scholarly journals Practicing Clinical Bioethics: Reflections from the Bedside

2019 ◽  
Vol 2 (1) ◽  
pp. 72-90
Author(s):  
Asma Mobin-Uddin
Keyword(s):  
Medical Decision Making ◽  
Ethical Issues ◽  
Medical Advice ◽  
Medical Decision ◽  
Muslim Community ◽  
Medical Decisions ◽  
Islamic Bioethics ◽  
Clinical Bioethics ◽  
Effective Dissemination ◽  
American Muslim

Biomedical dilemmas are becoming more complex as modern medical technologies continue to advance. In my capacity as a clinical bioethicist, I deal with patients and families confronted by ethical issues and questions that arise during medical treatment. Muslim patients often turn to their faith to help them make medical decisions. In their efforts to avoid what is religiously impermissible, they often ask local imams, community leaders, or Muslim physicians for advice. But these groups typically lack sufficient training when it comes to applying Islamic concepts to the medical dilemmas we face in American hospitals today. In fact, Muslim religious advisors who lack the appropriate medical and religious training should not be giving medical advice. Instead, they should refer their questions to the appropriate scholars, professionals, or referral centers. I have noticed that recommendations received from higher-level Islamic scholars with clinical backgrounds are usually more thoughtful, nuanced, and flexible. Clinicians, patients, and families must be able to access thoughtful Islamic scholarship that supports medical decision making in an accessible, timely, and clinically useful way. By intensifying efforts to combine religious scholarship, clinical understanding, and the effective dissemination of information, those in the field of Islamic bioethics scholarship can better help and support patients and families in determining the most appropriate religiously sanctioned options for their particular circumstances. The American Muslim community must prioritize this field of study.

Patient Autonomy, Capacity, and Consent

2020 ◽  
Author(s):  
Jessica Berg ◽  
Emma Cave
Keyword(s):  
Patient Autonomy ◽  
Medical Decision Making ◽  
The United States ◽  
Best Interests ◽  
Medical Decision ◽  
Human Rights Law ◽  
Federal Law ◽  
Medical Decisions ◽  
General Overview ◽  
Best Interests Standard

This chapter discusses patient autonomy, capacity, and consent involving children. It first provides a general overview of children’s rights with respect to making medical decisions in both the United States and Europe. The chapter then discusses the best interests standard (which is usually applied in cases of minors) and how to consider capacity in the context of children. In the discussions of European approaches, the chapter covers relevant international and regional human rights law. The jurisdiction of England and Wales are used as examples. The chapter also provides a general overview of US state approaches and federal law. The chapter concludes by noting some new areas of medical decision-making which challenge the traditional models.

scholarly journals Medical Decision Making for Youth in the Foster Care System

2016 ◽  
Author(s):  
Zachary Strassburger
Keyword(s):  
Foster Care ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Medical Decisions ◽  
Foster Care System ◽  
Birth Parents ◽  
Birth Parent ◽  
Laws And Policies ◽  
Do So ◽  
Care System

Youth in the foster care system often have no one person who isclearly authorized to make medical decisions for them. From acaseworker insisting upon a vaccine to a birth parent refusingpermission for psychotropic medication, this paper argues that thequestion of who makes these decisions matters for children’s rights.This paper reports the results of a survey of 132 stakeholdersrepresenting all U.S. states, 17 qualitative interviews, and a reviewof relevant laws and policies. The stakeholders and legal researchrevealed that in sixteen states, common practice disagreed with thewritten laws and policies about who should be making medical decisionsfor youth in the foster care system. Most often, foster parents aremaking medical decisions despite note having legal authority to do so,and birth parents are rarely making decisions even when they arelegally allowed to do so. This paper proposes that following federallaw about promoting family reunification, birth parents should be incharge of medical decision making for the first 12-24 months. Afterthat time, the foster parent, if one is available and has showncommitment to the child, should become the medical decision maker.Such a policy would promote birth parent involvement and familyreunification while acknowledging the need of young people in care fordecision makers who can make long-term commitments to their care.

Support for management medical decisions and the nature of uncertainty in them

2021 ◽  
Author(s):  
S.Yu. Zhuleva ◽  
A.V. Kroshilin ◽  
S.V. Kroshilina
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Information ◽  
General Scheme ◽  
The Body ◽  
Medical Decision ◽  
Problem Situation ◽  
Medical Decisions ◽  
Inaccurate Information ◽  
Individual Decisions

The process of making a medical decision is characterized by a lack of knowledge and inconsistency of the available information, the lack of the possibility of attracting competent medical experts, limited time resources, incomplete or inaccurate information about the patient's condition. These aspects may be the causes of medical errors, which lead to further aggravation of the problem situation. Purpose – it is necessary to define and justify managerial medical decisions and types of medical information in conditions of uncertainty, when each variant of the sets of outcomes of the situation (recommendations) has its own unique set of values. The fundamental difference between this process for medical use is the concept of the "best medical solution", in which the key role is given to the patient's state of health in obtaining and evaluating alternatives, as well as the need to take into account the time, adverse reactions of the body and the costs of implementing this solution. In the medical field, support for medical decision-making can be classified as organizational-managerial and therapeutic-diagnostic, but both are determined by the position of the person making the medical decision and are aimed at effective management of the medical institution as a whole. The article describes the causes and factors of the nature of uncertainty in the tasks of supporting medical decision-making in medical-diagnostic and organizational-managerial areas. The analysis of the features of supporting medical decision-making in conditions of uncertainty is carried out. Approaches and directions in this area, as well as the concept of “solution”, are considered. The essence of the management medical decision is reflected. The classification of management medical decisions is given, the requirements that are imposed on them are highlighted. The features of the development of management medical solutions in the conditions of incompleteness and uncertainty, the problems that arise when they are implemented in information systems are presented. The general scheme of the process of creating a management medical solution is shown. The features of making group and individual decisions are reflected. The algorithm of actions of the person making the medical decision in the conditions of uncertainty, incompleteness and risk in medical subject areas is presented.

scholarly journals The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis

2020 ◽  
Vol 5 (2) ◽  
pp. 238146832094070
Author(s):  
Andrea Meisman ◽  
Nancy M. Daraiseh ◽  
Phil Minar ◽  
Marlee Saxe ◽  
Ellen A. Lipstein
Keyword(s):  
Ulcerative Colitis ◽  
Decision Making ◽  
Decision Support ◽  
Focus Groups ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Support Needs ◽  
Final Decision ◽  
Care Providers ◽  
Medical Decisions

Purpose. To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs’ preferences. Methods. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic’s peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs’ roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. Results. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as “final decision makers.” Knowledge and experience were facilitators identified to participating in medical decision making. Conclusions. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.

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 The role of non-medical factors in physicians’ decision-making process in a pediatric telemedicine service

2019 ◽  
Vol 26 (2) ◽  
pp. 1152-1176 ◽  
Author(s):  
Motti Haimi ◽  
Shuli Brammli-Greenberg ◽  
Yehezkel Waisman ◽  
Nili Stein ◽  
Orna Baron-Epel
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Process ◽  
Medical Decisions ◽  
Telemedicine Service ◽  
Medical Factors ◽  
Complex Process ◽  
Clinical Scenarios

The complex process of medical decision-making is prone also to medically extraneous influences or “non-medical” factors. We aimed to investigate the possible role of non-medical factors in doctors’ decision-making process in a telemedicine setting. Interviews with 15 physicians who work in a pediatric telemedicine service were conducted. Those included a qualitative section, in which the physicians were asked about the role of non-medical factors in their decisions. Their responses to three clinical scenarios were also analyzed. In an additional quantitative section, a random sample of 339 parent -physician consultations, held during 2014–2017, was analyzed retrospectively. Various non-medical factors were identified with respect to their possible effect on primary and secondary decisions, the accuracy of diagnosis, and “reasonability” of the decisions. Various non-medical factors were found to influence physicians’ decisions. Those factors were related to the child, the applying parent, the physician, the interaction between the doctor and parents, the shift, and to demographic considerations, and were also found to influence the ability to make an accurate diagnosis and “reasonable” decisions. Our conclusion was that non-medical factors have an impact on doctor’s decisions, even in the setting of telemedicine, and should be considered for improving medical decisions in this milieu.

‘Hippocrates’ – support system for medical decision-making for primary care for early detection of socially significant diseases

2021 ◽  
pp. 11-14
Author(s):  
A. L. Vertkin ◽  
Yu. V. Sediakina ◽  
A. V. Pogonin ◽  
I. I. Romanenko
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Medicine ◽  
Clinical Pharmacology ◽  
Early Detection ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Medical Decisions ◽  
State Information ◽  
Testing Mode

Within the framework of the Federal Project ‘Creation of a unified digital contour in health care based on the unified state information system of health care’ of the National Project ‘Healthcare’, employees of the Moscow State Medical and Dental University n.a. A. I. Evdokimov (Department of Therapy, Clinical Pharmacology and Emergency Medicine) with the assistance of RPO ‘Outpatient Doctor’ in 2020, a system for supporting medical decisions was created. The program ‘Hippocrates’ works in the testing mode, but now it is fulfilling the tasks assigned to it to increase the early detection of chronic diseases, and it also plays an important role in teaching doctors to take action based on clinical guidelines.

Medical Epistemology

2018 ◽  
pp. 45-55
Author(s):  
Erwin B. Montgomery
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Modus Tollens ◽  
Medical Epistemology ◽  
Medical Decisions ◽  
Cause And Effect ◽  
Practical Syllogism ◽  
New Knowledge ◽  
Cutoff Threshold

Deductive approaches in medical decision-making have an air of certainty borrowed from philosophical deduction, as for example, in the hypothetico-deductive approach. However, deduction, although certain, is limited because it cannot contribute to new knowledge other than proving some claims to knowledge as false (using modus tollens). Syllogistic deduction requires modification to gain utility, such as the partial and practical syllogisms. However, these forms are logically invalid in that they do not ensure certainty in the conclusions. The partial syllogism can be rendered more certain by the use of probability. However, the necessity of a medical decision requires dichotomization of the continuous probability variable. A cutoff threshold applied to the probability is necessary to enable a dichotomous decision, such as whether to treat or not treat a patient. The practical syllogism introduces the notion of cause and effect, which also may influence medical decisions, although often in a counterproductive manner.

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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