scholarly journals Prisoners' insomnia: to treat or not to treat? Medical decision-making in places of detention

2008 ◽  
Vol 48 (4) ◽  
pp. 307-316 ◽  
Author(s):  
Bernice S. Elger
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Ethical Issues ◽  
Public Health Problem ◽  
Medical Decision ◽  
Evidence Based ◽  
Correctional Institutions ◽  
Efficient Treatment ◽  
Adequate Evaluation ◽  
Insomnia Treatment

Insomnia is a frequent reason for medical and psychiatric consultation in prisons. Medical decision-making in correctional health care should be based on the same principles as outside correctional institutions. In places of detention, principles should be balanced according to the same criteria as outside correctional institutions, while taking into account the unique harm-benefit ratios related to the specific context. The aim of this paper was to examine the existing attitudes and ethical issues related to decision-making about insomnia evaluation and treatment in places of detention. An analysis of the ethical issues and an evidence-based review of the consequences of different attitudes and treatments with regard to prison medicine were carried out. Insomnia is a public health problem and requires adequate evaluation and treatment to avoid more serious health consequences both within and outside correctional institutions. Insomnia treatment in places of detention is an ethical dilemma, but there is no evidence-based reason to avoid benzodiazepines in prison completely and to use only neuroleptics and antidepressants, which might represent more dangerous and less efficient treatment. In prison medicine, should we even treat insomnia? Widely accepted ethical strategies of decision-making indicate that we should. Institutional guidelines on insomnia should be based on ethically sound decision-making that takes into account the available evidence.

scholarly journals Technology of Supporting Medical Decision-Making Using Evidence-Based Medicine and Artificial Intelligence

2020 ◽  
Vol 176 ◽  
pp. 1703-1712
Author(s):  
Georgy Lebedev ◽  
Eduard Fartushnyi ◽  
Igor Fartushnyi ◽  
Igor Shaderkin ◽  
Herman Klimenko ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Evidence Based ◽  
Based Medicine

‘Evidence-based’, ‘Cost-Effective’ and ‘Preference-Driven’ Medicine: Decision Analysis Based Medical Decision Making is the Pre-Requisite

1996 ◽  
Vol 1 (2) ◽  
pp. 104-113 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Decision Making ◽  
Decision Analysis ◽  
Evidence Based Medicine ◽  
Medical Decision Making ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Medical Decision ◽  
Evidence Based ◽  
Meta Analyses ◽  
Based Medicine

Three broad movements are seeking to change the world of medicine. The proponents of ‘evidence-based medicine’ are mainly concerned with ensuring that strategies of proven clinical effectiveness are adopted. Health economists are mainly concerned to establish that ‘cost-effectiveness’ and not ‘clinical effectiveness’ is the criterion used in determining option selection. A variety of patient support and public interest groups, including many health economists, are mainly concerned with ensuring that patient and public preferences drive clinical and policy decisions. This paper argues that decision analysis based medical decision making (DABMDM) constitutes the pre-requisite for the widespread introduction of the main principles embodied in evidence-based medicine, cost-effective medicine and preference-driven medicine; that, in the light of current modes of practice, seeking to promote these principles without a prior or simultaneous move to DABMDM is equivalent to asking the cart to move without the horse; and that in fact DABMDM subsumes and enjoins the valuable aspects of all three. Particular attention is paid to differentiating between DABMDM and EBM, by way of analysis of various expositions of EBM and examination of two recent empirical studies. EBM, as so far expounded, reflects a problem-solving attitude that results in a heavy concentration on RCTs and meta-analyses, rather than a broad decision making focus that concentrates on meeting all the requirements of a good clinical decision. The latter include: Ensuring that inferences from RCTs and meta-analyses to individual patients (or patient groups) are made explicitly; paying equally serious attention to evidence on values and costs as to clinical evidence; and accepting the inadequacy of ‘taking into account and bearing in mind’ as a way of integrating the multiple and distinct elements of a decision.

Involving Minors in Medical Decision Making: Understanding Ethical Issues in Assent and Refusal of Care by Minors

2018 ◽  
Vol 38 (05) ◽  
pp. 533-538 ◽  
Author(s):  
Abigail Lang ◽  
Erin Paquette
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Pediatric Patients ◽  
Ethical Issues ◽  
Medical Decision ◽  
Decision Making Process ◽  
Patient Relationship

AbstractWhen caring for minors, the clinician–patient relationship becomes more ethically complex by the inclusion of parents in the clinician–parent–patient triad. As they age, children become more capable of participating in the decision-making process. This involvement may lead them to either accept or refuse proposed care, both of which are ethically acceptable positions when the minor's capacity to participate in decision making is carefully considered in the context of their age, development, and overall health. Certain conditions may be more likely to impact their capacity for participation, but it is important for clinicians to avoid categorical presumption that minors of a certain age or with certain conditions are incapable of participating in decisions regarding their care. Understanding the ethical bases for decision making in pediatric patients and considerations for the involvement of minors who both assent to and refuse proposed treatment will equip clinicians to respect the growing autonomy of minor patients.

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