Rethinking the Precedent Autonomy, Current Minimal Autonomy, and Current Well-Being in Medical Decisions for Persons with Dementia

2022 ◽  
Author(s):  
Yuanyuan Huang ◽  
Yali Cong ◽  
Zhifeng Wang
Keyword(s):  
Well Being ◽  
Medical Decisions

scholarly journals Time and Collective Biology: Relationships Between Individual and Societal Life Course Ideologies in Mexican Men’s Sexual Health Treatment

2021 ◽  
Vol 42 (1) ◽  
pp. 66-80
Author(s):  
Emily Wentzell
Keyword(s):  
Sexual Health ◽  
Life Course ◽  
Aging Treatment ◽  
Population Level ◽  
Well Being ◽  
Mexican Population ◽  
Medical Decisions ◽  
Race And Gender ◽  
Sexually Transmitted ◽  
Over Time

People may seek to embody cultural ideals of the life course through their use or rejection of medical interventions, including but not limited to anti-aging treatments. Here, I analyze this phenomenon via interviews with men engaging with two different forms of sexual health medicine in urban Mexico: erectile-dysfunction treatment and testing for sexually transmitted infections (STIs). I argue that, in contrast to the biomedical understanding of patients as individuals who change during their lives, my interlocutors understood themselves as components in broader “collective biologies” that change on a longer timeline. These are culturally-defined groups that people understand to be comprised of interrelated members whose behaviors concretely affect the group’s physical and social well-being over time. In both medical arenas discussed here, men used or rejected sexual health interventions in response to local narratives about the nature of the Mexican population as a collective biology, including ideas about how it should change over time away from its roots in the colonial past. They characterized predispositions to machismo and disinterest in preventative health care as embodied inheritances that the Mexican population should reject in order to achieve health-promoting modernity in the future. My analysis describes how these interlocutors sought to live out desirably modern forms of race and gender through their medical decisions in a way that they hoped would contribute to positive, embodied change in the Mexican social body over time. These findings show that, despite the assumptions of individualism generally naturalized in anti-aging treatment and biomedicine, people may make medical decisions in an effort to aid collective change over population-level timescales.

Forensic Issues in the Geriatric Psychiatry Consult Liaison Service and the Right to Accept and Refuse Treatment

2017 ◽  
Author(s):  
Eran D. Metzger ◽  
Jacob C. Holzer ◽  
Rebecca W. Brendel
Keyword(s):  
Functional Assessment ◽  
Geriatric Patients ◽  
Well Being ◽  
Geriatric Psychiatry ◽  
Medical Decisions ◽  
Decision Making Capacity ◽  
Language Pathology ◽  
Occupational And Physical Therapy ◽  
The Right ◽  
Hospitalized Geriatric Patients

The consultation liaison psychiatrist frequently encounters questions of decision-making capacity for hospitalized geriatric patients. This trend will only continue as the population ages and questions about the ability of aging patients to make medical decisions and broader life decisions arise more and more frequently. Consultation liaison psychiatrists tasked with determining these capacities may be faced with a duality of roles: responsibility to the patient but also protective obligations imposed by laws and regulations. Consultation liaison psychiatrists should engage these evaluations carefully and be forthright with patients. An approach focusing on the nature and cause of incapacity, the potential for reversibility of incapacity, adequately informing the patient, relying on colleagues in occupational and physical therapy as well as speech and language pathology for functional assessment, and understanding the patient’s life history and story can lead to results respectful of both the patient’s well-being and dignity. This chapter presents forensic issues relevant to the geriatric psychiatry consultation-liaison service through an illustrative clinical vignette.

Surrogate decision making for unrepresented patients: Proposing a harm reduction interpretation of the best interest standard

2020 ◽  
Vol 15 (2) ◽  
pp. 57-64
Author(s):  
Phoebe Friesen ◽  
Nada Gligorov
Keyword(s):  
Decision Making ◽  
Harm Reduction ◽  
Well Being ◽  
The United States ◽  
Alternative Interpretation ◽  
Surrogate Decision Making ◽  
Best Interest ◽  
Medical Decisions ◽  
Best Interest Standard ◽  
Surrogate Decision

Unrepresented patients are individuals who lack decision makingcapacity and have no family or friends to make medical decisions for them. This population is growing in number in the United States, particularly within emergency and intensive care settings. While some bioethical discussion has taken place in response to the question of who ought to make decisions for these patients, the issue of how surrogate medical decisions ought to be made for this population remains unexplored. In this paper, we argue that standard applications of surrogate decision making principles in health care are not well suited to many unrepresented patients with long-term mental health diagnosis. We argue that when applied to this population, the substituted judgment standard, designed to preserve patient preferences and values, may lead to the exclusion of their preferences. We argue further that the application of the best interest standard runs the risk of leading to harmful cases of overtreatment or undertreatment. We offer an alternative interpretation of the best interest principle that is better able to promote the well-being of unrepresented patients, especially for those who lack capacity because of mental disorders. This alternative is based on the practices and principles of harm reduction and includes three components: emphasis on considering the expressed preferences of unrepresented patients, a focus on reducing harm as well as the delivery of clinical benefits, and a recognition of the importance of promoting trust.

Spirituality and End-of-Life Outcomes

2018 ◽  
Author(s):  
Michael J. Balboni ◽  
Tracy A. Balboni
Keyword(s):  
Well Being ◽  
Medical System ◽  
National Standards ◽  
Medical Utilization ◽  
Treatment Preferences ◽  
Spiritual Support ◽  
Advanced Illness ◽  
Medical Decisions ◽  
Aggressive Care ◽  
Hospice Use

A growing number of studies show prospective associations between patient spirituality and quality of life. Evidence suggests that as physical health worsens, spiritual health holds a central role in determining patient well-being. Spirituality may enable patients to endure the suffering that comes with advanced illness and dying. Growing evidence also indicates that treatment preferences, medical decisions, and medical utilization are shaped by patients’ religiosity and the level of spiritual support from the medical team and religious communities. Spiritual support from the medical system is associated with increased hospice use, decreased aggressive care, and cost differences in the final week of life. This suggests that medical system spiritual support is an essential component that lessens futile medical treatment near life’s end. Those clinicians who are proficiently “fluent” in engaging religious beliefs may be better able to influence patients in making medical decisions. National standards have begun to incorporate these results.

The Relationship Between Hearing Loss Self-Management and Hearing Aid Benefit and Satisfaction

2019 ◽  
Vol 28 (2) ◽  
pp. 274-284 ◽  
Author(s):  
Elizabeth Convery ◽  
Gitte Keidser ◽  
Louise Hickson ◽  
Carly Meyer
Keyword(s):  
Decision Making ◽  
Hearing Loss ◽  
Hearing Aids ◽  
Clinical Decision Making ◽  
Hearing Aid ◽  
Well Being ◽  
Self Report ◽  
Self Management ◽  
Hearing Aid Benefit ◽  
The Relationship

Purpose Hearing loss self-management refers to the knowledge and skills people use to manage the effects of hearing loss on all aspects of their daily lives. The purpose of this study was to investigate the relationship between self-reported hearing loss self-management and hearing aid benefit and satisfaction. Method Thirty-seven adults with hearing loss, all of whom were current users of bilateral hearing aids, participated in this observational study. The participants completed self-report inventories probing their hearing loss self-management and hearing aid benefit and satisfaction. Correlation analysis was used to investigate the relationship between individual domains of hearing loss self-management and hearing aid benefit and satisfaction. Results Participants who reported better self-management of the effects of their hearing loss on their emotional well-being and social participation were more likely to report less aided listening difficulty in noisy and reverberant environments and greater satisfaction with the effect of their hearing aids on their self-image. Participants who reported better self-management in the areas of adhering to treatment, participating in shared decision making, accessing services and resources, attending appointments, and monitoring for changes in their hearing and functional status were more likely to report greater satisfaction with the sound quality and performance of their hearing aids. Conclusion Study findings highlight the potential for using information about a patient's hearing loss self-management in different domains as part of clinical decision making and management planning.

Inclusion of Transgender Voice and Communication Training in a University Clinic

2017 ◽  
Vol 2 (10) ◽  
pp. 109-115 ◽  
Author(s):  
Jennifer Oates ◽  
Georgia Dacakis
Keyword(s):  
Training Program ◽  
Clinical Education ◽  
Well Being ◽  
Evidence Base ◽  
Communication Training ◽  
Speech Language Pathology ◽  
Transgender People ◽  
Language Pathology ◽  
Effectiveness Of Training ◽  
Negative Impacts

Because of the increasing number of transgender people requesting speech-language pathology services, because having gender-incongruent voice and communication has major negative impacts on an individual's social participation and well-being, and because voice and communication training is supported by an improving evidence-base, it is becoming more common for universities to include transgender-specific theoretical and clinical components in their speech-language pathology programs. This paper describes the theoretical and clinical education provided to speech-language pathology students at La Trobe University in Australia, with a particular focus on the voice and communication training program offered by the La Trobe Communication Clinic. Further research is required to determine the outcomes of the clinic's training program in terms of student confidence and competence as well as the effectiveness of training for transgender clients.

Improving Feeding Outcomes in the NICU: Moving From Volume-Driven to Infant-Driven Feeding

2010 ◽  
Vol 19 (3) ◽  
pp. 68-74 ◽  
Author(s):  
Catherine S. Shaker
Keyword(s):  
Intensive Care Unit ◽  
Dynamic Systems ◽  
Neonatal Intensive Care ◽  
Well Being ◽  
Dynamic Systems Theory ◽  
Feeding Problems ◽  
Care Giving ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Current research on feeding outcomes after discharge from the neonatal intensive care unit (NICU) suggests a need to critically look at the early underpinnings of persistent feeding problems in extremely preterm infants. Concepts of dynamic systems theory and sensitive care-giving are used to describe the specialized needs of this fragile population related to the emergence of safe and successful feeding and swallowing. Focusing on the infant as a co-regulatory partner and embracing a framework of an infant-driven, versus volume-driven, feeding approach are highlighted as best supporting the preterm infant's developmental strivings and long-term well-being.

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