scholarly journals Age or maturity? African children's right to participate in medical decision-making processes

2020 ◽  
Vol 20 (2) ◽  
Author(s):  
Elvis Fokala ◽  
Annika Rudman
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Case Law ◽  
Best Interests ◽  
Medical Decision ◽  
Medical Procedures ◽  
Complex Relationship ◽  
Rights Of The Child ◽  
Decision Making Processes ◽  
Human Rights Based Approach

This article advocates an approach to children's participation in medical decision-making processes guided by the rationality of the best interests' principle, a child's evolving capacity and a child's age. Using a human rights-based approach, rooted in the UN Convention on the Rights of the Child and the African Children's Charter, it seeks to elucidate the contested three-way partnership between the child, its parent(s) and the assigned physician(s), which plays out in relation to most medical procedures involving children. In analysing legislation and case law, the article further aims to clarify the complex relationship between age and maturity in child participation; to facilitate a child's involvement in the three-way partnership; and to suggest the statutory recognition of an age indicator in domestic African law in relation to medical procedures.

Errors in Surgical Neuropathology and the Influence of Cognitive Biases: The Psychology of Intelligence Analysis

2006 ◽  
Vol 130 (5) ◽  
pp. 613-616 ◽  
Author(s):  
Roger E. McLendon
Keyword(s):  
Decision Making ◽  
Cognitive Psychology ◽  
Medical Decision Making ◽  
Cognitive Biases ◽  
Correct Diagnosis ◽  
Data Sources ◽  
Medical Decision ◽  
Intelligence Analysis ◽  
First Impression ◽  
Decision Making Processes

Abstract Context.—A significant difficulty that pathologists encounter in arriving at a correct diagnosis is related to the way information from various sources is processed and assimilated in context. Objective.—These issues are addressed by the science of cognitive psychology. Although cognitive biases are the focus of a number of studies on medical decision making, few if any focus on the visual sciences. Data Sources.—A recent publication authored by Richards Heuer, Jr, The Psychology of Intelligence Analysis, directly addresses many of the cognitive biases faced by neuropathologists and anatomic pathologists in general. These biases include visual anticipation, first impression, and established mindsets and subconsciously influence our critical decision-making processes. Conclusions.—The book points out that while biases are an inherent property of cognition, the influence of such biases can be recognized and the effects blunted.

Bioethics in the field of pediatric surgery

2020 ◽  
Vol 69 (4) ◽  
pp. 483-492
Author(s):  
Marko Bašković ◽  
Dora Škrljak Šoša
Keyword(s):  
Decision Making ◽  
Legal System ◽  
Pediatric Surgery ◽  
Medical Decision Making ◽  
Treatment Strategies ◽  
Moral Dilemmas ◽  
The State ◽  
Best Interests ◽  
Medical Decision ◽  
Team Members

It is the professional responsibility of pediatric surgeons to follow the principles of maintaining life and alleviating suffering, often by questioning whether they have acted correctly. Apart from the moral dilemmas of choosing the best treatment strategies, they are often in dilemmas with the parents, who also involve their own “strategy” in the whole story, which they think is the most optimal treatment for their child, despite the contrary recommendations of the profession. Children, and especially adolescents, may be somewhat involved in medical decision making. Mostly the parent-physician-child / adolescent triangle agrees, but this is not always the case, which is why pediatric surgeons encounter problems. Ethical committees, composed of competent people, supported by the legal system of the state, who are able by consensus of team members to advocate and ensure the best interests of patients, must be activated for the full scope of the solution.

scholarly journals P140: Emergency department decision-making for incapacitated and unrepresented patients: a comprehensive review of the literature

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S124-S125
Author(s):  
J.L. Willinsky ◽  
I. Hyun
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Medical Decision Making ◽  
Hospital Setting ◽  
Ethics Committees ◽  
Medical Decision ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Patient Cohort ◽  
Decision Making Processes

Introduction: Incapacitated patients who lack substitute decision-makers (SDM) are commonly encountered in the emergency department (ED). The number of these patients will rise dramatically as the Baby Boomers age. We can expect an influx of elderly patients who lack decisional capacity due to dementia and other illnesses, and who present without family. It is estimated that 3 to 4 percent of U.S. nursing home residents have no SDM or advance directives. Medical decision-making for this cohort poses an ethical challenge, particularly in the ED setting. Methods: A comprehensive review of the literature was conducted surrounding decision-making for incapacitated and unrepresented patients in the hospital setting. Articles were identified using MEDLINE (1946-October 2015) and Embase (1974-October 2015). The reference lists of relevant articles were hand searched. Articles describing decision-making processes that have been proposed, tested or applied in practice were chosen for full review. The aim of this review was to outline recognized medical decision-making processes for incapacitated and unrepresented patients, and to identify areas for future research. Results: The search yielded 20 articles addressing decision-making for incapacitated and unrepresented patients in the hospital setting. All of these articles focus on the intensive care unit and other hospital wards; no literature on the ED setting was found. Five types of formal consulting bodies exist to assist physicians in applying the best interest standard for this patient cohort: internal hospital ethics committees, external ethics committees, public guardians, court-appointed guardians, or judges. The majority of decisions for these patients, however, are made informally by a single physician or by a healthcare team, although it is well recognized that this approach lacks appropriate safeguards. There is no consensus surrounding the optimal approach to decision-making in these cases, and as such there is significant inconsistency in how medical decisions are made for these patients. Conclusion: There are several articles describing decision-making processes for incapacitated and unrepresented patients, none of which focus on the ED. These processes are not practical for use in the ED. Further inquiry is needed into the most ethical and respectful method of decision-making for this patient cohort in the ED.

scholarly journals Legal and Ethical Aspects of ‘Best Interests’ Decision-Making for Medical Treatment of Companion Animals in the UK

Animals ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 1009
Author(s):  
Carol Gray ◽  
Peter Fordyce
Keyword(s):  
Decision Making ◽  
Companion Animals ◽  
Best Interests ◽  
Medical Decision ◽  
Animal Protection ◽  
Ethical Frameworks ◽  
Rights Of The Child ◽  
Veterinary Surgeons ◽  
Protection Legislation ◽  
The Uk

Medical decisions for young children are made by those with parental responsibility, with legal involvement only if the decision is potentially detrimental to the child’s welfare. While legally classified as property, some argue that animals are in a similar position to children; treatment decisions are made by their owners, posing a legal challenge only if the proposed treatment has the potential to cause harm or unnecessary suffering, as defined by animal protection legislation. This paper formulates the approach to a ‘best interests’ calculation, utilising the factors included in the United Nations Convention on the Rights of the Child and relying on exchange of information between the human parties involved. Although this form of decision-making must primarily protect the animal from unnecessary suffering, it recognises that the information provided by the owner is critical in articulating the animal’s non-medical interests, and hence in formulating what is in the animal’s best overall welfare interests. While statute law does not mandate consideration of ‘best interests’ for animals, this approach might reasonably be expected as a professional imperative for veterinary surgeons. Importantly, this version of a ‘best interests’ calculation can be incorporated into existing ethical frameworks for medical decision-making and the humane treatment of animals.

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