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.

scholarly journals The Rights of Science and the Rights of Politics: Lessons from the Long-form Census Controversy

2012 ◽  
Vol 37 (3) ◽  
pp. 295-318 ◽  
Author(s):  
Michael Yeo
Keyword(s):  
Public Policy ◽  
Decision Making ◽  
Policy Decisions ◽  
Long Form ◽  
Science And Politics ◽  
The Relationship ◽  
Normative Account ◽  
Made In ◽  
Conceptual Resources

One of the main issues in the long-form census controversy concerned the relationship between science and politics. Through analysis of the arguments and underlying assumptions of four influential and exemplary interventions that were made in the name of science, this paper outlines a normative account of this relationship. The paper nuances the science-protective ideals that critics invoked and argues that such conceptual resources are needed if science is to be protected from undue political encroachment. However, in their zeal to defend the rights of science critics claimed for it more than its due, eclipsing the value dimension of policy decisions and failing to respect the role of politics as the rightful locus of decision making for value issues. An adequate normative account of the relationship between science and politics in public policy must be capable not only of protecting science from politics but also of protecting politics from science.

scholarly journals Emancipatory reflection on a nursing practice-based ethical issue about nurses’ paternalistic decision-making for patients

2019 ◽  
Vol 6 (1) ◽  
pp. 19-26
Author(s):  
Lian-Lian Tang
Keyword(s):  
Decision Making ◽  
Ethical Issue ◽  
Nursing Practice ◽  
Professional Socialization ◽  
Nursing Administration ◽  
Patient Centered ◽  
Socialization Theory ◽  
Decision Making Capacity ◽  
Centered Care ◽  
Policy Work

Abstract Objective This study aimed to demonstrate and promote the skill of critical emancipatory reflection through reflecting on a nursing practice-based ethical issue about nurses’ paternalistic decision-making for patients. Meanwhile, critical awareness will be developed and the underlying issues of paternalism in nursing decision-making will be analyzed. Then, by applying the procedure, improvement in nursing decision-making practice will be expected. Methods Taylor’s model of emancipatory reflection with four steps, including construction, deconstruction, confrontation, and reconstruction, is utilized to guide the author’s reflection. Results Guided by the socialization theory, the author’s personal and professional socialization is seen to be associated with the formation of the value of paternalism. The theory of reflexivity is applied to unearth the related issues, including deeper personal value, work environment, as well as historical and cultural contexts. Moreover, the power derived from policy, work relationship, and nursing administration, which could induce paternalism in the author’s nursing decision-making practice, was critically debated using the hegemony theory. Finally, new insights into paternalism will be achieved, which enable change in terms of how to facilitate patients’ autonomous decision-making. Conclusions The process of refection makes it clear that respecting patients’ right and performing patient-centered caring are the bases to change the paternalism existing in the nursing decision-making practice currently. The reconstruction step assists the author in terms of how to value the patients’ autonomy and balance patients’ safety and choice, rather than being overprotective; carry out risk assessment, and search for strong evidence to counterbalance the positive and negative aspects of risk-taking; communicate with patients appropriately in a manner that they can comprehend; spend more time to explore patients’ preference and choice; make every effort to elevate the patients’ decision-making capacity; implement patient-centered care and shared decision-making in nursing practice; consult with other colleagues and obtain the required support when limitations or challenges exist; try to justify and avoid hidden paternalism behind policy or guidelines; deal with the power in hand well and fairly; and also positively face the powers that constrain the author.

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

Integrating Ecosystem Management and Environmental Media for Public Policy on Public Health and Safety

2018 ◽  
pp. 321-338
Author(s):  
Augustine Nduka Eneanya
Keyword(s):  
Public Health ◽  
Public Policy ◽  
Decision Making ◽  
Environmental Policy ◽  
Policy Making ◽  
Health And Safety ◽  
Scientific Data ◽  
Scientific Uncertainty ◽  
Public Health And Safety

Over the past three decades, the relationship between ecology and public policy has changed because of the increasing role of scientific uncertainty in environmental policy making. While earlier policy questions might have been solved simply by looking at the scientific technicalities of the issues, the increased role of scientific uncertainty in environmental policy making requires that we re-examine the methods used in decision-making. Previously, policymakers use scientific data to support their decision-making disciplinary boundaries are less useful because uncertain environmental policy problems span the natural sciences, engineering, economics, politics, and ethics. The chapter serves as a bridge integrating environmental ecosystem, media, and justice into policy for public health and safety. The chapter attempts to demonstrate the linkage between the environmental policy from a holistic perspective with the interaction of air, water, land, and human on public health and safety.

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.

Integrating Ecosystem Management and Environmental Media for Public Policy on Public Health and Safety

2021 ◽  
pp. 612-629
Author(s):  
Augustine Nduka Eneanya
Keyword(s):  
Public Health ◽  
Public Policy ◽  
Decision Making ◽  
Environmental Policy ◽  
Policy Making ◽  
Health And Safety ◽  
Scientific Data ◽  
Scientific Uncertainty ◽  
Public Health And Safety

Over the past three decades, the relationship between ecology and public policy has changed because of the increasing role of scientific uncertainty in environmental policy making. While earlier policy questions might have been solved simply by looking at the scientific technicalities of the issues, the increased role of scientific uncertainty in environmental policy making requires that we re-examine the methods used in decision-making. Previously, policymakers use scientific data to support their decision-making disciplinary boundaries are less useful because uncertain environmental policy problems span the natural sciences, engineering, economics, politics, and ethics. The chapter serves as a bridge integrating environmental ecosystem, media, and justice into policy for public health and safety. The chapter attempts to demonstrate the linkage between the environmental policy from a holistic perspective with the interaction of air, water, land, and human on public health and safety.

Adherence to advance directives in critical care decision making: vignette study

The Elderly ◽  
2017 ◽  
pp. 213-216
Author(s):  
Trevor Thompson ◽  
Rosaline Barbour ◽  
Lisa Schwartz
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Advance Directives ◽  
Vignette Study ◽  
Care Decision
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