a typology of caregivers, which will unfold across the volume.


1993 ◽  
Vol 55 (1) ◽  
pp. 245 ◽  
Author(s):  
Marjorie E. Starrels ◽  
Victor G. Cicirelli

2018 ◽  
Vol 41 ◽  
Author(s):  
Patrick Simen ◽  
Fuat Balcı

AbstractRahnev & Denison (R&D) argue against normative theories and in favor of a more descriptive “standard observer model” of perceptual decision making. We agree with the authors in many respects, but we argue that optimality (specifically, reward-rate maximization) has proved demonstrably useful as a hypothesis, contrary to the authors’ claims.


2018 ◽  
Vol 41 ◽  
Author(s):  
David Danks

AbstractThe target article uses a mathematical framework derived from Bayesian decision making to demonstrate suboptimal decision making but then attributes psychological reality to the framework components. Rahnev & Denison's (R&D) positive proposal thus risks ignoring plausible psychological theories that could implement complex perceptual decision making. We must be careful not to slide from success with an analytical tool to the reality of the tool components.


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