The Variables of Moral Capacity (International Library of Ethics, Law, and the New Medicine)

The Variables of Moral Capacity (International Library of Ethics, Law, and the New Medicine) - Kindle edition by David C. Thomasma, David N. Weisstub.
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Dordrecht ; New York: New directions in the ethics of assisted suicide and euthanasia. Paediatric patient and family-centred care: Athletic enhancement, human nature, and ethics: Ethical issues in prison psychiatry. Monstrous crimes and the failure of forensic psychiatry. Acceptable risk in biomedical research: The ethics of screening in health care and medicine: National Center for Biotechnology Information , U. Items per page 5 10 20 50 Didn't get the message? Select item 1. Although multicenter ethical committees exist in some countries and also, in some cases, approval of one ethical committee does not need a second approval, international research can be impeded by different legal requirements.

The ethical conduct of research in PC patients with delirium is a complex issue. It is paramount to protect participants from any harm or risk, conduct ethical and lawful research according to ethical guidelines, and produce ethical and meaningful results. This is more difficult to achieve in research on delirium and especially in PC settings, in which many patients have reduced or fluctuating capacity, and consequently, their ability to give valid informed consent is compromised. Modifications to the informed consent process are required in research with delirious patients to decrease the likelihood of ultimately obtaining invalid and thus unethical results through the exclusion of patients who lack capacity or a proxy.

The nature of these modifications is dependent on the degree of risk that the research poses to the patient. When greater than minimal risk is posed by research, additional protection of the potential participants is required. Although much weight is given to the principle of autonomy and the expectation that patients can weigh risk vs. Although robust procedures around the process of obtaining informed consent are crucial, perhaps the most important safeguard for participants is researcher behavior, which must be meticulous, responsible, ethical, and caring.

The authors declare no conflicts of interest. National Center for Biotechnology Information , U. J Pain Symptom Manage. Author manuscript; available in PMC Aug Division of Palliative Care L. The publisher's final edited version of this article is available at J Pain Symptom Manage. See other articles in PMC that cite the published article. Abstract Context Delirium occurs commonly in settings of palliative care PC , in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges.

Methods Together with an analysis of the ethical deliberations at the SUNDIPS meeting, we conducted a narrative literature review by key words searching of relevant databases and a subsequent hand search of initially identified articles. Results Key issues identified include the inclusion of PC patients in delirium research, capacity determination, and the mandate to respect patient autonomy and ensure maintenance of patient dignity. Conclusion Delirium research in PC patients must meet the common standards for such research in any setting. Ethics, palliative care, delirium, research.

Introduction Delirium is a complex neuropsychiatric disorder characterized by acute or subacute changes to mental status with impaired consciousness, attention, and cognition. Informed Consent and Capacity The authors recognize that the terms consent and assent as obtained through an authorized representative proxy are used differently in certain jurisdictions. Possible Solutions to the Challenge of Consent Where consent poses a challenge, research efforts may gravitate toward either the use of study designs or the recruitment of subpopulations that are less challenging.

Increasing the Understanding of the Proposed Research by Potential Participants This can be done by shortening the informed consent form, simplifying the language, and avoiding medical terms or jargon. Less Formal Capacity Assessments In a previous observational study in delirium, a formal test of capacity produced a demonstrable selection bias.

Facilitated Consent In a facilitated consent process, a close relative helper asks questions on behalf of the patient, but the actual consent is provided by the patient after discussion with the physician. Deferred Consent Deferred consent is used in emergency research and refers to the consent obtained after the treatment or intervention has commenced and when the patient has regained capacity or a proxy is engaged deferred proxy.

Experienced Consent This approach to consent was described by Rikkert et al. Proxy Consent Although not without problems, proxy consent is a core safeguard for vulnerable participants who cannot consent on their own behalf. International ethical guidelines for biomedical research involving human subjects. An international compilation of human research standards edition.

Produced by the European Commission Ethical and policy issues in research involving human participants. Research ethics guidance for nurses. National statement on ethical conduct in human research published by the National Health and Medical Research Council of Australia and the Australian Research Council Open in a separate window. Acknowledging Cultural and International Dimensions Aside from international legislative differences, culture may dictate different approaches to obtaining informed consent.

Conclusions The ethical conduct of research in PC patients with delirium is a complex issue. Diagnostic and statistical manual of mental disorders.

Moral rights to healthcare

Task Force on D-I. Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: Delirium at the end of life: Occurrence, causes, and outcome of delirium in patients with advanced cancer: Reversibility of delirium in terminally ill patients and predictors of mortality. Delirium and cognitive dysfunction in the intensive care unit. Occurrence and outcome of delirium in medical in-patients: Making decisions about delirium: The recognition and documentation of delirium in hospital palliative care inpatients.


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Psychiatric issues in palliative care: Young LJ, George J. Do guidelines improve the process and outcomes of care in delirium? Ethical considerations in end-of-life care and research. Are special ethical guidelines needed for palliative care research? Duke S, Bennett H. Lee S, Kristjanson L.

Human research ethics committees: Int J Palliat Nurs. The ethics and practicalities of consent in palliative care research: Cancer pain relief and palliative care. World Health Organization; Geneva: Ethical issues in palliative care research revisited. Ethical issues in palliative care research. Law, medicine, and the market. Oxford University Press; New York: Reducing delirium after hip fracture: J Am Geriatr Soc. Ethical research in delirium: Ethical principles and guidelines for the protection of human subjects of research.

Canadian Institutes of Health Research. Autonomy and the psychiatric patient. Research in palliative care populations: Are hospices ready to participate in palliative care research? Results of a national survey. Crowley R, Casarett D. Burden and benefit of psychosocial research at the end of life. The ethics of consent in delirium studies. MORECare research methods guidance development: Randomised controlled trials of palliative care—a survey of the views of advanced cancer patients and their relatives.

A systematic review examining the literature on attitudes of patients with advanced cancer toward research. Capacity, consent, and selection bias in a study of delirium. A brief historical and theoretical perspective on patient autonomy and medical decision making: Vollmann J, Winau R. Informed consent in human experimentation before the Nuremberg code.

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The silent world of doctor and patient. Grisso T, Appelbaum PS. Assessing competence to consent to treatment: A guide for physicians and other health professionals. Oxford University Press; Oxford: Informed consent and justified hard paternalism. University of Birmingham; Birmingham, U. The utility of the Mini-Mental State Examination in guiding assessment of capacity to consent to research.

Doing research on the ethics of doing research.

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