scholarly journals Coercive Measures in Psychiatry: A Review of Ethical Arguments

2021 ◽  
Vol 12 ◽  
Author(s):  
Marie Chieze ◽  
Christine Clavien ◽  
Stefan Kaiser ◽  
Samia Hurst
Keyword(s):  
Decision Making ◽  
Evaluation Process ◽  
Well Being ◽  
Fundamental Rights ◽  
Involuntary Hospitalization ◽  
Coercive Measures ◽  
Freedom Of Movement ◽  
Procedural Values ◽  
Further Development

Introduction: Coercion is frequent in clinical practice, particularly in psychiatry. Since it overrides some fundamental rights of patients (notably their liberty of movement and decision-making), adequate use of coercion requires legal and ethical justifications. In this article, we map out the ethical elements used in the literature to justify or reject the use of coercive measures limiting freedom of movement (seclusion, restraint, involuntary hospitalization) and highlight some important issues.Methods: We conducted a narrative review of the literature by searching the PubMed, Embase, PsycINFO, Google Scholar and Cairn.info databases with the keywords “coercive/compulsory measures/care/treatment, coercion, seclusion, restraint, mental health, psychiatry, involuntary/compulsory hospitalization/admission, ethics, legitimacy.” We collected all ethically relevant elements used in the author's justifications for or against coercive measures limiting freedom of movement (e.g., values, rights, practical considerations, relevant feelings, expected attitudes, risks of side effects), and coded, and ordered them into categories.Results: Some reasons provided in the literature are presented as justifying an absolute prohibition on coercion; they rely on the view that some fundamental rights, such as autonomy, are non-negotiable. Most ethically relevant elements, however, can be used in a balanced weighting of reasons to favor or reject coercive measures in certain circumstances. Professionals mostly agree that coercion is only legitimate in exceptional circumstances, when the infringement of some values (e.g., freedom of movement, short-term autonomy) is the only means to fulfill other, more important values and goals (e.g., patient's safety, the long-term rebuilding of patient's identity and autonomy). The results of evaluations vary according to which moral elements are prioritized over others. Moreover, we found numerous considerations (e.g., conditions, procedural values) for how to ensure that clinicians apply fair decision-making procedures related to coercion. Based on this analysis, we highlight vital topics that need further development.Conclusion: Before using coercive measures limiting freedom of movement, clinicians should consider and weigh all ethically pertinent elements in the situation and actively search for alternatives that are more respectful of patient's well-being and rights. Coercive measures decided upon after a transparent, carefully balanced evaluation process are more likely to be adequate, understood, and accepted by patients and caregivers.

scholarly journals How should we regulate artificial intelligence?

2018 ◽  
Vol 376 (2128) ◽  
pp. 20170360 ◽  
Author(s):  
Chris Reed
Keyword(s):  
Artificial Intelligence ◽  
Neural Networks ◽  
Decision Making ◽  
Current System ◽  
General System ◽  
Fundamental Rights ◽  
Ex Post ◽  
Ex Ante ◽  
Human Decision

Using artificial intelligence (AI) technology to replace human decision-making will inevitably create new risks whose consequences are unforeseeable. This naturally leads to calls for regulation, but I argue that it is too early to attempt a general system of AI regulation. Instead, we should work incrementally within the existing legal and regulatory schemes which allocate responsibility, and therefore liability, to persons. Where AI clearly creates risks which current law and regulation cannot deal with adequately, then new regulation will be needed. But in most cases, the current system can work effectively if the producers of AI technology can provide sufficient transparency in explaining how AI decisions are made. Transparency ex post can often be achieved through retrospective analysis of the technology's operations, and will be sufficient if the main goal is to compensate victims of incorrect decisions. Ex ante transparency is more challenging, and can limit the use of some AI technologies such as neural networks. It should only be demanded by regulation where the AI presents risks to fundamental rights, or where society needs reassuring that the technology can safely be used. Masterly inactivity in regulation is likely to achieve a better long-term solution than a rush to regulate in ignorance. This article is part of a discussion meeting issue ‘The growing ubiquity of algorithms in society: implications, impacts and innovations'.

OP47 Need For New Thrombectomy Centers? A Practical Decision Framework

2019 ◽  
Vol 35 (S1) ◽  
pp. 11-11
Author(s):  
Maria Vutcovici Nicolae ◽  
Lucy Boothroyd ◽  
Leila Azzi ◽  
Laurie Lambert ◽  
Michèle de Guise
Keyword(s):  
Decision Making ◽  
Real World ◽  
Critical Mass ◽  
Evaluation Process ◽  
Field Evaluation ◽  
Stroke Care ◽  
Healthcare Services ◽  
Performance Criteria ◽  
Sources Of Information

IntroductionStroke is a major contributor to mortality, disability and long-term use of healthcare services. As for all chrono-dependant conditions, clinical results are associated with timely access to appropriate care. Thrombectomy (EVT) is an effective treatment for large vessel occlusions, but can only be provided in highly-specialized centers by experienced personnel. We sought to develop a framework to aid decision-making on the appropriateness of opening new EVT centers in Québec, Canada.MethodsData sources included provincial administrative healthcare databases, population density statistics, field evaluation of Québec's four existing EVT care networks, and literature review concerning structural and performance criteria for EVT centers. We consulted EVT clinical teams, interdisciplinary stroke experts, patients, professional association representatives, healthcare managers and decision-makers.ResultsAccess to EVT is suboptimal in all 17 regions of Québec, with virtually no access in remote areas. Results of key performance indicators indicated favorable treatment delays after arrival at the EVT center. However, door-to-needle and door-in-door-out times were long for patients transferred from non-EVT centers. High use of ambulances indicated the potential to transport patients to the most appropriate center. In light of ‘real world’ results and other sources of information, the need for a new EVT center should consider the following criteria: sub-optimal EVT access within the region; transport time to an existing EVT center >1 hour; expected patient volume within 2 hours of transport; impact on volume of existing programs; availability of long-term financial support; availability of a critical mass of neurointerventionists, vascular neurologists, and neurosurgeons; demonstrated quality of stroke care; and, presence of a stroke unit.ConclusionsThe triangulation of literature, clinician experience and the Québec context enriched the evaluation process. Furthermore, this facilitated the development of a framework that was broadly applicable across regions to the real-world setting of decision-making in a complex system of care.

Experiences of the First 16 Hospitals Using Copper-Silver Ionization forLegionellaControl: Implications for the Evaluation of Other Disinfection Modalities

2003 ◽  
Vol 24 (8) ◽  
pp. 563-568 ◽  
Author(s):  
Janet E. Stout ◽  
Victor L. Yu
Keyword(s):  
Decision Making ◽  
Evaluation Criteria ◽  
Evaluation Process ◽  
Water Systems ◽  
Evidence Based ◽  
Disinfection Methods ◽  
Legionnaires Disease ◽  
Hospital Acquired

AbstractBackground and Objectives:Hospital-acquired legionnaires' disease can be prevented by disinfection of hospital water systems. This study assessed the long-term efficacy of copper-silver ionization as a disinfection method in controllingLegionellain hospital water systems and reducing the incidence of hospital-acquired legionnaires' disease. A standardized, evidence-based approach to assist hospitals with decision making concerning the possible purchase of a disinfection system is presented.Design:The first 16 hospitals to install copper-silver ionization systems forLegionelladisinfection were surveyed. Surveys conducted in 1995 and 2000 documented the experiences of the hospitals with maintenance of the system, contamination of water withLegionella, and occurrence of hospital-acquired legionnaires' disease. All were acute care hospitals with a mean of 435 beds.Results:All 16 hospitals reported cases of hospital-acquired legionnaires' disease prior to installing the copper-silver ionization system. Seventy-five percent had previously attempted other disinfection methods including superheat and flush, ultraviolet light, and hyperchlorination. By 2000, the ionization systems had been operational from 5 to 11 years. Prior to installation, 47% of the hospitals reported that more than 30% of distal water sites yieldedLegionella. In 1995, after installation, 50% of the hospitals reported 0% positivity, and 43% still reported 0% in 2000. Moreover, no cases of hospital-acquired legionnaires' disease have occurred in any hospital since 1995.Conclusions:This study represents the final step in a proposed 4-step evaluation process of disinfection systems that includes (1) demonstrated efficacy ofLegionellaeradication in vitro using laboratory assays, (2) anecdotal experiences in preventing legionnaires' disease in individual hospitals, (3) controlled studies in individual hospitals, and (4) validation in confirmatory reports from multiple hospitals during a prolonged time (5 to 11 years in this study). Copper-silver ionization is now the only disinfection modality to have fulfilled all four evaluation criteria.

scholarly journals Attitudes and decision-making in the child protection system

2017 ◽  
Vol 25 (2) ◽  
pp. 2-14 ◽  
Author(s):  
Paulo Delgado ◽  
Vânia S. Pinto ◽  
João M. S. Carvalho
Keyword(s):  
Decision Making ◽  
Foster Care ◽  
Residential Care ◽  
Family Environment ◽  
Child Protection ◽  
Well Being ◽  
Fundamental Rights ◽  
Protection System ◽  
Decision Making Process ◽  
Rights Of The Child

In the contexts of family neglect or maltreatment, the State intervenes by safeguarding the development and well-being of the child or young person in danger. In more severe situations, the intervention may lead to the child’s removal from the family. The Portuguese Law on the Protection of Children and Young People in Danger (Law 142/2015 of September 8th) favours the placement of the child in a family environment, especially for children up to the age of six. Despite this, in Portugal, in 2015, 8 600 children were in out-of-home care, only 3.5% of which were placed in foster care, while the remaining children were in residential care. Therefore, one of the fundamental rights of the child – living in a family environment – is compromised in practice. This study aims to understand the decision-making process of 200 higher education students in domains related to child protection, and those of 200 professionals who are responsible for providing case assessments and recommendations for intervention in the Portuguese child protection system. Using the Child Welfare Attitudes Questionnaire (Davidson-Arad & Benbenishty, 2008, 2010), the study aimed to identify the participants’ attitudes regarding removal of at-risk children from home, reunification and optimal duration of alternative care, children’s and parents’ participation in the decision-making process, and assessment of foster care and residential care, with the purpose of promoting children’s development and well-being. We concluded that both sets of participants (professionals and students) can be divided in two groups, one which is pro-removal and the other, which is less so. In comparison with students, professionals less often favour the removal of the child and more often defend reunification. There are no significant differences among participants regarding their opinion about the role of foster and residential care, and the participation of the child in the decision-making process. However, professionals tend to support parents’ participation in the decision-making process more than students do. Finally, we present some implications of our findings for the practice of child protection.

The Rationale for a Well-Being Approach

2020 ◽  
pp. 13-24
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Environmental Sustainability ◽  
Well Being ◽  
Local Context ◽  
Structural Barriers ◽  
Truth Telling ◽  
Key Points ◽  
Social Narrative

This chapter presents the rationale for a well-being approach. A well-being approach—that is, establishing well-being as the goal and measure of what matters in order to create a future in which people, communities, and the planet can all thrive—provides a new compass for decision-making, resource allocation, social narrative, and even consciousness. The chapter highlights the benefits, positive outcomes, and potential for transformation via a well-being approach. Some of the key points include the ability of a well-being approach to: shift the focus to things that matter most to people and communities; create more urgency to address inequities and shift power; break down structural barriers and “silos” to encourage cross-sector collaboration; link human well-being and environmental sustainability; create a new expectation, demand, and accountability for a well-being agenda; and focus on the future through long-term agendas and inter-generational leadership. Meanwhile, key among the enabling conditions for well-being in the local context are truth telling about history and experiences, and ensuring that benefits are equitably shared.

scholarly journals Evaluation of Sanitation Strategies and Initiatives Implemented in Mexico from Community Capitals Point of View

Water ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 295 ◽  
Author(s):  
Thalía Turrén-Cruz ◽  
Juan García-Rodríguez ◽  
Miguel López Zavala
Keyword(s):  
Decision Making ◽  
Well Being ◽  
Point Of View ◽  
Community Capitals ◽  
Sanitation Services ◽  
Community Capitals Framework ◽  
Lack Of Information ◽  
Basic Sanitation ◽  
Treat All

Sanitation is fundamental to human development and well-being. For developing countries, such as Mexico, one of the greatest long-term challenges is to treat all the wastewater generated. Several projects have been implemented to achieve this goal, but, due to the idiosyncrasies of local people, they have failed. This study aims to analyze both, previous and current sanitation strategies and initiatives that are implemented in Mexico. Through the analysis of data reported by the literature, using the Community Capitals Framework (CCF) and focusing on human factors, the data was analyzed to identify whether communities are being considered to guarantee the success of the technologies and resources implemented. Besides the lack of information, it was understood that, despite the governance efforts to provide sanitation, the task remains incomplete; some top priority drivers, such as population growth and water supply, seem to define the progress or decline in providing quality basic sanitation services. Using the CCF, it was observed that financial, political, and built (infrastructural) are being prioritized over the human, social, cultural, and natural capitals. Therefore, it is important to highlight the communities’ point of view on the development and decision making of projects and public policies, not just for sanitation but also for common well-being.

Conferences as Learning Spaces on Climate Change and Sustainability

2015 ◽  
pp. 37-59
Author(s):  
Mona Betour El Zoghbi
Keyword(s):  
Climate Change ◽  
South Africa ◽  
Decision Making ◽  
Well Being ◽  
Youth Participation ◽  
Learning Spaces ◽  
New Learning ◽  
Meaningful Engagement ◽  
Depth Interviews

The international community is increasingly recognizing the importance of youth's meaningful engagement and empowerment for managing long-term climate change challenges, and of their consultation on policies and decisions that affect their well-being and sustainable development. Yet the extent to which new learning is generated in current spaces for youth participation in local, national and global negotiations and decision-making on environmental issues remains less understood. This Chapter discusses the importance and effectiveness of youth-targeted and youth-led environmental conferences, forums, workshops and similar events in advancing the learning experiences of youth participants in these events. Testimonials from young people, generated through in-depth interviews of youth participants at environmental conferences and forums in the Netherlands and South Africa provide key insights into their engagement. The findings highlight the need for more empowering and critically engaging platforms for youth participation and for adequate mentoring of young participants.

Conferences as Learning Spaces on Climate Change and Sustainability

2017 ◽  
pp. 896-918
Author(s):  
Mona Betour El Zoghbi
Keyword(s):  
Climate Change ◽  
South Africa ◽  
Decision Making ◽  
Well Being ◽  
Youth Participation ◽  
Learning Spaces ◽  
New Learning ◽  
Meaningful Engagement ◽  
Depth Interviews

The international community is increasingly recognizing the importance of youth's meaningful engagement and empowerment for managing long-term climate change challenges, and of their consultation on policies and decisions that affect their well-being and sustainable development. Yet the extent to which new learning is generated in current spaces for youth participation in local, national and global negotiations and decision-making on environmental issues remains less understood. This Chapter discusses the importance and effectiveness of youth-targeted and youth-led environmental conferences, forums, workshops and similar events in advancing the learning experiences of youth participants in these events. Testimonials from young people, generated through in-depth interviews of youth participants at environmental conferences and forums in the Netherlands and South Africa provide key insights into their engagement. The findings highlight the need for more empowering and critically engaging platforms for youth participation and for adequate mentoring of young participants.

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