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1.
J Law Med ; 28(2): 389-420, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33768748

RESUMO

Australia is obliged under the Convention on the Rights of Persons with Disabilities to provide decision-making support to people with cognitive impairment. While there has been considerable recent activity looking at how the law should respond to the challenges raised by the Convention, there has been little discussion in Australia of how these changes will impact upon the care of people with dementia (the largest class of person with cognitive impairment in Australia). This section examines current Australian legal approaches to decision-making for people with dementia in four jurisdictions (New South Wales, South Australia, Victoria and Western Australia) through an analysis of reported tribunal decisions in each of these jurisdictions. It notes the scope for informal supported decision-making and the basis for the invocation of guardianship orders, including the new Victorian supportive guardianship order, and compares the new standards raised by the Convention. The section considers legal reforms which could improve the implementation of supported decision-making for people living with dementia.


Assuntos
Demência , Competência Mental , Tomada de Decisões , Humanos , New South Wales , Vitória , Austrália Ocidental
2.
Br J Nurs ; 30(5): 320-321, 2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-33733855

RESUMO

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers two recent cases in the Court of Protection that determined if the COVID-19 vaccine was in the best interests of a person who lacked the mental capacity to decide on immunisation after relatives objected its administration.


Assuntos
/administração & dosagem , Legislação de Enfermagem , Competência Mental/legislação & jurisprudência , Idoso , /enfermagem , Instituição de Longa Permanência para Idosos , Humanos , Casas de Saúde , Reino Unido/epidemiologia , Populações Vulneráveis
3.
J Pediatr ; 231: 24-30, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33484694

RESUMO

We address ethical, legal, and practical issues related to adolescent self-consent for human papillomavirus (HPV) vaccination. HPV vaccination coverage continues to lag well behind the national goal of 80% series completion. Structural and behavioral interventions have improved vaccination rates, but attitudinal, behavioral, and access barriers remain. A potential approach for increasing access and improving vaccination coverage would be to permit adolescents to consent to HPV vaccination for themselves. We argue that adolescent self-consent is ethical, but that there are legal hurdles to be overcome in many states. In jurisdictions where self-consent is legal, there can still be barriers due to lack of awareness of the policy among healthcare providers and adolescents. Other barriers to implementation of self-consent include resistance from antivaccine and parent rights activists, reluctance of providers to agree to vaccinate even when self-consent is legally supported, and threats to confidentiality. Confidentiality can be undermined when an adolescent's self-consented HPV vaccination appears in an explanation of benefits communication sent to a parent or if a parent accesses an adolescent's vaccination record via state immunization information systems. In the context of the COVID-19 pandemic, which has led to a substantial drop in HPV vaccination, there may be even more reason to consider self-consent. The atmosphere of uncertainty and distrust surrounding future COVID-19 vaccines underscores the need for any vaccine policy change to be pursued with clear communication and consistent with ethical principles.


Assuntos
Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus , Adolescente , Fatores Etários , Humanos , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estados Unidos
4.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495179

RESUMO

We present an unusual case of an acutely unwell patient with an upper gastrointestinal bleed whose resuscitation efforts were delayed by the discovery of his, similarly, acutely unwell pet on the medical high dependency unit. We highlight the challenges this provided the clinical team and focus on the issues relating to patient safety, consent and multidisciplinary action which may be more relevant to daily clinical practice.


Assuntos
Transfusão de Sangue , Hemorragia Gastrointestinal/terapia , Gastroscopia , Pesar , Animais de Estimação , Animais , Galinhas , Humanos , Masculino , Competência Mental , Pessoa de Meia-Idade , Preferência do Paciente , Assistência Centrada no Paciente
6.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33028661

RESUMO

The current coronavirus disease 2019 (COVID-19) pandemic has triggered an intense global research effort to inform the life-saving work of frontline clinicians who need reliable information as soon as possible. Yet research done in pressured circumstances can lead to ethical dilemmas, especially for vulnerable research subjects. We present the case of a child with neurocognitive impairment who is diagnosed with COVID-19 infection after presenting with fever and a seizure. The child lives in a group home and is in the custody of the state; her parents lost parental rights many years ago. Some members of the health care team want to enroll her in a randomized clinical trial evaluating an experimental treatment of COVID-19. For minor patients to enroll in this clinical trial, the institutional review board requires assent of patients and consent of guardians. An ethics consult is called to help identify relevant concerns in enrollment. In the accompanying case discussion, we address historical perspectives on research involving people with disabilities; proper management of research participation for people with disabilities including consent by proxy, therapeutic misconception, and other threats to the ethical validity of clinical trials; and the potentially conflicting obligations of researchers and clinicians.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Competência Mental , Transtornos Neurocognitivos/complicações , Pneumonia Viral/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Consentimento do Representante Legal/ética , Criança , Infecções por Coronavirus/complicações , Feminino , Humanos , Pandemias , Pneumonia Viral/complicações
7.
Gac. sanit. (Barc., Ed. impr.) ; 34(5): 435-441, sept.-oct. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-198865

RESUMO

OBJECTIVE: To validate the Brazilian version of the Short Assessment of Health Literacy in Portuguese-speaking Adults (SAHLPA), a 50-item test proposed as a particularly helpful instrument to assess health literacy in people with limited skills, in the Portuguese population. METHODS: We used the standard procedure for cultural adaptation and administered the instrument to 249 participants. We examined construct validity using groups with expectedly increasing levels of health literacy (laypersons from the general population, engineering researchers, health researchers, and physicians), and through association with age and educational attainment, dichotomizing scores at the median of the layperson's group. RESULTS: Exploratory factor analysis revealed the instrument was one-dimensional and justified reduction to 33 items. SAHLPA-33 displayed adequate reliability (Cronbach's α = 0.73). The frequency of limited health literacy was highest among laypersons and lowest among physicians (p <0.001; p for trend <0.001). The proportion of participants with limited health literacy decreased with increasing education attainment (age- and sex-adjusted p for trend <0.001). Limited health literacy also tended to decrease with age, although the association was non-significant (sex- and education-adjusted p for trend = 0.067). CONCLUSION: We culturally adapted a brief and simple instrument for health literacy assessment, and showed it was valid and fairly reliable. In Portuguese low-literate adults, SAHLPA-33 fills the gap in health literacy assessment instruments, and may be used to guide communication strategies with vulnerable patients and communities


OBJETIVO: Validar la versión brasileña del Short Assessment of Health Literacy inPortuguese-speakingAdults (SAHLPA), una prueba de 50 ítems que ha sido propuesta como una herramienta particularmente útil para evaluar la alfabetización en salud en personas con bajas competencias, en la población portuguesa. MÉTODOS: Se usó el procedimiento habitual para la adaptación cultural. El instrumento fue administrado a 249 participantes. Se evaluó la validez de constructo utilizando grupos con niveles esperados crecientes de alfabetización en salud (personas no cualificadas de la población general, investigadores en el área de la ingeniería, investigadores en salud y médicos) y a través de la asociación con la edad y la escolaridad, dicotomizando las puntuaciones por la mediana de las del grupo de la población general. RESULTADOS: El análisis factorial exploratorio reveló que el instrumento era unidimensional y así ha sido reducido a 33 ítems. El SAHLPA-33 reveló una consistencia interna aceptable (α de Cronbach = 0,73). La frecuencia de alfabetización en salud limitada fue más elevada en la población general y menor en los médicos (p <0,001; p para la tendencia <0,001). La proporción de participantes con alfabetización en salud limitada disminuyó con el aumento de la escolaridad (p para la tendencia ajustada por edad y sexo <0,001). La alfabetización en salud también tendió a disminuir con la edad, aunque la asociación no era significativa (p para la tendencia ajustada por sexo y escolaridad = 0,067). CONCLUSIÓN: Se adaptó un instrumento simple y rápido para evaluar la alfabetización en salud individual y se mostró que era válido y razonablemente fiable. En los adultos portugueses con bajo nivel de alfabetización, SAHLPA-33 llena el vacío en instrumentos de evaluación de alfabetización en salud. Puede utilizarse para guiar estrategias de comunicación con personas y comunidades vulnerables


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Idoso , Idoso de 80 Anos ou mais , Letramento em Saúde/classificação , Psicometria/instrumentação , Compreensão/classificação , Competência Mental/classificação , Portugal/epidemiologia , Reprodutibilidade dos Testes , Escolaridade , Distribuição por Sexo
9.
Harefuah ; 159(9): 672-677, 2020 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-32955810

RESUMO

INTRODUCTION: The need to evaluate decision-making capacity for treatment among patients over 65 with cognitive impairment has increased because of the ageing of the population. The inability to make decisions about treatment may be part of cognitive impairment and the prevalence of this phenomenon increases according to the age and severity of the cognitive impairment. The lack of a clear definition of the law regarding the assessment of the decision-making capacity for treatment, the lack of structured training as part of the formal medical education and the lack of uniformity in performing assessment of the decision-making capacity for treatment among physicians leads to many errors and inconsistencies in assessment. In addition to physicians' clinical judgement, additional tools have been developed that enable more accurate assessment of the decision-making capacity for treatment of the older patients. Enhancement of the knowledge of the medical staff on the issue of assessment of the decision-making capacity for treatment, together with encouraging the use of validated tools can reduce the rate of errors, evaluate all the components of decision-making capacity for treatment and help older people realize their constitutional rights and maintain individual autonomy. The current review will discuss existing tools for assessing the decision-making capacity for treatment among those aged over 65 with cognitive impairment.


Assuntos
Disfunção Cognitiva , Tomada de Decisões , Médicos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Humanos , Competência Mental
10.
N Z Med J ; 133(1522): 133-137, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994623

RESUMO

In the older generations, cognitive impairment and wealth are both increasing. Doctors routinely assess decisional capacity in health matters yet are less adept in the assessment of other domains. Recent New Zealand Court decisions will likely result in increased requests by lawyers for contemporaneous medical assessments of the capacity to make a will. The clinical assessment is underpinned by the legal test for testamentary capacity. A psychogeriatrican and a barrister explain the principles and the clinical application. Careful assessments could protect the older adult and minimise the risk of a contested will after death.


Assuntos
Disfunção Cognitiva , Avaliação Geriátrica , Competência Mental , Testamentos/legislação & jurisprudência , Idoso , Envelhecimento , Tomada de Decisões , Humanos , Nova Zelândia
11.
Int J Law Psychiatry ; 72: 101601, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32889420

RESUMO

The coronavirus pandemic, referred to here as Covid-19, has brought into sharp focus the increasing divergence of devolved legislation and its implementation in the United Kingdom. One such instance is the emergency health and social care legislation and guidance introduced by the United Kingdom Central Government and the devolved Governments of Wales, Scotland and Northern Ireland in response to this pandemic. We provide a summary, comparison and discussion of these proposed and actual changes with a particular focus on the impact on adult social care and safeguarding of the rights of citizens. To begin, a summary and comparison of the relevant changes, or potential changes, to mental health, mental capacity and adult social care law across the four jurisdictions is provided. Next, we critique the suggested and actual changes and in so doing consider the immediate and longer term implications for adult social care, including mental health and mental capacity, at the time of publication.several core themes emerged: concerns around process and scrutiny; concerns about possible changes to the workforce and last, the possible threat on the ability to safeguard human rights. It has been shown that, ordinarily, legislative provisions across the jurisdictions of the UK are different, save for Wales (which shares most of its mental health law provisions with England). Such divergence is also mirrored in the way in which the suggested emergency changes could be implemented. Aside from this, there is also a wider concern about a lack of parity of esteem between social care and health care, a concern which is common to all. What is interesting is that the introduction of CVA 2020 forced a comparison to be made between the four UK nations which also shines a spotlight on how citizens can anticipate receipt of services.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Legislação Médica/tendências , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Humanos , Competência Mental/legislação & jurisprudência , Transtornos Mentais/terapia , Irlanda do Norte/epidemiologia , Pandemias , Reino Unido/epidemiologia
12.
J Alzheimers Dis ; 77(2): 539-541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925073

RESUMO

The ongoing coronavirus disease 2019 (COVID-19) pandemic has substantially affected patients with dementia and their caregivers. However, we found not all Alzheimer's disease (AD) patients were afraid of COVID-19 infection. Therefore, we investigated the association between rate of awareness of COVID-19 and depressive tendency in AD. 126 consecutive outpatients with AD were enrolled in this study from May 25, on the day when the declaration of emergency was lifted in Japan, through June 30, 2020. In addition to routine psychological tests, the participants were asked the following two questions: "Do you know COVID-19?" and "Why are you wearing a face mask?". Moderate to severe AD patients were found to have a low COVID-19 recognition rate and did not fully understand why they were wearing face masks. In addition, because they did not understand the seriousness of the COVID-19 outbreak, their Geriatric Depression Scale scores were also substantially lower. These results may appear to simply indicate that people with severe dementia are unaware of current events. However, these results provide insights into how to care for patients with dementia and how to allocate the time and support of our limited staff during the COVID-19 outbreak.


Assuntos
Doença de Alzheimer , Conscientização , Infecções por Coronavirus , Competência Mental , Pandemias , Assistência ao Paciente , Pneumonia Viral , Idoso , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Doença de Alzheimer/virologia , Betacoronavirus , Cuidadores/psicologia , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pandemias/prevenção & controle , Assistência ao Paciente/métodos , Assistência ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Sistemas de Apoio Psicossocial , Índice de Gravidade de Doença
13.
Rev. int. med. cienc. act. fis. deporte ; 20(79): 471-485, sept. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-197049

RESUMO

El objetivo principal de este estudio fue conocer el perfil evolutivo de la función ejecutiva (FE) y la madurez intelectual (MI) en relación con la condición físico-motora en niños preescolares. Han participado 81 niños, de edades comprendidas entre 3 a 6 años, 44 niños y 37 niñas. Se realizaron pruebas de condición física de fuerza, equilibrio, velocidad, resistencia y tiempo de reacción. Se analizaron las FE y la MI con los test de Laberintos de Porteus y el test de Goodenough respectivamente. En la evolución de las variables cognitivas y de condición física según la edad de los niños, se observan diferencias significativas entre los grupos de edad. La velocidad de desplazamiento junto con la dinamometría manual y el tiempo de reacción son variables que se asocian a las FE y a la MI. Por tanto, existe un paralelismo evolutivo entre el desarrollo de la FE y MI con el desarrollo de la condición física


The main aim of this study is to understand the evolutionary profile of the executive function (EF) and the intellectual maturity (IM) in relation to the physical-motor condition in preschool children. A group of 81 children, 3-6 years old, participated in the project (44 boys and 37 girls). Regarding the testing protocol, tests for assessing physical fitness were included (i.e., strength, balance, speed, resistance and reaction time). The EF and the IM were analyzed with the Porteus Maze test and the Goodenough test, respectively. The results showed an age effect on both cognitive variables and physical fitness, with significant differences between those variables between age groups. Additionally, the regression analysis reported a significant association between physical fitness (i.e., sprint, handgrip strength and reaction time) and the FE and the MI. In summary, the results obtained suggest a parallelism between the EF and IM with the development of physical fitness


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Função Executiva/fisiologia , Desenvolvimento Infantil/fisiologia , Competência Mental , Cognição/fisiologia , Aptidão Física , Escolaridade , Inquéritos e Questionários , Antropometria , Índice de Massa Corporal , Consentimento Livre e Esclarecido , Análise de Variância , Escala Fujita-Pearson , Atividade Motora
14.
S Afr Fam Pract (2004) ; 62(1): e1-e4, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32787389

RESUMO

Medical practitioners are confronted daily with decisions about patients' capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end-of-life decision-making capacity of a 72-year-old female with treatment-resistant schizophrenia and terminal cancer is discussed, as are the role of the treating clinician and the importance of health-related values. There is a recommendation that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient's wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient's capacity will change the treatment approach. Clinicians should attend to any possible underlying issues, instead of focusing strictly on capacity. Compared to the general populations people with serious mental illness (SMI) have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services. Conversations about end-of-life care can occur without fear that a person's psychiatric symptoms or related vulnerabilities will undermine the process. More research about palliative care and advance care planning for people with SMI is needed. This is even more urgent in light of the coronavirus disease-2019 (COVID-19) pandemic, and South African health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with SMI.


Assuntos
Tomada de Decisões , Competência Mental/psicologia , Neoplasias/psicologia , Psicologia do Esquizofrênico , Assistência Terminal/psicologia , Idoso , Betacoronavirus , Infecções por Coronavirus/psicologia , Feminino , Humanos , Consentimento Livre e Esclarecido/psicologia , Pandemias , Pneumonia Viral/psicologia , Esquizofrenia
16.
Int J Law Psychiatry ; 71: 101593, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768103

RESUMO

A state's real commitment to its international human rights obligations is never more challenged than when it faces emergency situations. Addressing actual and potential resourcing pressures arising from the COVID-19 pandemic has resulted in, amongst other things, modifications to Scottish mental health and capacity law and the issuing of new guidance relating to associated practice. Whether these emergency or ordinary measures are invoked during the crisis there are potential implications for the rights of persons with mental illness, learning disability and dementia notably those relating to individual autonomy and dignity. This article will consider areas of particular concern but how strict adherence to the legal, ethical and human rights framework in Scotland will help to reduce the risk of adverse consequences.


Assuntos
Infecções por Coronavirus/epidemiologia , Direitos Humanos/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Saúde Mental/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Pandemias , Escócia/epidemiologia
17.
Int J Law Psychiatry ; 71: 101572, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768110

RESUMO

Psychiatric inpatients are particularly vulnerable to the transmission and effects of COVID-19. As such, healthcare providers should implement measures to prevent its spread within mental health units, including adequate testing, cohorting, and in some cases, the isolation of patients. Respiratory isolation imposes a significant limitation on an individual's right to liberty, and should be accompanied by appropriate legal safeguards. This paper explores the implications of respiratory isolation in English law, considering the applicability of the common law doctrine of necessity, the Mental Capacity Act 2005, the Mental Health Act 1983, and public health legislation. We then interrogate the practicality of currently available approaches by applying them to a series of hypothetical cases. There are currently no 'neat' or practicable solutions to the problem of lawfully isolating patients on mental health units, and we discuss the myriad issues with both mental health and public health law approaches to the problem. We conclude by making some suggestions to policymakers.


Assuntos
Infecções por Coronavirus/prevenção & controle , Hospitais Psiquiátricos/ética , Hospitais Psiquiátricos/legislação & jurisprudência , Controle de Infecções/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Pandemias/prevenção & controle , Isolamento de Pacientes/ética , Isolamento de Pacientes/legislação & jurisprudência , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Inglaterra/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , País de Gales/epidemiologia
18.
Int J Law Psychiatry ; 71: 101602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768125

RESUMO

This article examines the changes made to mental health and capacity laws in Northern Ireland through temporary emergency legislation, known as the Coronavirus Act 2020. The purpose of the legislation was to respond to the emergency situation created by the COVID-19 pandemic, in particular the increase pressure placed on health services in the United Kingdom. An overview is provided of the government's rationale for the changes to Northern Ireland mental health and capacity laws, as well as exploring how they are likely to be operationalised in practice. Consideration is also given as to how such changes may impact upon existing human rights protections for persons assessed as lacking mental capacity. It is argued that it is important that regular parliamentary oversight is maintained in relation to the potential impact and consequences of such changes during the period they are in force. This should be done in order to assess whether they remain a necessary, proportionate and least restrictive response to the challenges faced in managing mental health and capacity issues in Northern Ireland during this public health emergency.


Assuntos
Infecções por Coronavirus/epidemiologia , Saúde Mental/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Betacoronavirus , Internação Compulsória de Doente Mental/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Humanos , Competência Mental/legislação & jurisprudência , Irlanda do Norte/epidemiologia , Pandemias , Saúde Pública/legislação & jurisprudência
19.
Am J Bioeth ; 20(8): 54-64, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757910

RESUMO

Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient's preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients.


Assuntos
Diretivas Antecipadas/ética , Cognição , Demência , Ética Médica , Competência Mental , Preferência do Paciente , Tomada de Decisões/ética , Dissidências e Disputas , Humanos , Princípios Morais
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