Ethics and law in paramedic practice: boundaries of capacity and interests

2020 ◽  
Vol 12 (10) ◽  
pp. 1-8
Author(s):  
Hamish Carver ◽  
Dominique Moritz ◽  
Phillip Ebbs
Keyword(s):  
Decision Making ◽  
End Of Life Care ◽  
Clinical Care ◽  
Relevant Information ◽  
Best Interests ◽  
Evidence Based ◽  
Ethical Standards ◽  
Healthcare Ethics ◽  
The Everyday ◽  
The Relationship

Decision-making is central to the everyday practice of paramedicine. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedics are required to make these decisions within settings that are often disordered, uncontrolled and unpredictable, where all the relevant information and circumstances are not fully known. Decision-making in this environment is intended to provide care and treatment in the best interests of the patient. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient's own wishes? More speci∼cally, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.

Multi-dimensional approach to end-of-life care: The Welfare Model

2018 ◽  
Vol 26 (7-8) ◽  
pp. 1955-1967
Author(s):  
Shin Wei Sim ◽  
Tze Ling Gwendoline Beatrice Soh ◽  
Lalit Kumar Radha Krishna
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Clinical Care ◽  
Best Interests ◽  
Life Care ◽  
Clinical Practices ◽  
Vulnerable Patients ◽  
Team Evaluation ◽  
Welfare Model

Appropriate and balanced decision-making is sentinel to goal setting and the provision of appropriate clinical care that are attuned to preserving the best interests of the patient. Current family-led decision-making in family-centric societies such as those in Singapore and other countries in East Asia are believed to compromise these objectives in favor of protecting familial interests. Redressing these skewed clinical practices employing autonomy-based patient-centric approaches however have been found wanting in their failure to contend with wider sociocultural considerations that impact care determinations. Evaluation of a number of alternative decision-making frameworks set out to address the shortcomings of prevailing atomistic and family-centric decision-making models within the confines of end-of-life care prove these alternative frameworks to be little better at protecting the best interests of vulnerable patients. As a result, we propose the Welfare Model that we believe is attentive to the relevant socio-culturally significant considerations of a particular case and better meets the needs of end-of-life care goals of preserving the welfare of patients. Employing a multi-professional team evaluation guided by regnant psychosocial, legal, and clinical standards and the prevailing practical and clinical realities of the particular patient’s setting the Welfare Model provides a clinically relevant, culturally sensitive, transparent, and evidence-based approach to care determinations.

Best Interests Decisions in Clinical Practice: Reviewing the Current Evidence

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 176-176
Author(s):  
Emanuele Valenti ◽  
◽  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
End Of Life Care ◽  
Well Being ◽  
Best Interests ◽  
Current Evidence ◽  
Clinical Settings ◽  
Healthcare Ethics ◽  
Early Results ◽  
Made In

"‘Best interests’ decisions are often needed when patients lack capacity to make their own healthcare decisions. Despite the ubiquity of ‘best interests’, there remains considerable ambiguity about what best interests are and how the standard should be applied, alongside a lack of understanding about how best interests decisions are actually made in clinical practice. Balancing Best Interests in Healthcare Ethics and Law (BABEL) is an interdisciplinary project, funded by a Wellcome Trust Collaborative Award, which aims to explore best interests decision-making in healthcare, both empirically and normatively. In this paper, we outline initial findings from a narrative review that asked, ‘what evidence do we have about how best interests decisions are made in clinical practice in England and Wales?’. Data were extracted from included papers using a standardised form, and then subjected to thematic analysis, focussing on what the papers told us about the process of decision-making, the stakeholders involved, the barriers and facilitators. Early results suggest we have some limited evidence about how best interests decisions are made in clinical settings, and the majority of this evidence concerns mental health and end-of-life care. Common factors taken into account in these decisions include: the patient’s clinical circumstances; risk assessment; the patient’s wishes; cost-effectiveness; avoiding harm; the patient’s well-being; autonomy; capacity assessment; and family’s wishes. "

CAN BAYESIAN METHODS MAKE DATA AND ANALYSES MORE RELEVANT TO DECISION MAKERS?

2001 ◽  
Vol 17 (1) ◽  
pp. 114-122 ◽  
Author(s):  
Steven H. Sheingold
Keyword(s):  
Decision Making ◽  
Bayesian Methods ◽  
Paradigm Shift ◽  
Relevant Information ◽  
Decision Makers ◽  
Evidence Based ◽  
Critical Importance ◽  
Bayesian Approaches ◽  
Bayesian Analyses ◽  
And Performance

Decision making in health care has become increasingly reliant on information technology, evidence-based processes, and performance measurement. It is therefore a time at which it is of critical importance to make data and analyses more relevant to decision makers. Those who support Bayesian approaches contend that their analyses provide more relevant information for decision making than do classical or “frequentist” methods, and that a paradigm shift to the former is long overdue. While formal Bayesian analyses may eventually play an important role in decision making, there are several obstacles to overcome if these methods are to gain acceptance in an environment dominated by frequentist approaches. Supporters of Bayesian statistics must find more accommodating approaches to making their case, especially in finding ways to make these methods more transparent and accessible. Moreover, they must better understand the decision-making environment they hope to influence. This paper discusses these issues and provides some suggestions for overcoming some of these barriers to greater acceptance.

scholarly journals From Strategic Management to Information Strategy Management It will be possible to increase the available time Strategic Decision Making?

2021 ◽  
Vol 04 (05) ◽  
Author(s):  
Jose Rascão ◽  
Keyword(s):  
Decision Making ◽  
Global Economy ◽  
Relevant Information ◽  
Strategy Management ◽  
Strategic Decision ◽  
Industrial Society ◽  
Strategic Decision Making ◽  
Process Understanding ◽  
Decision Making System ◽  
The Relationship

This article investigates the main concepts and activities of information,while it is in the strategic decision-making system, treated by literature. Since information has become the source of value of the global economy for organizations, information plays a key role in contributingto the development oforganizations' performance by selecting business-relevant information. The relationship between strategic information management and business activities contributes to the strategic decision-making processfor a more effective and efficient decision-making process. Understanding the importance of information as a strategic resource in the management of organizations is becoming more important for strategists, than the formulation ofstrategic models,of industrial society. In the 21st century no Manager will be able to define and implement the strategy successfully, without a basic understanding of information for strategic decision making.

Information Systems for the Management of the Organizations

2018 ◽  
pp. 313-346
Author(s):  
Antonio Juan Briones Penalver
Keyword(s):  
Decision Making ◽  
Global Economy ◽  
Relevant Information ◽  
First Century ◽  
Strategic Decision ◽  
Industrial Society ◽  
Strategic Decision Making ◽  
Relationship Of ◽  
The Relationship ◽  
Selection Of

This chapter investigates the main concepts and activities of information in strategic decision-making systems. Since information became the global economy value source for organizations, information assumes a key role in contributing to the development of the performance of organizations through the selection of relevant information for businesses. The relationship of the strategic management of information with business activities contributes to the process of strategic decision making for more effective and efficient decisions. The understanding of the importance of information as a strategic resource in the management of organizations is becoming more important to strategists than the formulation of strategy models of industrial society. In the twenty-first century, no manager will be able to set and implement the strategy successfully without a basic understanding of information for strategic decision making.

The Role of Informed Consent in Medical Decision Making

2001 ◽  
Author(s):  
Jessica W. Berg ◽  
Paul S. Appelbaum ◽  
Charles W. Lidz ◽  
Lisa S. Parker
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Process Model ◽  
Clinical Care ◽  
Single Point ◽  
Accurate Information ◽  
Course Of Action ◽  
Potential Benefits ◽  
Event Model ◽  
The Relationship

How can informed consent be integrated into the physician-patient relationship in a manner that is respectful of both the idea of informed consent and the imperatives of clinical care? A realistic answer to that question could, we believe, remove much of the resistance of many healthcare professionals to the idea of informed consent. This chapter’s goal is to offer a practical procedural framework within which clinicians can operate to facilitate patients’ decision making in a manner that meets both these desiderata. The interactions of physicians and patients in making decisions about medical treatment can be conceptualized in two ways. Decision making can be approached as an event that occurs at a single point in time (an “event model”), or it can be viewed as a continuous element of the relationship between patients and their caregivers (a “process model”). The implications of these different ways of conceptualizing decisions about treatment are quite profound, rooted as they are in distinct visions of the relationship between physicians and patients. The event model of informed consent is predicated on a relatively simple paradigm. A patient seeking medical care approaches a physician for assistance. After assessing the patient’s condition, the physician reaches a diagnosis and formulates a recommended plan of treatment. The physician’s conclusions and recommendations are presented to the patient, along with information concerning the risks and potential benefits of the proposed treatment, and possible alternatives and their risks and potential benefits. Weighing the available data, the patient reflects on the relative risks and benefits of each course of action and then selects the medically acceptable alternative that most closely fits the patient’s particular values. On the surface at least, the event model conforms well to the legal requirements for informed consent. The event model emphasizes the provision of full and accurate information to patients at the time of decision making. Consent forms are often used for this purpose; indeed, the consent form can be said to be the central symbol of the event model (see Chapter 9). Patients’ understanding, although desirable in the abstract, is less crucial to this model than is the provision of information.

Medical ethics

2020 ◽  
pp. 20-25
Author(s):  
Mike Parker ◽  
Mehrunisha Suleman ◽  
Tony Hope
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Critical Assessment ◽  
Best Interests ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Ethical Aspects ◽  
Scientific Medicine ◽  
Critical Skills ◽  
Based Medicine

Medicine is both a scientific and a moral enterprise. It is as important to give reasons for the ethical aspects of clinical decisions as it is for the scientific aspects. The corollary of evidence-based medicine is reason-based ethics. Two concepts central to many ethical aspects of clinical practice are autonomy and best interests. Evidence-based medicine emphasizes the importance of critical assessment: interventions should be evaluated on the basis of evidence, not tradition. Critical skills are therefore crucial to modern scientific medicine. Importantly, medicine is a moral enterprise as well as a scientific one. Many clinical decisions involve a combination of factual and ethical aspects. It is as important to be able to give good reasons for the ethical aspects of clinical decisions as it is for the science. Society increasingly expects this from doctors as part of transparent decision-making.

scholarly journals The bioethics of end-of-life care in Internal Medicine: decision making and setting of care

2013 ◽  
pp. 133-138
Author(s):  
Giancarlo Traisci
Keyword(s):  
Internal Medicine ◽  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Present Report ◽  
Clinical Care ◽  
Terminal Phase ◽  
Life Care ◽  
Physician Patient Relationship

Introduction In the field of Internal Medicine, the management of the terminal phase of an illness raises important issues involving clinical care, with particular reference to the physician-patient relationship. The present report describes the professional code of conduct relative to the assessments and decision making involved in end-of-life care. Materials and methods The article summarizes and discusses Italian common deontological low and the current positions of national and international experts in the field of end-of-life care. Results The ethical issues regarding euthanasia, withdrawal/withholding of health care, and medical treatment that uselessly prolongs the life of a terminal patient are defined and analyzed in conjunction with the outcomes suggested by the palliative medicine. Discussion Physicians caring for patients at the end of their lives must give consideration to bioethical approach.

Performance on Philadelphia Jevs Work Samples and Subsequent Employment Status

1979 ◽  
Vol 10 (4) ◽  
pp. 214-218 ◽  
Author(s):  
Norman L. Berven ◽  
Dennis R. Maki
Keyword(s):  
Decision Making ◽  
Employment Status ◽  
Relevant Information ◽  
Rehabilitation Counselors ◽  
Competitive Employment ◽  
Work Sample ◽  
Validity Data ◽  
Rehabilitation Agency ◽  
Work Samples ◽  
The Relationship

Client performance data on JEVS work samples are frequently available to rehabilitation counselors to facilitate decision making. The present study investigated the relationship between performance on JEVS work samples and subsequent employment status. Subjects were 233 rehabilitation clients who had completed one or more of the JEVS work samples and whose cases had been closed by the state rehabilitation agency. For seven of 20 work samples investigated, clients who performed at a higher level were more likely to attain competitive employment. The results suggest that the seven work samples provide relevant information about client employability. The extremely limited validity data on commercially available work sample systems and the critical need for research in this area are emphasized.

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