scholarly journals Should dementia sufferers be punished for past crimes?

2021 ◽  
Author(s):  
◽  
Amelia Jeffares
Keyword(s):  
Decision Making ◽  
Personal Identity ◽  
Advance Directives ◽  
Psychological Factors ◽  
Criminal Responsibility ◽  
Advanced Dementia ◽  
Diminished Capacity ◽  
Decision Making Capacity ◽  
The One ◽  
Person With Dementia

<p>This paper examines whether we ought to prosecute historic offences committed by people who have subsequently developed dementia. Currently, a person with dementia might avoid conviction on the basis of their currently diminished capacity. They may be unfit to plead, for example. The problem is that advanced dementia may undermine persistence of personal identity. Once someone develops dementia, they may no longer be the person who committed the crime. If so, they would not need to be excused for their offending. They would simply not be liable. If we think persistence of personal identity is based on psychological factors – as most of us do – a person with advanced dementia will not be the same person as the one who committed the crime. They will not deserve prosecution, never mind punishment. This issue has been overlooked by legal theorists. Although much has been written on the legal significance of dementia, it has been primarily in the context of advance directives or decision-making capacity. I will argue that advanced dementia is a challenge to criminal responsibility.</p>

scholarly journals Should dementia sufferers be punished for past crimes?

2021 ◽  
Author(s):  
◽  
Amelia Jeffares
Keyword(s):  
Decision Making ◽  
Personal Identity ◽  
Advance Directives ◽  
Psychological Factors ◽  
Criminal Responsibility ◽  
Advanced Dementia ◽  
Diminished Capacity ◽  
Decision Making Capacity ◽  
The One ◽  
Person With Dementia

<p>This paper examines whether we ought to prosecute historic offences committed by people who have subsequently developed dementia. Currently, a person with dementia might avoid conviction on the basis of their currently diminished capacity. They may be unfit to plead, for example. The problem is that advanced dementia may undermine persistence of personal identity. Once someone develops dementia, they may no longer be the person who committed the crime. If so, they would not need to be excused for their offending. They would simply not be liable. If we think persistence of personal identity is based on psychological factors – as most of us do – a person with advanced dementia will not be the same person as the one who committed the crime. They will not deserve prosecution, never mind punishment. This issue has been overlooked by legal theorists. Although much has been written on the legal significance of dementia, it has been primarily in the context of advance directives or decision-making capacity. I will argue that advanced dementia is a challenge to criminal responsibility.</p>

scholarly journals DECISION-MAKING AT THE FIRST MANAGEMENT LEVEL: THE INTERFERENCE OF THE ORGANIZATIONAL CULTURE

2018 ◽  
Vol 19 (3) ◽  
Author(s):  
GUSTAVO G. MARCHISOTTI ◽  
MARIA DE L. C. DOMINGOS ◽  
RODRIGO L. DE ALMEIDA
Keyword(s):  
Decision Making ◽  
Organizational Culture ◽  
Treatment Technique ◽  
Exploratory Research ◽  
Structured Interviews ◽  
Management Level ◽  
Decision Making Capacity ◽  
Practical Usefulness ◽  
The One ◽  
Different Origins

ABSTRACT Purpose: This article aims at explaining how a decision is made in the first management level, within five different organizations, from different origins - American, Brazilian and Chinese - in different branches of activity. Originality/value: This is an original work, since it goes beyond the frontiers of knowledge about the subject researched, both for its approach and for its practical usefulness in the day-to-day of the decision makers, being useful for both professionals - and decision making - and for companies - on how to improve the decision-making capacity of their managers. Design/methodology/approach: Fifty managers were interviewed, through the application of a qualitative exploratory research, with the collection of data through semi-structured interviews and content analysis as data analysis and treatment technique. Findings: One may conclude that the decision-making of the first level decision-making managers is more rational. Also, the organizational culture, among the studied variables is the one with the greater impact in the way this management level makes the decisions. This influence of the organizational culture contains three important elements: 1. the need of the manager to act procedurally, using the rules and standards of the company, 2. the use of supporting tools for the decision-making and 3. the learning from the current relationship - or from the past one - with their peers. To go deeper in the theme, we suggest the analysis of the influence of gender in decision-making, under the focus of rationality or intuition, in the first level of the managerial function of the organizations.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2018 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

Clinical Issues

2021 ◽  
pp. 151-175
Author(s):  
Timothy E. Quill ◽  
Judith K. Schwarz
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Oral Intake ◽  
Decisional Capacity ◽  
Clinical Issues ◽  
Decision Making Capacity ◽  
Seriously Ill

All seriously ill persons should complete advance directives specifying indications for limiting future provision of food and fluids. AD’s for SED specify When oral intake is to be limited and What limitations are to be imposed. Two categories include: (1) withholding all assisted oral intake from a person who has lost decision-making capacity, and previously indicated her wish to not receive any assisted feeding, and (2) Comfort Feeding Only (CFO) which involves providing as much or as little food and fluid as the patient seems to desire. CFO has three subcategories: (a) “Self-feeding only”—limiting oral intake to what the patient is able to self-administer. (b) Both “self-feeding” and “caregiver assisted-feeding” in whatever amount the patient enjoys. (c) “Minimum Comfort Feeding Only” is a modification for those who had expressed a desire to SED but lost decisional capacity before implementation, but now seem to desire food or fluid.

scholarly journals Medical Decision-Making in Oncology for Patients Lacking Capacity

2020 ◽  
pp. e186-e196
Author(s):  
Jonathan M. Marron ◽  
Kaitlin Kyi ◽  
Paul S. Appelbaum ◽  
Allison Magnuson
Keyword(s):  
Decision Making ◽  
Developmentally Disabled ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Medical Decisions ◽  
Diminished Capacity ◽  
Decision Making Capacity ◽  
Minor Children ◽  
Oncology Practice ◽  
Do So

Modern oncology practice is built upon the idea that a patient with cancer has the legal and ethical right to make decisions about their medical care. There are situations in which patients might no longer be fully able to make decisions on their own behalf, however, and some patients never were able to do so. In such cases, it is critical to be aware of how to determine if a patient has the ability to make medical decisions and what should be done if they do not. In this article, we examine the concept of decision-making capacity in oncology and explore situations in which patients may have altered/diminished capacity (e.g., depression, cognitive impairment, delirium, brain tumor, brain metastases, etc.) or never had decisional capacity (e.g., minor children or developmentally disabled adults). We describe fundamental principles to consider when caring for a patient with cancer who lacks decisional capacity. We then introduce strategies for capacity assessment and discuss how clinicians might navigate scenarios in which their patients could lack capacity to make decisions about their cancer care. Finally, we explore ways in which pediatric and medical oncology can learn from one another with regard to these challenging situations.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2016 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

Best Practices, Enduring Challenges, and Opportunities for VSED

2021 ◽  
pp. 126-130
Author(s):  
Timothy E. Quill ◽  
Paul T. Menzel ◽  
Thaddeus M. Pope ◽  
Judith K. Schwarz
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Best Practices ◽  
Advance Directives ◽  
Symptom Management ◽  
Early Phase ◽  
Terminal Illness ◽  
Care Providers ◽  
Decision Making Capacity ◽  
Challenges And Opportunities

VSED begins with excellent symptom management supported by experienced clinicians. VSED is largely patient controlled, but involvement of experienced palliative care providers and family is strongly recommended. Decision making capacity is frequently lost late in the process as death nears, so written advance directives to continue withholding food and fluids should be completed prior to initiating VSED to forestall any misunderstandings of the patient’s wishes. Challenges associated with VSED include its two week duration before death, the personal determination required, and the possibility of delirium in the latter stages that potentially compromises the commitment to forgo fluids. These challenges should be anticipated and planned for. The primary advantages of VSED include: 1) predictable two week duration from initiation to death; 2) alertness for the early phase, 3) no terminal illness requirement, 4) largely under the patient’s control, and 5) awareness of the possibility of VSED can provide comfort to those worried about unacceptable future suffering.

Dealing with advance directives for critically ill adolescents

1992 ◽  
Vol 12 (5) ◽  
pp. 31-37 ◽  
Author(s):  
CH Rushton ◽  
ME Lynch
Keyword(s):  
Public Policy ◽  
Decision Making ◽  
Critical Care ◽  
Advance Directives ◽  
Nursing Practice ◽  
Critical Care Nurses ◽  
Essential Dimension ◽  
Decision Making Capacity ◽  
Improved Methods

Respecting the values and preferences of adolescents regarding treatment is an essential dimension of nursing practice. As public policy and societal thinking about the role of minors in healthcare decisions evolves, critical care nurses are in a pivotal position to provide leadership and guidance. Critical care nurses who care for adolescents should embrace the opportunity created by the PSDA to implement creative strategies for involving minors in decision making, seek improved methods of assessing decision-making capacity, and document the values and preferences of minors.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2016 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

Clinical Issues

2021 ◽  
pp. 34-59
Author(s):  
Timothy E. Quill ◽  
Judith K. Schwarz ◽  
V. J. Periyakoil
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Oral Care ◽  
Oral Intake ◽  
Informed Choice ◽  
Dry Mouth ◽  
Health Care Proxy ◽  
Decision Making Capacity ◽  
Seriously Ill

VSED requires a decisionally capable, seriously ill patient who makes an informed choice to intentionally hasten death because of unacceptable current suffering or fear of imminent future suffering. In addition to being well informed and determined, patients must have access to ongoing caregiving support and a committed clinician partner. The treating clinician must carefully evaluate the reasons for the patient’s request and her decision-making capacity. Most patients who forgo all oral intake, food and liquids, die peacefully from dehydration within ten to fourteen days. Difficult symptoms of thirst and dry mouth can be adequately relieved with good oral care and access to medications to relieve additional distress. Many patients will be reassured by awareness of the option of VSED even if they never actually exercise it. Completion of advance directives (both health care proxy and instructional) as well as MOLST forms are recommended for anyone initiating VSED, as many patients lose decision-making capacity late in the process.

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