Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.590
Filtrar
1.
Pediatrics ; 146(Suppl 1): S18-S24, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737228

RESUMO

With a few notable exceptions, adolescents do not possess the legal authority to provide consent for or refuse medical interventions. However, in some situations, the question arises regarding whether a mature minor should be permitted to make a life-altering medical decision that would be challenged if made by the minor's parent. In this article, I explore what we currently know about the adolescent brain and how that knowledge should frame our understanding of adolescent decision-making. The prevailing approach to determining when adolescents should have their decisions respected in the medical and legal context, an approach that is focused on establishing capacity under a traditional informed consent model, will be reviewed and critiqued. I will suggest that the traditional model is insufficient and explore the implications for the adolescent role in health care decision-making.


Assuntos
Desenvolvimento do Adolescente , Encéfalo/crescimento & desenvolvimento , Tomada de Decisão Clínica , Doença de Hodgkin/tratamento farmacológico , Consentimento Livre e Esclarecido/psicologia , Recusa do Paciente ao Tratamento/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Fatores Etários , Feminino , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Mães , Patient Self-Determination Act , Autonomia Pessoal , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
2.
Pediatrics ; 146(Suppl 1): S25-S32, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737229

RESUMO

In this article, I examine the role of minors' competence for medical decision-making in modern American law. The doctrine of parental consent remains the default legal and bioethical framework for health care decisions on behalf of children, complemented by a complex array of exceptions. Some of those exceptions vest decisional authority in the minors themselves. Yet, in American law, judgments of minors' competence do not typically trigger shifts in decision-making authority from adults to minors. Rather, minors' decisional capacity becomes relevant only after legislatures or courts determine that the default of parental discretion does not achieve important policy goals or protect implicated constitutional rights in a particular health care context and that those goals can best be achieved or rights best protected by authorizing capable minors to choose for themselves. It is at that point that psychological and neuroscientific evidence plays an important role in informing the legal inquiry as to whether minors whose health is at issue are legally competent to decide.


Assuntos
Tomada de Decisão Clínica , Competência Mental/legislação & jurisprudência , Menores de Idade/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Adolescente , Desenvolvimento do Adolescente , Criança , Desenvolvimento Infantil , Serviços de Saúde da Criança/legislação & jurisprudência , Educação Infantil , Bem-Estar da Criança/legislação & jurisprudência , Direitos Civis , Tomada de Decisão Clínica/ética , Família , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Competência Mental/normas , Menores de Idade/psicologia , Relações Pais-Filho , Consentimento dos Pais/ética , Patient Self-Determination Act , Autonomia Pessoal , Procurador/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
3.
Pediatrics ; 146(Suppl 1): S33-S41, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737230

RESUMO

Cases of adolescents in organ failure who refuse solid organ transplant are not common, but several have been discussed in the media in the United States and the United Kingdom. Using the framework developed by Buchanan and Brock for surrogate decision-making, I examine what role the adolescent should morally play when deciding about therapy for life-threatening conditions. I argue that the greater the efficacy of treatment, the less voice the adolescent (and the parent) should have. I then consider how refusals of highly effective transplant cases are similar to and different from refusals of other lifesaving therapies (eg, chemotherapy for leukemia), which is more commonly discussed in the media and medical literature. I examine whether organ scarcity and the need for lifelong immunosuppression justify differences in whether the state intervenes when an adolescent and his or her parents refuse a transplant. I argue that the state, as parens patriae, has an obligation to provide the social supports needed for a successful transplant and follow-up treatment plan, although family refusals may be permissible when the transplant is experimental or of low efficacy because of comorbidities or other factors. I conclude by discussing the need to limit media coverage of pediatric treatment refusals.


Assuntos
Temas Bioéticos , Meios de Comunicação de Massa/ética , Transplante de Órgãos/ética , Consentimento dos Pais/ética , Recusa do Paciente ao Tratamento/ética , Adolescente , Família , Feminino , Humanos , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Masculino , Transplante de Órgãos/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Participação do Paciente , Patient Self-Determination Act , Ética Baseada em Princípios , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Gêmeos Monozigóticos , Reino Unido , Estados Unidos
4.
S Afr Med J ; 110(2): 100-101, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657677

RESUMO

The South African Constitution provides that children have the right to healthcare, as well as all other rights. Furthermore, in all matters affecting them, their best interests must be 'of paramount importance'. It seems common practice that, when parents refuse blood transfusions for their children solely on religious grounds, doctors and health authorities apply for a court order to overturn such refusals. However, since the implementation of the Children's Act of 2005, it may be that the onus is no longer on doctors and authorities to apply to court to reverse the decision of parents and guardians. It can be argued instead that the burden has shifted to the parents to apply to court for an order to overrule the decision of doctors, by proving to the court that alternative choices are available. Guidance is given for situations, particularly in the public sector, where alternative choices are not available.


Assuntos
Transfusão de Sangue/legislação & jurisprudência , Pais , Religião e Medicina , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Criança , Direitos Humanos/legislação & jurisprudência , Humanos , Função Jurisdicional , África do Sul
5.
Pediatr Cardiol ; 41(6): 1160-1165, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32419096

RESUMO

In order to evaluate physicians' willingness to seek legal action to mandate surgery when parents refuse surgery for various congenital heart lesions, we surveyed pediatric cardiologists and cardiovascular surgeons at 4 children's hospitals. We asked whether physicians would support parental refusal of surgery for specific heart defects and, if not, whether they would seek legal action to mandate surgery. We then analyzed associations between physicians' willingness to mandate surgery and national operative mortality rates for each lesion. We surveyed 126 cardiologists and 9 cardiac surgeons at four tertiary referral centers. Overall response rate was 77%. Greater than 70% of physicians would seek legal action and mandate surgery for the following lesions: ventricular septal defect, coarctation of the aorta, complete atrioventricular canal, transposition of the great arteries, tetralogy of Fallot, and unobstructed total anomalous pulmonary venous return. Surgery for all of these lesions has reported mortality rates of < 5%. Physicians were less likely to seek legal action when parents refused surgery for Shone complex, any single ventricle lesion, or any congenital heart disease accompanied by Trisomy 13 or Trisomy 18. Among experts in pediatric cardiology, there is widespread agreement about the appropriate response to parental refusal of surgery for most congenital heart lesions, and these lesions tended to be heart defects with lower surgical mortality rates. Lesions for which there was greater consensus among experts were those with the best outcomes. There was less consensus for lesions with higher mortality rates. Such surveys, revealing disagreement among expert professionals, can provide an operational definition of the current professional "gray zone" in which parental preferences should determine treatment.


Assuntos
Atitude do Pessoal de Saúde , Cardiologia/estatística & dados numéricos , Cardiopatias Congênitas/cirurgia , Cuidados Paliativos/psicologia , Recusa do Paciente ao Tratamento/psicologia , Cardiologia/legislação & jurisprudência , Criança , Cardiopatias Congênitas/psicologia , Humanos , Cuidados Paliativos/legislação & jurisprudência , Pais/psicologia , Inquéritos e Questionários , Recusa do Paciente ao Tratamento/legislação & jurisprudência
6.
Bioethics ; 34(3): 306-317, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32100330

RESUMO

This paper is an analysis of the limits of family authority to refuse life saving treatment for a family member (in the Chinese medical context). Family consent has long been praised and practiced in many non-Western cultural settings such as China and Japan. In contrast, the controversy of family refusal remains less examined despite its prevalence in low-income and middle-income countries. In this paper, we investigate family refusal in medical emergencies through a combination of legal, empirical and ethical approaches, which is highly relevant to the ongoing discussion about the place of informed consent in non-Western cultures. We first provide an overview of the Chinese legislation concerning informed consent to show the significance of family values in the context of medical decision-making and demonstrate the lack of legal support to override family refusal. Next, we present the findings of a vignette question that investigated how 11,771 medical professionals and 2,944 patients in China responded to the family refusal of emergency treatment for an unconscious patient. In our analysis of these results, we employ ethical reasoning to question the legitimacy of family refusal of life-sustaining emergency treatment for temporarily incompetent patients. Last, we examine some practical obstacles encountered by medical professionals wishing to override family refusal to give context to the discussion.


Assuntos
Tomada de Decisões , Tratamento de Emergência , Família , Valores Sociais/etnologia , Recusa do Paciente ao Tratamento/ética , Recusa do Paciente ao Tratamento/legislação & jurisprudência , China , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/legislação & jurisprudência
8.
Med Law Rev ; 28(1): 124-154, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31257451

RESUMO

It has been ten years since the case of Hannah Jones-the 12-year-old girl who was permitted to refuse a potentially life-saving heart transplant. In the past decade, there has been some progress within law and policy in respect of children's participatory rights (UNCRC-Article 12), and a greater understanding of family-centred decision-making. However, the courts still largely maintain their traditional reluctance to find children Gillick competent to refuse medical treatment. In this article, I revisit Hannah's case through the narrative account provided by Hannah and her mother, to ascertain what lessons can be learnt. I use an Ethics of Care framework specially developed for children in mid-childhood, such as Hannah, to argue for more a creative and holistic approach to child decision-making in healthcare. I conclude that using traditional paradigms is untenable in the context of palliative care and at the end of life, and that the law should be able to accommodate greater, and even determinative, participation of children who are facing their own deaths.


Assuntos
Tomada de Decisões , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Doente Terminal , Recusa do Paciente ao Tratamento/ética , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Criança , Feminino , Guias como Assunto , Humanos , Cuidados Paliativos/ética , Pais , Autonomia Pessoal , Assistência Terminal/ética , Reino Unido
10.
Dermatol Online J ; 25(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31553860

RESUMO

In medical practice, physicians are sometimes faced with patients who reject the gold-standard treatment for a condition. In this hypothetical clinical scenario, we present the case of a patient who refuses Mohs micrographic surgery for management of infiltrative basal cell carcinoma and instead requests off-label therapy with imiquimod. We discuss the treating dermatologist's options in response to this patient's request and the ethical considerations surrounding the case. We conclude that the physician has the right to refuse to provide treatment that deviates from standard clinical practice but that the physician should counsel the patient on all options, provide thorough informed consent, offer contact information for the patient to pursue a second opinion or a radiation oncology referral, and ensure safe transfer of care should the patient desire treatment with a different provider.


Assuntos
Carcinoma Basocelular/terapia , Consentimento Livre e Esclarecido , Recusa do Médico a Tratar/ética , Neoplasias Cutâneas/terapia , Padrão de Cuidado , Recusa do Paciente ao Tratamento/ética , Idoso , Antineoplásicos/uso terapêutico , Carcinoma Basocelular/patologia , Dermatologistas , Feminino , Humanos , Imiquimode/uso terapêutico , Cirurgia de Mohs , Uso Off-Label , Transferência de Pacientes , Encaminhamento e Consulta , Recusa do Médico a Tratar/legislação & jurisprudência , Neoplasias Cutâneas/patologia , Recusa do Paciente ao Tratamento/legislação & jurisprudência
11.
Br J Nurs ; 28(9): 592-593, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31070974

RESUMO

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the case of NHS Cumbria CCG v Rushton [2018] , and the importance of recording and giving effect to advance decisions to refuse treatment.


Assuntos
Diretivas Antecipadas/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Medicina Estatal/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Idoso de 80 Anos ou mais , Feminino , Humanos , Legislação de Enfermagem , Reino Unido
12.
J Am Acad Psychiatry Law ; 47(2): 233-239, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31048366

RESUMO

In 2003, Arizona began a jail-based restoration to competency program for detainees in its largest jail system in Phoenix. Today, jail-based competency programs have become the rule statewide to the degree that very few incompetent detainees are now referred to the Arizona State Hospital for restoration services. This article focuses on the topic of treatment refusal and the use of forced medications for detainees who are in these jail-based restoration programs. We describe Arizona's novel statewide jail-based programs, Arizona's statutory and case law approach to treatment refusal, and the restoration to competency programs in one large county jail that has no legal mechanism outside of civil commitment for the determination of whether forced treatment will be permitted. We conclude with a discussion of specific override procedures that might apply directly to incompetent detainees in a jail-based competency restoration program and whether the use of these procedures is prudent in a jail environment.


Assuntos
Competência Mental/legislação & jurisprudência , Transtornos Mentais/terapia , Prisioneiros/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Arizona , Humanos , Prisioneiros/psicologia
14.
Int J Law Psychiatry ; 64: 250-259, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31122636

RESUMO

This article critically assesses the way a certain court has determined the capacity of a person diagnosed with anorexia to refuse medical treatment. It is shown that when making this determination, the court has adopted a process of circular reasoning, meaning anyone with the diagnosis will be found to lack capacity to refuse its treatment. This circular reasoning means that indicia of capacity that ought to be considered by the court is ignored. The result is a procedure in which the anorexic patient has no voice, and an outcome against which he or she has no effective legal recourse. This problem, it is argued, can be overcome in two ways. Firstly, courts must make sure that the 'functional' test of capacity is properly applied, meaning any finding of incapacity must rest on evidenced deficits in decision-making ability. Secondly, courts must properly engage with the subjective reasoning of the person making the treatment refusal.


Assuntos
Anorexia/psicologia , Competência Mental/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Adulto , Anorexia/terapia , Tomada de Decisões , Humanos , Jurisprudência , Competência Mental/psicologia , Recusa do Paciente ao Tratamento/psicologia
15.
Bioethics ; 33(8): 931-936, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31034100

RESUMO

This article will explore whether the law should allow people with anorexia nervosa to refuse nutrition and hydration with special reference to the English decision in Re E (Medical Treatment: Anorexia). It argues that the judge in that case made the correct decision in holding that the patient, who suffered from severe anorexia nervosa, lacked capacity to make valid advance directives under the Mental Capacity Act 2005 of the United Kingdom, and that medical procedures that are apparently against her wishes should be carried out for the sake of preserving her life. The law should generally not permit patients with anorexia nervosa to decline nutrition and hydration, precisely because their autonomous ability to make such decisions has been substantially circumscribed by this psychiatric condition.


Assuntos
Diretivas Antecipadas/ética , Diretivas Antecipadas/legislação & jurisprudência , Anorexia Nervosa/terapia , Tomada de Decisões/ética , Competência Mental/legislação & jurisprudência , Recusa do Paciente ao Tratamento/ética , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Reino Unido
17.
Med Leg J ; 87(1): 23-26, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30706758

RESUMO

This article considers situations where treatment is refused and whether this is reasonable taking into account statutory duties, efficacy of treatment, the role and advice of NICE, local and general resources. What should be the priorities for treatment? Eligibility for treatment, the economic case for an early intervention and/or preventative medicine, caesarean sections, human rights, examples from the cases.


Assuntos
Medicina Estatal/economia , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Custos de Cuidados de Saúde/normas , Direitos Humanos , Humanos , Jurisprudência , Direitos do Paciente , Medicina Estatal/organização & administração , Recusa do Paciente ao Tratamento/ética , Recusa do Paciente ao Tratamento/tendências , Reino Unido
18.
J Leg Med ; 39(4): 335-399, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31940252

RESUMO

Following the rise and fall of lobotomy, a majority of U.S. states took legislative aim at psychosurgical procedures. This article canvasses, organizes, and analyzes the existing body of United States statutes and regulations mentioning psychosurgery. Many states regulate psychosurgery without defining the term; existing definitions are imprecise, but many would arguably apply to contemporary procedures like deep brain stimulation. Common to many states are restrictions on surrogate consent to psychosurgery, codifications of patients' consent or refusal rights, and situation-specific bans on the practice targeting certain contexts of vulnerability. Many states have only a handful of scattered laws bearing on psychosurgery, but a few have wide-ranging and well-integrated regulatory regimes. In reviewing these laws we perceive much room for harmonization and modernization. Greater consistency in protecting vulnerable persons from troubling uses of psychosurgery is achievable even alongside an effort to remove undue legal obstacles impeding patient access to potentially therapeutic procedures. Our hope in surveying current psychosurgery law is to inaugurate a conversation on how best to shape its future.


Assuntos
Consentimento Livre e Esclarecido/legislação & jurisprudência , Legislação como Assunto , Direitos do Paciente/legislação & jurisprudência , Psicocirurgia/legislação & jurisprudência , Psicocirurgia/tendências , Governo Estadual , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Direitos Civis , Humanos , Institucionalização/legislação & jurisprudência , Estados Unidos , Populações Vulneráveis/legislação & jurisprudência
19.
Med Law Rev ; 27(2): 215-241, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30053254

RESUMO

This article investigates the ability of mental incapacity tests to account for problems of control, through a study of the approach to alcohol dependence and a comparison with the approach to anorexia nervosa, in England and Wales. The focus is on two areas of law where questions of legal and mental capacity arise for people who are alcohol dependent: decisions about treatment for alcohol dependence and diminished responsibility for a killing. The mental incapacity tests used in these legal contexts are importantly different-one involves a 'cognitive' test, while the other includes an explicit impaired-control limb-and the comparison provides insight into a longstanding debate about the virtues of one type of test over the other. It is shown that both kinds of test can take control problems into account, but also that both can be interpreted in narrow and wide ways that significantly influence the outcome of the assessment. It is therefore argued that to a large extent, it is not the kind of mental incapacity test that matters, but how the test is interpreted. It is further proposed that value judgements are playing an unrecognised and inappropriate role in shaping this interpretation. This raises concerns about the current approach to assessing the impact of alcohol dependency on the capacity to make decisions about alcohol use or treatment, as well as broader concerns about flexibility within incapacity tests.


Assuntos
Alcoolismo/psicologia , Anorexia Nervosa/psicologia , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Testes de Estado Mental e Demência , Autocontrole , Viés , Direitos Civis/legislação & jurisprudência , Direitos Civis/psicologia , Cognição , Disfunção Cognitiva/psicologia , Comportamento Compulsivo/psicologia , Tomada de Decisões , Inglaterra , Humanos , Consentimento Livre e Esclarecido/psicologia , Valores Sociais , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Recusa do Paciente ao Tratamento/psicologia , País de Gales
20.
Rev Med Chil ; 146(7): 914-917, 2018 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-30534892

RESUMO

The law N° 20.584 established the informed consent. This could suggest that patients have a right to refuse a blood transfusion. However, the dominant jurisprudence in protection claims filed against Jehovah Witnesses who rejected a blood transfusion, reveals that they do not have such a right. There were two exceptions in 2008, where courts acknowledged the patient's autonomy and denied the petition to authorize a blood transfusion. Most cases precede law N° 20.584. However, those cases which were upheld by the courts after the promulgation of the law, although few, follow exactly the same doctrine as before the appearance of this act.


Assuntos
Transfusão de Sangue/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Testemunhas de Jeová , Religião e Medicina , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Transfusão de Sangue/ética , Chile , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...