Dissertations / Theses: 'Decisional autonomy'

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Jörgensen, Linn, and Sara Flytström. "Surrogatmodern - utnyttjad eller autonom? : En kvalitativ idéanalys om den svenska debattens syn på surrogatarrangemang." Thesis, Högskolan i Halmstad, Akademin för lärande, humaniora och samhälle, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-45106.

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This essay is comparing the different perspectives of the debate on surrogacy in two Swedish Newspapers. The purpose of this study is to contribute with knowledge about the different perspectives of the debate about surrogacy in relation to women's autonomy. The theory is defined by decisional autonomy and practical autonomy, which is written by Jonathan Pugh. Through an idea analysis, the material of the essay is analyzed through an analysis tool created with Pugh’s theory. The delimitation of material is selected from articles from Dagens Nyheter and Svenska Dagbladet between 2010 and 2020. The result shows that 12 of the arguments in the articles are based on the decisional autonomy perspective, where six of them are based on both decisional and practical autonomy in their arguments. Practical autonomy is the main argument in four of them. The conclusion is that the side of the debate that is against surrogacy argues that the woman does not have enough autonomy to decide to be a surrogacy mother, without pressure or manipulation. The other side of the debate, that is for the altruistic model argues that she has enough autonomy to make her own decision. Another conclusion in this essay is that most of the arguments, even regarding practical autonomy, are based on decisional autonomy, since practical autonomy is mostly a tool for protecting women or helping them to implement their wishes. That's why decisional autonomy is most frequently used in the debate of surrogacy.

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Martín, Badia Júlia. "Cap a l’autonomia de l’adolescent: model d’acompanyament per a professionals assistencials." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/667813.

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[cat] El respecte a l’autonomia dels pacients ha esdevingut un principi fonamental de la bioètica que ha marcat canvis legislatius i de model assistencial, tanmateix el cas dels pacients menors és especialment controvertit: no s’aprofita la presa de decisions sobre la seva salut per acompanyar-los en el procés de maduració i és difícil respectar l’autonomia que no es reconeix ni es fomenta. La causa d’aquest fet és doble. D’una banda, s’ha tingut i es té una visió de la persona menor com immadura, sense capacitat de raonament. A més, en l’àmbit sanitari sovint es té una visió biocèntrica del pacients. Això impedeix que els professionals sanitaris prenguin consciència del seu rol educatiu i, conseqüentment, la relació assistencial no és apoderadora, sinó paternalista o adultista. D’altra banda, el marc legal en què es recolzen els professionals basa la capacitat decisòria de la persona menor en criteris ambigus per subjectius (maduresa i interès superior del menor) i el seu únic criteri objectiu (l’edat), que ofereix seguretat jurídica, no és estandarditzable. D’aquesta manera, si els adults no assumeixen el deure de garantir que les persones menors puguin exercir els seus drets, el discurs dels drets dels menors queda buit de contingut. Atenent a aquesta situació, es proposa un model d’acompanyament en la forja de l’autonomia pensat per a pacients menors d’entre 12 i 15 anys (franja del menor madur), és a dir, un model d’acompanyament dels pacients menors en el procés de forja de l’autonomia. Aquest model té com a objectiu la forja de l’autonomia de l’adolescent, entesa com el dret i la capacitat de prendre decisions que, en l’àmbit sanitari, van destinades a l’autocura. Per tant, caldrà ajudar-lo a apoderar-se, a desenvolupar capacitats. I l’estratègia per fer-ho no pot ser altra que la participació, en la mesura que les capacitats s’adquireixen exercint-les. L’acompanyament consistirà, doncs, en un cercle virtuós entre autonomia, participació i capacitats. És un model que ha de ser assumible per a qualsevol professional que treballi amb adolescents, per tal que afavoreixi la coordinació entre diversos àmbits (sanitari, educatiu, social...) i, conseqüentment, una visió integradora de la persona menor. Alhora, ha de ser aplicable a les especificitats de cada àmbit. És un model centrat en l’adolescent i la família, que requereix que els professionals el posin en pràctica amb habilitats de dues menes: comunicatives i educatives. Aquest model té tres condicions. Primera, cal una visió biopsicosocial de l’adolescent. Segona, cal exercir una responsabilitat apoderadora vers ell. I tercera, l’acompanyament ha de ser comunitari. A més, es basarà en principis ètics essencials com la dignitat, la vulnerabilitat, la justícia i la solidaritat. I tindrà tres objectius: un, la forja de la identitat, que és narrativa i relacional; dos, l’apoderament, que tindrà a veure amb el desenvolupament de capacitats i de consciència moral; i tres, la cura, entesa com l’atenció a la veu i al cos de l’adolescent. En definitiva, el model que proposem entén que l’acompanyament és el reconeixement de l’adolescent com a subjecte de necessitats, com a subjecte de drets i deures, i com a subjecte de capacitats per forjar l’autocura, l’autonomia i el seu projecte vital. Per garantir l’aplicabilitat del model a la pràctica diària de qualsevol professional que treballi amb adolescents proposem un procediment deliberatiu de presa de decisions que consta de 9 passos i incloem un capítol final amb recomanacions per als diferents nivells assistencials.
[eng] The respect for patients’ autonomy has become a fundamental principle of bioethics, which has led to legal changes and a shift of the healthcare model, but in the case of minor patients it is very controversial: medical decisions are not taken advantage of in order to support these patients in their maturing process, so it is difficult to respect the autonomy which is neither recognized nor promoted. There is a double cause for this. On the one hand, minors have been and are seen as immature, as having no reasoning power and, in the medical field, in a biocentrical way. This has prevented healthcare professionals to gain awareness of their educative role and, consequently, the current healthcare relationship is not an empowering one but a paternalistic or adultistic one. On the other hand, the legislation upon which professionals rely establishes three criteria for dealing with minors’ decisional capacity, two of which are ambiguous, because of being subjective (maturity and best interests of the child). The third one, the age, is objective, so it gives legal security, but is not standardisable. In this way, if adults do not assume their duty of ensure that these rights are exercisable, the discourse of the rights of the child has no content. Taking this situation into account, this thesis suggests a model of autonomy promotion in minors of 12 to 15 years old (age bracket called “mature minor”), that is to say, a model of accompanying minor patients in their process of forging autonomy. The aim of this model is the forge of autonomy. It can be understood as the right and capacity to make decisions, which in the medical field are intended to develop self-care. Hence, the adolescent will need help to empower himself and to develop basic capacities. And the strategy to do so must be participation, as long as capacities can only be acquired by exercising them. Supporting adolescents will then consist on a virtuous circle between autonomy, participation and capacities. This model has to be assumable for any professional working with adolescents, in order to foster coordination between fields (healthcare, education, social work) and, therefore, an integrative view of minors. But, at the same time, it has to be applicable to the specificities of each field, so as not to make any professional go beyond his profession. This model is adolescent and family-centred, which requires two types of abiliites from professionals: communicative and pedagogical. This model has three requirements. One, having a biopsychosocial view of adolescents. Second, exercing an empowering responsibility towards them. And third, understanding that accompanying adolescents is a community process. In addition, it will be based on essential ethical principles, such as dignity, vulnerability or solidarity. And it will have three ends: one, forging identity, which is narrative and relational; two, empowerment, which has to do with developing capacities and moral development; and three, care, which should be understood as caring of adolescent’s voice and body. In short, the suggested model understands that supporting adolescents means recognizing them as subjects of needs, subjects of rights and duties and subjects of capacities to forge self-care, autonomy and their vital project. In order to ensure that the model is applicable to the daily practice of any professional working with adolescents, we propose a deliberative decision-making procedure that consists of 9 steps, as well as we include a last chapter of recommendations for professionals according to each healthcare service.

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Pack, Robert Harold. "Charter schools: Innovation, autonomy, and decision-making." Diss., The University of Arizona, 1999. http://hdl.handle.net/10150/288954.

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This multiple case study examined one start-up and one conversion charter school in California. Eighty hours of classroom observations and thirteen teacher interviews were the basis for this descriptive comparative study. The research was guided by the following questions: (1) Do classrooms and school structures in these two charter schools appear different than traditional public schools; (2) Have teachers' methodologies changed since coming to teach at the charter school; (3) What are the similarities and differences between these two charter schools; and (4) Has teachers' autonomy changed since coming to a charter school? This study found that in comparison to teachers' previous position, (1) Teachers had not changed how they taught; and (2) Most teachers had the same amount of classroom autonomy. Additionally: (3) Teachers felt their primary motivation for innovating within their classroom was themselves, their time, and their energy; (4) Teachers did not think teaching in a charter school affected their innovativeness; (5) Teachers did not mention autonomy as a factor influencing their classroom innovativeness; (6) Teachers believed they had more autonomy regarding hiring and budgeting decisions; (7) There were no significant differences in the innovativeness between the teachers of the start-up or conversion schools; the conversion school had the most and the least innovative teachers; (8) The start-up charter school was slightly more innovative overall than the conversion charter school; (9) The two charter schools had more in common than they had differences; (10) New consensus-based, teacher-led decision-making at both schools intensified the micro-politics and burdens placed upon teachers' time, impacting their classroom performance. Unique to the start-up: (11) New operational paradigms required teachers to take on additional support services resulting in less planning time, teachers' feeling overwhelmed, and concern with keeping staff; (12) Parents and students influenced teachers to change back to less innovative practices; and (13) A small campus, faculty, and number of students appeared to create a family-like atmosphere. Based on the findings of this study, two underpinnings of the charter school movement, creating innovative classrooms and increasing teacher autonomy behind the classroom doors were problematic at these charter schools.

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Jaïem, Lotfi. "Contribution à l'autonomie des robots : vers la garantie de performance en robotique mobile autonome par la gestion des ressources matérielles et logicielles." Thesis, Montpellier, 2016. http://www.theses.fr/2016MONTT338/document.

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La performance est un concept multiforme largement décliné et défini en robotique de manipulation où il relève de contraintes spécifiques : environnement non dynamique de dimensions limitées, énergie infinie. Les indicateurs de performance proposés dans le cadre de missions robotiques terrestres sont moins largement acceptés.Pour notre part nous les déclinons en axes principaux : énergie, sécurité, localisation, stabilité, et secondaires : durée par exemple.Dans le cadre de ce travail nous nous intéressons à des missions robotiques soumises à des contraintes de performance liées à la durée, la sécurité et l'énergie dans un environnement connu mais dynamique.La déclinaison des contraintes imposées à la mission et au robot permet de décomposer la mission en une suite d'activités aux contraintes invariantes. Chacune de ces activités pouvant être réalisée à l'aide d'un ensemble de tâches robotiques (se déplacer, se localiser, analyser une image, etc.) pouvant elles-mêmes être implémentées de différentes façons en fonction des actionneurs, capteurs ou algorithmes pouvant être utilisés.Le problème adressé est le suivant : comment choisir les ressources matérielles et logicielles à utiliser tout au long de la mission de façon à vérifier les contraintes de performance imposées ? C'est un problème de sac à dos multicritères NP-Complet et l'espace de recherche devient très rapidement inexplorable. De façon à proposer et garantir une solution applicable sous des contraintes temps réel, nous faisons appel à un algorithme permettant de trouver un ensemble ordonné de bonnes solutions en temps linéaire.L'approche de gestion de ressources proposée a été implémentée sur un robot Pioneer-3DX et une architecture de contrôle s'appuyant sur le Middleware ContrACT.Cette approche a été validée dans le cadre d'une mission de patrouille d'une longueur de 200 m et durant une dizaine de minutes, au sein du laboratoire LIRMM, pour vérifier l'état de vannes.Pour la mission choisie, l'espace d'états à considérer est supérieur à 10^{14}.Tout au long de la mission, les ressources matérielles et logicielles sont choisies dynamiquement et d'une façon autonome afin de satisfaire les contraintes de performance imposées.Si des ressources ne sont plus opérationnelles, ou si trop d'évitements d'obstacles non prévus sont effectués, l'approche développée est capable de trouver en ligne une nouvelle solution d'affectation des ressources vérifiant les contraintes de performance imposées, si elle existe.Ces travaux participant donc à l'accroissement du niveau de tolérance aux fautes du système robotisé
The performance is a multi-form concept widely defined in manufacturing robotics with specific environment conditions (static and perfectly known) and infinite energy).However, performance indicators proposed in mobile robotics are less widely accepted.We differenciate between main performance axes (energy, safety, localization and stability) and secondary performance axes (duration for example).In our work, we are interested on missions realized under duration, safety and energy performance constraints, in a known but dynamic environment.Applying the different constraints decomposes the mission into a sequence of activities realized under invariant constraints.Each one, can be realized by a set of robotic tasks (move, be located, analyze an image, etc.).These tasks can be implemented in various ways according to the different possibles actuators, sensors and algorithms configurations.The adressed problem is the following: how to choose the hardware and software resources to use along a mission while satisfying the different performance constraints ? It is a multicriteria knapsack problem known to be NP-hard, where the complexity becomes very quickly unexplorable.To propose and guarantee an applicable solution under real-time constraints, we used an algorithm allowing to find a set of good solutions in few iterations.The proposed resources management approach is implemented on a Pioneer-3DX robot using a control architecture based on the Middleware ContrACT.This approach has been validated on a patrolling mission travelling 200 m within the LIRMM laboratory during about 10 mn, to verify the state of valves.For the considered mission, the state space dimension is higher than 10^{14}.The hardware and software resources are dynamically and autonomously selected along the mission to satisfy the different performance constraints.If a resource becomes faulty and/or many obstacle avoidances occure and lead to performance drift, the developed approach finds on line a new resources allocation solution (if it exists).So this approach allows to enhance the fault tolerance of the robotic system

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Biurrun, Garrido Ainoa. "La humanización de la asistencia al parto: Valoración de la satisfacción, autonomía y del autocontrol." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/457137.

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INTRODUCCIÓN: Desde la segunda mitad del siglo XX, la asistencia a la gestación y al nacimiento ha sufrido un proceso de medicalización y tecnificación. Esta medicalización de la atención ha suscitado opiniones encontradas; mientras algunos han considerado la medicalización y tecnificación de la asistencia al nacimiento como signos positivos del progreso médico, otros han hecho responsable a estos procesos, de la deshumanización de las atenciones a las embarazadas, por lo que han reclamado el retorno a un trato más respetuoso con cada persona, con cada gestante, parturienta y/o puérpera. Como respuesta al fenómeno de la medicalización, en los últimos años se está asistiendo a un cambio en el modelo de atención sanitaria al nacimiento. En este cambio se pone énfasis al concepto de humanización asociado a la atención sanitaria en el trabajo de parto. No obstante, se debe recordar que, optar por una asistencia más o menos tecnificada implica decidir, escoger entre diferentes modelos asistenciales y ello tiene implicaciones a diferentes niveles: éticos, políticos, institucionales y organizativos. OBJETIVO: Conocer la experiencia de las mujeres, con el fin de profundizar en lo que significa para ellas una atención humanizada y satisfactoria al parto. METODOLOGÍA: En primer lugar, para la realización de este trabajo, se realizó una revisión de la bibliografía publicada con la que se elaboró una aproximación histórica obstétrica contextualizada, y se conocieron los factores que determinan según la bibliografía una atención humanizada al nacimiento. Posteriormente, se realizó un estudio cualitativo con un diseño fenomenológico interpretativo según la perspectiva de Gadamer. Se realizaron 21 entrevistas a mujeres con una gestación de bajo y medio riesgo obstétrico, para identificar los elementos que contribuyen a una percepción de atención humanizada y satisfactoria del parto. Posteriormente, se llevaron a cabo 8 entrevistas adicionales con el objetivo de profundizar en la experiencia de las mujeres en relación a la toma de decisiones informadas durante la atención al parto. RESULTADOS: Se observó que los elementos que las mujeres reconocieron como fundamentales para una experiencia positiva, satisfactoria y humanizada de la atención recibida estaban relacionados con: las expectativas previas que éstas tenían, las cuales estaban condicionadas por el imaginario social del parto como situación de riesgo, con la vivencia que tuvieron; en caso de partos anteriores, con la seguridad percibida, con el respeto a la privacidad y con el soporte emocional recibido durante el trabajo de parto y parto. Además, se constató que la experiencia de las mujeres en relación con la toma de decisiones informada durante la atención al parto, viene determinada por su capacidad de decisión durante este proceso en determinados aspectos y que dicha capacidad se desarrolla a lo largo de un proceso que se inicia en el tercer trimestre de embarazo y concluye en el parto, siendo distintas las demandas que las mujeres realizan a los profesionales según el momento asistencial. CONCLUSIONES: La concepción social que define el parto como una "situación de riesgo" influye en las expectativas de las mujeres y en la experiencia de dar a luz. La seguridad proporcionada por la infraestructura hospitalaria y la tecnología es un factor importante para las mujeres entrevistadas. El reconocimiento de la capacidad independiente para tomar decisiones, el respeto a la privacidad y el sentimiento de conexión con los profesionales que se establece durante la relación asistencial, también se consideraron elementos fundamentales. Es importante que los profesionales de la salud sean particularmente sensibles con respecto a los elementos que garantizan un respeto a la privacidad, que las mujeres sean preguntadas antes de ser atendidas y que los profesionales de la salud y en especial las matronas adopten una sensibilidad ética que contribuya al respeto de la autonomía de las mujeres.
INTRODUCTION: Since the second half of the 20th century, the care during pregnancy and childbirth has undergone a process of ‘medicalization’ and ‘technification’. This incremental medicating during the attention received by the patient has caused a difference of opinion: while some consider the increasing use of medication and technology throughout childbirth attention a positive indicator of medical progress, others make these processes responsible for the dehumanization in the care of pregnant women. Hence, they call for the return to a more respectful treatment for each person, pregnant woman, woman in labour and/or postpartum woman. As a result of the ‘medicalization’ phenomena, in recent years a change in the model of the attention received during childbirth has taken place. In this change, the concept of humanization related to healthcare attention during the childbirth has been emphasized. However, it must be pointed out that the choice of a more or less technical assistance means deciding among different models of attention that have different consequences: ethical, political, institutional and organizational. OBJECTIVE: To understand women’s experience with the purpose of going into detail about what it means for them a humanized and satisfactory attention to childbirth. METHODOLOGY: As a first step of this research, it was carried out a review about the published bibliography with which a contextual historical obstetric approach was developed, and there were identified the elements that determine a humanized childbirth attention according to the bibliography. Afterwards, it was performed a qualitative study with a phenomenological interpretative design following Gadamer’s perspective. There were conducted 21 interviews in women with low and medium gestational obstetrical gestation to identify the elements that contribute to a perception of humanized and satisfactory delivery. After that, we conducted 8 additional interviews in order to deepen in the women’s experience related to informed decision making during childbirth attention. RESULTS: It was observed that the elements that the women recognized as fundamental for a positive, satisfactory and humanized experience of the attention received were related to: prior expectations they had of it, which were conditioned by the social imaginary of childbirth as a risky situation with the experience that they had; in case of previous births, with the perceived safety, respect for privacy and emotional support received during labour and delivery. In addition, it was found that women’s experience in relation to informed decision making during childbirth attention, it is determined by its decision making capacity during this process in certain aspects and this capacity is developed throughout a process which begins in the third trimester of pregnancy and concludes in childbirth, making different requests to the professionals depending on the situation during the assistance. CONCLUSIONS: The social conception that defines childbirth as a “risk situation” influences the expectations that the women around us form and influences the experience of giving birth; the security provided by the hospital infrastructure and technology is an important factor for the women interviewed. Recognition of independent capacity to make decisions, respect for privacy and the feeling of a connection with the midwives, were also seen as fundamental elements. It is important that healthcare professionals be particularly sensitive with regard to privacy, that women are asked before they are attended to by trainees and that midwives adopt an ethical sensitivity that contributes to respect for the women’s autonomy.

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Leonard, Samantha Jane. "Difficult decisions : autonomy, prenatal choice and prognostic ambiguity." Thesis, University of Bristol, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.683564.

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New methods of fetal anomaly detection will offer increasingly detailed information to prospective parents but are likely to lead to more frequent discovery of anomalies with an ambiguous prognosis for the future child. It is important to consider the ethical implications of such ambiguity prior to introducing new tests. An examination of the bioethics literature reveals 'promoting autonomy' as the predominant justification for fetal anomaly detection. Two questions arise: does the fetal anomaly detection programme as it stands promote autonomy, and is 'promoting autonomy' an appropriate ethical principle in this context? To answer these questions, an empirical bioethics approach using a reflexive balancing methodology is employed. This examines qualitative data from interviews of prospective parents who had had to decide, on the basis of such an ambiguous prognosis, whether or not to continue their pregnancy. On the basis of different accounts of autonomy, it is argued that the fetal anomaly detection programme does not promote autonomy when decisions are based on an uncertain prognosis. Moreover, 'promoting autonomy' is not, on its own, an appropriate aim in this setting, as the participants did not use their choice as a means of self-expression, the decisions were made by two people and were heavily swayed by considerations for the future child, and under conditions of uncertainty it is not possible to attain the level of rational decision-making required by most accounts of autonomy. Furthermore, the impacts of the decision reduce the benefit of any potential opportunity for self-expression through these choices. The data indicated that a welfare approach might be more appropriate, and it was concluded that, whilst a welfare approach did not entirely encompass all of the nuances of the participants' experiences, it was the better fit, giving some useful indications for an ethical framework for an expanded offer of testing.

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Baker, Eileen F. "Autonomy and Informed Consent." Bowling Green State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1491391673593916.

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Daltorio, Kathryn A. "Obstacle Navigation Decision-Making: Modeling Insect Behavior for Robot Autonomy." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1365157897.

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Swindell, Jennifer Sproul. "Respecting autonomy in cases of ambivalence regarding end of life decisions." Diss., Connect to online resource - MSU authorized users, 2008.

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Veale, Martin Orla. "Advance care directives and medical treatment decision-making: preserving patient autonomy." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=123329.

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The principle of autonomy allows each person control over his or her body, and, consequently, to decide what medical treatment he or she will accept or refuse. However, where the individual does not have the ability, or capacity, to make such a decision, they may be subjected to medical treatment carried out in what a substitute decision-maker perceives to be their "best interests", which may not conform to their previous wishes that were reached autonomously. In order to preserve autonomy in the anticipation of a lack of capacity, individuals can formalise their health care plans in documents known as advance care directives. In many common law jurisdictions, the use of these types of documents is provided for by legislation. In this thesis I aim to review the legality of these directives where there is no legislation providing for their use, using Ireland as a case study, as the statutory law in Ireland is currently silent on this issue.I propose that the principle of autonomy which is protected under Irish law allows for the use of advance care directives without the need for legislation. I set out the criteria, as I see them, of a lawful advance care directive under Irish legal jurisdiction. I will address this issue by reviewing the Irish law in relation to the right to autonomy, the criteria for assessment of capacity, and health care decision-making, drawing on relevant examples from other common law jurisdictions.
Le principe d'autonomie permet à chacun de prendre les décisions relatives à son corps, et par conséquent, permet à l'individu de décider quel traitement médical accepter ou refuser. Toutefois, lorsque l'individu n'a pas la capacité de décider, il ou elle peut être soumis à des traitements médicaux qu'un décideur substitut considère être en son « meilleur intérêt ». Cette décision n'est pas nécessairement conforme aux désirs exprimés par la personne traitée alors qu'elle en avait la capacité. Pour préserver leur autonomie alors qu'ils en ont encore la capacité, certains rédigent un document appelé directive préalable de traitement. Dans plusieurs juridictions de « common law », ces directives font l'objet d'un cadre législatif. Cette thèse considère la légalité de telles directives dans les juridictions dépourvues d'un tel cadre législatif et utilise l'Irlande comme étude de cas parce que le droit statutaire irlandais ne se prononce pas sur les directives préalables de traitement.

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Shirley, Jamie L. "Autonomy at the end of life : a discourse analysis /." Thesis, Connect to this title online; UW restricted, 2005. http://hdl.handle.net/1773/7231.

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Bell, Jennifer Ann Harrison. "Cancer patient decision-making and relational autonomy related to clinical trial participation." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/46381.

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Clinical trials (CTs) in cancer care play an essential role in advancing knowledge and improving patient care. Low CT enrolment, however, threatens this field of science and may prevent people with cancer from benefiting from the latest therapeutic interventions. The aim of this research was to explore cancer patients’ CT decision-making process and how they exercise relational autonomy within this process. Relational autonomy acknowledges patients are situated within a larger relational and socio-political context that is characterized by inherent power differentials and social inequities that may influence CT decisions. The objectives of this research were to: a) understand cancer patients’ decision-making process related to CT participation and how they exercise relational autonomy within this process; b) examine the personal, social, and system influences on cancer patients’ decision-making process related to CT participation and their ability to exercise their relational autonomy; and c) identify the best practices utilized by CT personnel that support cancer patients in exercising their relational autonomy in the CT decision-making process. Two different yet complementary methodologies, interpretive description and grounded theory, guided in-depth interviews with 12 CT personnel, 40 breast and prostate cancer patients, and 11 support persons to address the objectives. Three major themes were uncovered that impact cancer patients’ decision-making process and ability to exercise their relational autonomy: (1) power differentials between patients and physicians, (2) therapeutic misconception, and (3) inequities in access to CTs. The overarching construct ‘no wo/man is an island’ captured patients’ CT decision-making process and experiences of autonomy, including the relational complexity of CT decisions and the key influences on this process. Results from this research highlight how CT decision-making is a complex endeavor comprised of key phases and processes that are not only personally but also socially and structurally located. Practice implications of this research include targeted education for CT personnel and patients to equalize power relationships within CT recruitment. In addition, standardization of cancer drug approval, better monitoring and follow-up cancer care, and a more accessible and quality healthcare system can address structural barriers in order to support patients’ relational autonomy within the context of CTs.

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Paulsrud, David. "Teacher autonomy in Sweden and Finland : Investigating decision-making and control comparatively." Thesis, Uppsala universitet, Institutionen för pedagogik, didaktik och utbildningsstudier, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-356793.

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This thesis aims to investigate and compare Swedish and Finnish teachers´ perceived autonomy through a quantitative analysis of the empirical data from a survey conducted within the research project Teacher autonomy in Sweden, Finland, Ireland and Germany (Wermke & Salokangas, 2018). Within the project, the concept teacher autonomy is viewed as multidimensional and highly dependent upon national context, why an analytical device has been constructed in order to investigate teachers´ perceived autonomy comparatively. Based on conceptual research, the device comprises four domains of teachers´ work where autonomy can be exercised (educational, social, developmental and administrational), and three different levels of autonomy (classroom, school, profession). In this thesis, the analytical device is used to compare the perceived autonomy of the Swedish and Finnish teachers participating in the survey. The theoretical foundation of this thesis is Richard M Ingersoll´s research on power distribution in schools, and the construction of the survey is based upon his operationalization of teacher autonomy as teachers´ influence over important decisions that affect their work, and how teachers´ decisions are evaluated and controlled. The results indicates that both Swedish and Finnish teachers are autonomous when it comes to educational issues, but that Finnish teachers are more individually oriented and experience more control from parents, whereas Swedish teachers seem to make more decisions collegially and perceive themselves as more controlled by colleagues and the school management. Moreover, the answers from the respondents suggested that Finnish teachers have more influence over their continuous professional development, while Swedish teachers are responsible for administrative decisions to a higher extent. In order to interpret and discuss the results they are related to different characteristics of the respective national contexts.

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D'Incao, Daniela Bergesch. "Adaptação e validação transcultural da medida integrada de independência decisória para adolescentes." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/173582.

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A presente dissertação de mestrado objetivou a adaptação transcultural para o Português Brasileiro da Medida Integrada de Independência Decisória para Adolescentes (MIIDA). Esta foi desenvolvida por pesquisadores da Bélgica, constitui-se de três subescalas que avaliam a tomada de decisão dependente e independente, com base nos preceitos da Teoria da Autodeterminação (TAD). O estudo de validação contou com uma amostra de 672 adolescentes (52,7% meninas), de 11 a 20 anos (M=15,6; DP=1,6), estudantes de escolas da rede pública de Porto Alegre (RS). Após análises a estrutura do instrumento mostrou-se consistente de acordo com a medida original, apresentando uma solução de dois fatores para as três subescalas: Quem decide, independência decisória e dependência decisória. Além disso, foram realizadas análises de correlação com a escala de Autoestima de Rosenberg (1965) e com a escala de Estilos Parentais (Teixeira, Bardagi & Gomes, 2004) com intuito de verificar a validade de construto da MIIDA. Os resultados demonstraram que a MIIDA apresenta boas propriedades psicométricas e evidências de validade e fidedignidade, sendo um instrumento útil para avaliar a independência decisória em termos de motivação para a tomada de decisão.
This master's thesis made the cultural adaptation to Brazilian Portuguese of the Integrated Measure of Decisional Independence for Adolescents. It is based on the precepts of Self- Determination Theory and consists of three subscales that assess the dependent and independent decision-making. The validation study included a sample of 672 adolescents (52.7 % female) , 11-20 years ( M = 15.6 , SD = 1.6), attending public schools in Porto Alegre, Brazil. Factorial analyses indicated a two-factor solution for the three subscales: Who decides, independent and dependent decision-making. The results pointed out for good psychometric properties and evidence of validity and reliability, being a useful tool to evaluate the decision-making independence regarding motivation for decision-making.

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Hayes, Thomas. "Advance decisions to refuse treatment : autonomy and governmentality at the end of life." Thesis, Cardiff University, 2016. http://orca.cf.ac.uk/100452/.

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Advance decisions to refuse medical treatment (“ADRTs”) have been recognised in English law through a series of cases which arose at the end of the Twentieth Century and subsequently by the Mental Capacity Act 2005. ADRTs allow adults, with the requisite mental capacity, to refuse forms of medical treatment that they anticipate being provided with at a time when they have lost mental capacity in respect of the anticipated treatment. The most frequently advanced argument for the recognition of these instruments is to respect and extend personal autonomy and/or self-determination. However, this thesis treats that particular normative ground as but one among a number of factors which have been crucial to the emergence of ADRTs. It is argued that the advancement in medical capabilities for prolonging life in its final stages is a sine qua non of ADRTs in practical terms. The demographic and financial pressures in which end-of-life care is provided add impetus to the argument for the recognition of ADRTs. However, it is suggested that the political environment in which ADRTs have emerged has also been of fundamental significance to their recognition in law. Using Michel Foucault’s theory of governmentality it will be shown ADRTs have been developed within advanced liberal programmes of government, in response to the inability of the traditional approaches of those forms of government to govern individuals who lack capacity at the end of life. The employment of this theory provides a novel perspective on the debates which have raged in this area of law and bioethics, allowing for a focus on the population, as well as the individual, and a focus on practices rather than on the outcomes.

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Nwaishi, Casmir Chibuike. "The Intimate Connection Between Autonomy and Decision-Making in Applied Health Care Ethics." Thesis, Linköping University, Centre for Applied Ethics, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-2402.

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The intimate connection between autonomy and decision-making in applied health care, especially in various kinds of consent and refusal has taken center stage in medical ethics since the Salgo decision in 1957. Prior to that time, the physician’s supposedly moral duty to provide appropriate medical care typically surpassed the legal obligation to respect patient’s autonomy. The Salgo decision concluded that physicians have a legal duty to provide facts necessary for the patient to make an informed decision. "The doctor knows best" long ago was replaced with "The doctor proposes; the patient disposes." There is no legal obligation for the patient’s choice to be palatable to anyone, other than that patient himself/herself. Although Beauchamp and Childress justified the obligation to solicit decisions from patients and potential research subjects by the principle of respect for autonomy, they however, acknowledged that the principle’s precise demands remain unsettled and open to interpretations and specification. This thesis addresses a current debate in the bioethical community on the four-principle approach. Using Tom Beauchamp and James Childress as case study, to discuss mainly the principle of respect for autonomy, I go on to explain their central arguments concerning this principle in relation to decision making in health care ethics. Rather than focus on their respective weaknesses, which many theorist and health care professionals do, I emphasis instead on the contribution the principle of respect for autonomy can make in the process of ethical decision making in health care situation.

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Gardell, Therese, and Hanna Lindström. "Hur sjuksköterskor kan handla i situationer där personer med demenssjukdom inte äter, samt hur de motiverar sitt handlande : - en litteraturstudie." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-686.

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Fleming, Douglas James. "Instructor autonomy in curriculum decision making, a study of an adult ESL settlement program." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape16/PQDD_0011/MQ29157.pdf.

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Helsing, Isabelle, and Jonna Åkersén. "Personcentrerad omvårdnad ur ett patientperspektiv." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-47846.

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Bakgrund: Personcentrerad vård är en av kärnkompetenserna som krävs för att patienter ska erhålla en så god och säker vård med olika hälso-sjukvårdsprofessioner. Den bygger på ett flertalet begrepp, såsom, livsvärld, partnerskap och delat beslutsfattande.Livsvärlden definieras som den subjektiva världen som människan upplever den. Partnerskapdefinieras som en interpersonell relation där ett gemensamt ansvar och mål återfinns. Delat beslutsfattande definieras som en process där patienter och vårdgivare överväger resultatet av olika tillvägagångssätt, detta bör utgå från patientens personliga preferenser. Syfte: Att beskriva personcentrerad omvårdnad ur ett patientperspektiv. Metod: Systematisk litteraturöversikt Resultat: Livsvärldsperspektivet var något som upplevdes som viktigt i vårdrelationen.Den delade makten är kunskapsutbytet, vilket stärker vårdrelationen och patientens upplevelse av att bli sedd och bekräftad. Att ha tillgång till samma vårdpersonal och kunna delta i omvårdnaden innebar att patienternas autonomi respekterades och ett partnerskap kunde upprättas. Slutsats: Det finns idag kunskapsluckor gällande patienters upplevelser av personcentrerad omvårdnad. Det kan konstateras att patientperspektivet i en framtid kommer att ha en fortsatt avgörande betydelse för relationen mellan patient och sjuksköterska. Nyckelord: Autonomi, Delat beslutsfattande, Livsvärld, Partnerskap.
Background: Person-centered care is one of the core competencies required for patients to receive as good and safe care with different healthcare professions. It is based on a number of concepts, such as, life world, partnership and shared decision-making. The life world is defined as the subjective world in which a patient experiences it. Partnership is defined as an interpersonal relationship where a shared responsibility and goals are found. Shared decision-making is defined as a process where the patients and caregivers consider the outcome of different approaches, based on the patient’s personal preferences. Aim: To describe person-centered nursing from a patient perspective. Method: Systematic literature review. Results: The life-world perspective was perceived as important in the care relationship. The shared power is the exchange of knowledge, which strengthens patient’s experience of being seen and confirmed. Having access to the same healthcare staff and being able to participate in nursing meant that patient’s autonomy was respected and a partnership could establish. Conclusion: Today there are knowledge gaps regarding patient’s experiences of person-centered care. The patient perspective in the future will be of decisive importance for the relationship between the patient and the nurse. Keywords: Autonomy, Lifeworld, Partnership, Shared decision-making.

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Hofer, Ludovic. "Decision-making algorithms for autonomous robots." Thesis, Bordeaux, 2017. http://www.theses.fr/2017BORD0770/document.

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Afin d'être autonomes, les robots doivent êtres capables de prendre des décisions en fonction des informations qu'ils perçoivent de leur environnement. Cette thèse modélise les problèmes de prise de décision robotique comme des processus de décision markoviens avec un espace d'état et un espace d'action tous deux continus. Ce choix de modélisation permet de représenter les incertitudes sur le résultat des actions appliquées par le robot. Les nouveaux algorithmes d'apprentissage présentés dans cette thèse se focalisent sur l'obtention de stratégies applicables dans un domaine embarqué. Ils sont appliqués à deux problèmes concrets issus de la RoboCup, une compétition robotique internationale annuelle. Dans ces problèmes, des robots humanoïdes doivent décider de la puissance et de la direction de tirs afin de maximiser les chances de marquer et contrôler la commande d'une primitive motrice pour préparer un tir
The autonomy of robots heavily relies on their ability to make decisions based on the information provided by their sensors. In this dissertation, decision-making in robotics is modeled as continuous state and action markov decision process. This choice allows modeling of uncertainty on the results of the actions chosen by the robots. The new learning algorithms proposed in this thesis focus on producing policies which can be used online at a low computational cost. They are applied to real-world problems in the RoboCup context, an international robotic competition held annually. In those problems, humanoid robots have to choose either the direction and power of kicks in order to maximize the probability of scoring a goal or the parameters of a walk engine to move towards a kickable position

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Rivera, Victor. "HOW TRADITIONAL DEFINITIONS OF AUTONOMY IMPAIR DECISION-MAKING IN SPINAL MUSCULAR ATROPHY AND ALZHEIMER DISEASE." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/553526.

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Urban Bioethics
M.A.
Clinical decision making is influenced by available literature, technology, and guidelines, but also by cultural expectations, physician experience, and personal biases. The treatment of various forms of disability is especially vulnerable to these prejudices. Alzheimer Dementia (AD) and Spinal Muscular Atrophy (SMA) represent forms of cognitive and physical disability, respectively. In severe forms of both diseases, patients are often unable to communicate and do not meet traditional definitions of autonomy. However, physicians and consensus guidelines adhere to these very same definitions of autonomy, which subsequently disadvantages patients that cannot verbalize. This bias is reflected in available guidelines for catheter-directed thrombectomy for acute ischemic strokes, which passively discourage physicians from treating patients with baseline AD. Inversely, pediatric definitions of autonomy may expose patients to over-treatment with nusinersen, a medication recently approved for the treatment of SMA. Adapting theories of bodily autonomy will allow physicians to approach the treatment of those who cannot verbalize in a more ethical fashion.
Temple University--Theses

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Veshi, Denard <1988&gt. "The Concept of Autonomy in End-of-Life Decisions: Ethical and Legal Regulation regarding Advance Directives." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2016. http://amsdottorato.unibo.it/7258/.

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In this thesis the concept of autonomy in end-of-life decisions is analyzed through ethical and legal comparative approaches. The definition of advance directives – living wills and the appointment of a legal proxy – is studied. In addition, Recommendation CM/Rec (2009) 11 and the “Guide on the decision-making process regarding medical treatment in end-of-life situations” is examined. Currently, end-of-life decisions are part of the exclusive competence of national parliaments. Thus, different parliaments have adopted different policies underpinned by different moral principles. What follows is an absence of a common European legal framework. National laws on advance directives in various Western European countries – such as Romance-speaking countries (Italy, France, Portugal, and Spain), English-speaking countries (Ireland and the United Kingdom of Great Britain and Northern Ireland), and German-speaking countries (Austria, Germany, and Switzerland) – are examined. This thesis seeks to analyse national norms governing advance directives by hypothesising the reasons for the lack of a common attitude towards end-of-life decisions. Particular attention is paid to the current Italian situation regarding end-of-life decisions since Italy is one of the few Western European countries that does not have a specific law governing end-of-life situations. Herein, the Italian bill no. 2350 “Provisions relating to therapeutic alliance, informed consent, and advance directives for treatments” – approved in different texts in 2009 by the Senate and in 2011 by the Chamber of Deputies – is criticized because its norms are considered controversial. Additionally, the judicial interpretation of amended Articles 404–413 of the Italian Civil Code is examined. The aim of the thesis is to identify the common European standards in end-of-life decisions. Moreover, similarities and differences between different policies will be pointed out. Furthermore, possible suggestions for modifying the Italian bill 2350 by taking the experience of other Western European countries into consideration will be made.

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Dafflon, Baudoin. "Modèle multi-agent d'inspiration physique pour la prise de décision : Application à la conduite en convoi." Thesis, Belfort-Montbéliard, 2014. http://www.theses.fr/2014BELF0240/document.

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Le travail de thèse de Baudoin Dafflon se situe dans la thématique générale des systèmes auto-organisés, dans la version centrée sur les systèmes multi-agents. Ce travail repose sur l’idée que l’organisation d’un système distribué peut émerger à partir du comportement de chacune des d’entités autonomes et proactives qui le composent. L’organisation émergente satisfait l’objectif confié au système auto-organisé. Cette thèse s’est particulièrement occupé de domaines applicatifs où les systèmes auto-organisés sont formés par des entités matérielles intelligents, en général mobiles, situées dans un environnement physique relativement incertain. Ses études de cas appartiennent à la problématique de la conduite en convoi de flottes de véhicules autonomes.En particulier, B. Dafflon s’est intéressé à la prise de décision pour ce genre de systèmes. Cette question est particulièrement importante lorsque l’environnement est incertain, soit par ce que les entités autonomes en ont une connaissance imparfaite, soit par ce que des phénomènes aléatoires peuvent se produire. Dans ce cas chaque entité doit décider, de façon décentralisée quelle est la meilleure action locale à exécuter pour que l’organisation globale soit préservée. Si bien l’échange d’informations entre entités n’est pas exclu d’emblée pour ce type de systèmes, les travaux de cette Thèse ont été conduits en adoptant la contrainte de non-communication, dans le but d’explorer la portée des approches purement autonomes et locales de la prise de décision par les agents.Parmi les contributions substantielles apportées par cette thèse nous pouvons mentionner les suivants. Premièrement, la proposition d’une architecture qui sépare la fonction décision de la fonction contrôle, ce qui permet de mieux intégrer des fonctionnalités qui prennent en compte l’incertain. Un exemple dans le domaine applicatif (la conduite en convoi) serait l’évitement d’obstacles. Deuxièmement, B. Dafflon propose l’introduction d’une hiérarchie de systèmes multi-agents où la prise de décision est également envisagée comme un processus auto-organisé dans un monde virtuel d’agents. Ce monde virtuel est défini par un processus d’abstraction des informations données par les percepts des agents matériels. Finalement, cette Thèse propose des modèles d’interaction pour ces agents virtuels qui reposent sur des processus physiques (lois d’attraction-répulsion, dynamique des gazes, ...). L’intérêt en est que la décision peut être élaborée de façon calculatoire, en évaluant des indicateurs globaux inspirés des processus physiques modélisés.Les travaux présentés dans cette thèse ont été effectués et ont été financés par le projet ANR-VTT SafePlatoon
Baudoin Dafflon’s doctoral work is placed in the general frame of self-organised systems. This kind of systems bases on the hypothesis that their organizationcan be the result of the individual behaviour of each one of the autonomous and proactive component entities. This emergent organization satisfies the objectives entrusted to the self-organizing system. This thesis is mainly directed to application domains in which the self-organizing system is composed of intelligent, frequently mobile material devices places in a physical, uncertain environment. Case-studies made included in this Thesis belong to the vehicle platoon problem.This Thesis interests mainlyto the decision-making problem of the self organizing systems of this kind. This aspect is particularly important when the system evolves in an uncertain environment. Uncertainty can be the consequence of an imperfect knowledge of the environment or because of the occurrence of unpredictable events. In those situations the autonomous entities have to decide locally about the best action to be performed in order for the global organization to be maintained. Even if information exchange among autonomous entities is not excluded a-priori, this doctoral work has been done under the restriction of non-communication, in order to investigate the reach of completely de-centralised approaches.Among the contributions of this thesis we can mention the following. Firstly, the proposal of an architecture that separates decision making and control, thereby allowing a simpler integration of uncertainty-management. An example from the application domain (vehicle platoons) is obstacle avoidance. Secondly, this thesis introduces a hierarchy of multi-agent systems such that decision-making is also conceived as a self-organized process in a virtual agent’s world. The later is built from an abstraction process based on the perceptions produced by material agents. Lastly, this thesis proposes physics-inspired interaction mechanisms for virtual agents. Those interaction models based on phenomena such as attraction-repulsion forces or gas dynamics, allow for a computational decision making process based on the laws and properties of the adopted physical models.Doctoral work presented in this Thesis has been done in the framework of the ANR-VTT project

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Colnago, Jessica Helena. "Privacy agents in the IoT : considerations on how to balance agent autonomy and user control in privacy decisions." Universidade Federal de São Carlos, 2016. https://repositorio.ufscar.br/handle/ufscar/8429.

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Não recebi financiamento
This thesis explored aspects that can help balance the level of user control and system autonomy for intelligent privacy agents in the context of the Internet of Things. This proposed balance could be reached considering aspects related to wanting to be interrupted to have control and being able to be interrupted to exert this control. Through literature review of interruption and privacy literature, variables related to these two perspectives were identified. This led to the variable set "Intelligent Privacy Interruptions”. To verify and validate this set, two research actions were performed. The first one was an online survey that allowed us to perform a sanity check that these variables were acceptable in this work’s context. The second was an experience sampling user study with 21 participants that allowed us to better understand how user behavior is informed by these variables. Based on these two interventions it was possible to note that the selected variables seem to show relevance and that they can be used to inform the development and design of privacy agents. The limitations of the partial results notwithstanding, through a quantitative analysis of data collected form the user study and the qualitative analysis of the exit interviews, it was possible to note a common mental process between the participants of the user study when deciding whether to withhold or delegate decision control to the agent. Future studies should be performed to verify the possibility of expansion and creation of a behavior and preference model that can be integrated to the decisionmaking system of intelligent privacy agents.
Este trabalho investigou aspectos que podem ajudar a balancear o nível de controle de usuários e de autonomia de agentes inteligentes de privacidade no contexto da Internet das Coisas. Entende-se que esse balanceamento proposto poderia ser alcançado considerando aspectos relacionados a “querer” ser interrompido para ter controle e “poder” ser interrompido para exercer o controle. Por meio de revisão da literatura de interrupções e privacidade, variáveis relacionadas a esses dois aspectos foram identificadas, embasando a proposta de um conjunto de variáveis para “Interrupções de Privacidade Inteligentes”. Para verificar e validar esse conjunto de variáveis, duas ações de pesquisa foram feitas. A primeira foi um questionário online que serviu como uma verificação inicial de que as variáveis são adequadas ao novo contexto proposto por esse trabalho. A segunda foi um estudo de amostragem de experiência com 21 usuários para se entender melhor como essas variáveis podem vir a informar o comportamento de usuários. Os resultados obtidos sugerem que as variáveis selecionadas apresentam relevância e que podem ser usadas para informar o desenvolvimento e design de agentes de privacidade. Embora os resultados ainda sejam limitados, principalmente pela duração do estudo e grupo e número de usuários, através da análise quantitativa dos dados coletadas no estudo com usuários e da análise qualitativa das entrevistas realizadas pós-estudo notou-se um processo mental comum entre os usuários participantes do estudo para as tomadas de decisão de reter o controle ou delegá-lo ao agente. Estudos futuros devem ser realizados, procurando verificar a possibilidade de expandir o relacionamento das variáveis para a criação de um modelo de comportamento e preferência dos usuários que seja integrável ao sistema de decisão de agentes inteligentes de privacidade.

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Belhaj, Nabila. "Generic autonomic service management for component-based applications." Thesis, Université Paris-Saclay (ComUE), 2018. http://www.theses.fr/2018SACLL004/document.

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Au cours de la dernière décennie, la complexité des applications a considérablement évolué afin de répondre aux besoins métiers émergeants. Leur conception implique une composition distribuée de composants logiciels. Ces applications fournissent des services à travers les interactions métiers maintenues par leurs composants. De telles applications sont intrinsèquement en évolution dynamique en raison de la dynamicité de leurs contextes. En effet, elles évoluent dans des environnements qui changent tout en présentant des conditions très dynamiques durant leur cycle de vie d’exécution. De tels contextes représentent une lourde charge pour les développeurs aussi bien pour leurs tâches de conception que de gestion. Cela a motivé́ le besoin de renforcer l’autonomie de gestion des applications pour les rendre moins dépendantes de l’intervention humaine en utilisant les principes de l’Informatique Autonomique. Les Systèmes Informatiques Autonomes (SIA) impliquent l’utilisation des boucles autonomiques, dédiées aux systèmes afin de les aider à accomplir leurs tâches de gestion. Ces boucles ont pour objectif d’adapter leurs systèmes à la dynamicité de leurs contextes, en se basant sur une logique d’adaptation intégrée. Cette logique est souvent donnée par des règles statiques codées manuellement. La construction de ces règles demande beaucoup de temps tout en exigeant une bonne expertise. En fait, elles nécessitent une compréhension approfondie de la dynamicité du système afin de prédire les adaptations précises à apporter à celui-ci. Par ailleurs, une telle logique ne peut envisager tous les scénarios d’adaptation possibles, donc, ne sera pas en mesure de prendre en compte des adaptations pour des situations précédemment inconnues. Les SIA devraient donc être assez sophistiqués afin de pouvoir faire face à la nature dynamique de leurs contextes et de pouvoir apprendre par eux-mêmes afin d’agir correctement dans des situations inconnues. Les SIA devraient également être capables d’apprendre de leur propre expérience passée afin de modifier leur logique d’adaptation en fonction de la dynamicité de leurs contextes. Dans ce manuscrit, nous abordons les lacunes décrites en utilisant les techniques d’Apprentissage par Renforcement (AR) afin de construire notre logique d’adaptation. Cependant, les approches fondées sur l’AR sont connues pour leur mauvaise performance lors des premières phases d’apprentissage. Cette mauvaise performance entrave leur utilisation dans le monde réel des systèmes déployés. Par conséquent, nous avons amélioré cette logique d’adaptation avec des capacités d’apprentissage plus performantes avec une approche AR en multi-pas. Notre objectif est d’optimiser la performance de l’apprentissage et de le rendre plus efficace et plus rapide, en particulier durant les premières phases d’apprentissage. Nous avons aussi proposé́ un cadriciel générique visant à aider les développeurs dans la construction d’applications auto-adaptatives. Nous avons donc proposé de transformer des applications existantes en ajoutant des capacités d’autonomie et d’apprentissage à leurs composants. La transformation consiste en l’encapsulation des composants dans des conteneurs autonomiques pour les doter du comportement auto-adaptatif nécessaire. Notre objectif est d’alléger la charge des tâches de gestion des développeurs et de leur permettre de se concentrer plus sur la logique métier de leurs applications. Les solutions proposées sont destinées à être génériques, granulaires et basées sur un standard connu, à savoir l’Architecture de Composant de Service. Enfin, nos propositions ont été évaluées et validées avec des résultats expérimentaux. Ils ont démontré leur efficacité en montrant un ajustement dynamique des applications transformées face aux dynamicités de leurs contextes en un temps beaucoup plus court comparé aux approches existantes
During the past decade, the complexity of applications has significantly scaled to satisfy the emerging business needs. Their design entails a composition of distributed and interacting software components. They provide services by means of the business interactions maintained by their components. Such applications are inherently in a dynamic evolution due to their context dynamics. Indeed, they evolve in changing environments while exhibiting highly dynamic conditions during their execution life-cycle (e.g., their load, availability, performance, etc.). Such contexts have burdened the applications developers with their design and management tasks. Subsequently, motivated the need to enforce the autonomy of their management to be less dependent on human interventions with the Autonomic Computing principles. Autonomic Computing Systems (ACS) implies the usage of autonomic loops, dedicated to help the system to achieve its management tasks. These loops main role is to adapt their associated systems to the dynamic of their contexts by acting upon an embedded adaptation logic. Most of time, this logic is given by static hand-coded rules, often concern-specific and potentially error-prone. It is undoubtedly time and effort-consuming while demanding a costly expertise. Actually, it requires a thorough understanding of the system design and dynamics to predict the accurate adaptations to bring to the system. Furthermore, such logic cannot envisage all the possible adaptation scenarios, hence, not able to take appropriate adaptations for previously unknown situations. ACS should be sophisticated enough to cope with the dynamic nature of their contexts and be able to learn on their own to properly act in unknown situations. They should also be able to learn from their past experiences and modify their adaptation logic according to their context dynamics. In this thesis manuscript, we address the described shortcomings by using Reinforcement Learning (RL) techniques to build our adaptation logic. Nevertheless, RL-based approaches are known for their poor performance during the early stages of learning. This poor performance hinders their usage in real-world deployed systems. Accordingly, we enhanced the adaptation logic with sophisticated and better-performing learning abilities with a multi-step RL approach. Our main objective is to optimize the learning performance and render it timely-efficient which considerably improves the ACS performance even during the beginning of learning phase. Thereafter, we pushed further our work by proposing a generic framework aimed to support the application developers in building self-adaptive applications. We proposed to transform existing applications by dynamically adding autonomic and learning abilities to their components. The transformation entails the encapsulation of components into autonomic containers to provide them with the needed self-adaptive behavior. The objective is to alleviate the burden of management tasks on the developers and let them focus on the business logic of their applications. The proposed solutions are intended to be generic, granular and based on a well known standard (i.e., Service Component Architecture). Finally, our proposals were evaluated and validated with experimental results. They demonstrated their effectiveness by showing a dynamic adjustment to the transformed application to its context changes in a shorter time as compared to existing approaches

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Santos, Deivisson Vianna Dantas dos 1978. "A gestão autônoma da medicação : da prescrição à escuta." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313042.

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Orientador: Rosana Teresa Onocko Campos
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: No contexto atual, onde o saber científico se sobrepõe ao saber experiencial, a inclusão das posições dos usuários de serviços de saúde no direcionamento dos seus tratamentos ainda está distante da realidade. Esta tese reporta aspectos de uma pesquisa qualitativa que teve a oportunidade de intervir em práticas de cuidado em 10 serviços de saúde de dois municípios do Estado de São Paulo (Campinas e Amparo). Seguindo o princípio da Reforma Psiquiátrica brasileira da defesa dos direitos do usuário em participar das decisões sobre seu tratamento, utilizou-se a estratégia da gestão autônoma da medicação, de 2011 a 2012. Tal estratégia tem como proposta "empoderar" os usuários quanto ao uso de medicamentos em seus projetos terapêuticos. A partir de entrevistas semi-estruturadas com os moderadores destes grupos, antes e depois da intervenção, construiu-se narrativas sob os preceitos da hermenêutica gadameriana. Os trabalhadores que experimentaram a estratégia assumiram um papel mais crítico quanto suas próprias práticas clínicas. Identificaram na metodologia horizontal, grupal e direcionada para uma escuta não filtrada pelas categóricas científicas do campo da saúde uma ferramenta para a valorização da voz dos usuários. Relataram que a individualidade de cada sujeito foi fonte de um saber capaz de promover uma clínica mais flexível e propícia para uma construção conjunta de ações de saúde. Perceberam também que os usuários puderam repensar o papel dos medicamentos em suas vidas e, apesar das resistências institucionais, autorizaram-se a negociar seus tratamentos com seus prescritores
Abstract: In a context where scientific knowledge overlaps the experiential knowledge, the practice of sharing decisions with patients is still far from reality, despite the consensus that physicians must base their recommendations on the patient¿s values rather than on their own. This study reports aspects of a qualitative research that had the opportunity to intervene in care practices in 10 health facilities at two Brazilian cities (Campinas and Amparo). Following the principle of Brazilian Psychiatric Reform, defending users' rights to participate in decisions about their treatment, we worked with the gaining autonomy and medication (GAM) guide in order to seek the empowerment of the users regarding the use of psychotropic medication in their therapeutic projects. Semi-structured interviews were conducted with the GAM Group¿s moderators before and after the intervention, the material collected was transformed in narratives according Gadamer¿s hermeneutic principles. From the analysis, among other things, the workers attested the difficulty of avoiding the exercise of power over users via administration of psychotropic drugs. Besides, the health workers began to take a more critical approach to their own clinical practices. They also reported to practice a more flexible clinic, making shared decisions with their patients regarding their treatments
Doutorado
Política, Planejamento e Gestão em Saúde
Doutor em Saude Coletiva

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Kreuz, Giovana. "Autonomia decisória do idoso com câncer: percepções do idoso, da família e da equipe de saúde." Pontifícia Universidade Católica de São Paulo, 2017. https://tede2.pucsp.br/handle/handle/19853.

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Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq
Considering the population aging and its association with the estimation of grow cases of cancer in Brazil for the 2016 and 2017 years, being the elderly as the most susceptible to that disease, emerge the need to rethink the perceptions about old age and autonomy. This work proposes to analyze the perception of participation of elderly patients with cancer in decisions on their treatments, from patients, relatives, and health care team points of view, and more specifically analyzes intervenient aspects in the participation of elderly person with cancer in decisions about their own treatments. Data were collected through semi-structured interviews with 5 older patients under cancer treatment, 3 family members and 4 health professionals during the hospital stay. Content analysis and interpretation was developed based on the theoretical foundations for qualitative research of Bardin (2011) and Strauss and Corbin (2008), allowing the elaboration of the categories: autonomy, which addresses shared autonomy and the delegation of autonomy; loss of autonomy, approaching dependence; health and disease in old age, approaching the perceptions between disease and aging and the terminologies used to designate the elderly and the old age; autonomy and finitude, approaching the Advance Healthcare Directives and the relationship between the elderly and the health team. In the autonomy category, considering the diversity and heterogeneity of old age, and accepting the interlocution of various knowledge, the results indicate that the elderly perceive autonomy as a possibility to manage aspects of their own life, indicating that their choices are recognized and respected. The relatives position themselves to respect the decisions of the elderly, allowing them to maintain autonomy, although age is pointed by health professionals as a family argument for the exclusion of the elderly from decision making. Health professionals affirm that autonomy should be maintained regardless of age, although they point cognition and absence of severe mental disorder as criteria for determine its maintenance. The report that the health team excludes the elderly from the decisionmaking process, when communicating with the family, established a counterpoint in an interview with a relative. Loss of autonomy category indicates the dependence as an obstacle to exercise autonomy, being feared by the majority of patients and perceived as different from needing or asking for help, revealing a changing status. Regarding health and illness in old age, the interviewed elderly did not associate cancer with age, but in family conception it was perceived as an important factor. In Portuguese, the word “velho” has negative and pejorative connotation, and “idoso” indicates respect and dignity towards the person. The autonomy and finitude category revealed that patients and their families are unaware of Advance Healthcare Directives, and the health team has a partial knowledge about it, so this alternative is not used in that health center. This study reveals nuances between the effectiveness of the elderly autonomy and the ideal perception presented by the participants of the research; autonomy can be configured in a self-centered, shared way or delegated, according to context and needs
Considerando o envelhecimento populacional e sua associação às estimativas de aumento de câncer no Brasil nos anos de 2016 e 2017, sendo os idosos os mais suscetíveis à doença, configura-se a necessidade de se repensar as percepções sobre velhice e autonomia. A proposta deste trabalho foi analisar a percepção da participação de pacientes idosos com câncer nas decisões sobre seus tratamentos, sob a ótica dos pacientes, de seus familiares e da equipe de saúde que os assiste, dando ênfase à análise dos aspectos intervenientes na participação do idoso com câncer na decisão de seus tratamentos. Os dados foram coletados por meio de entrevistas semiestruturadas com 5 idosos com câncer em tratamento oncológico, 3 familiares e 4 profissionais da saúde, durante o período de internação hospitalar. A análise de conteúdo e interpretação foram desenvolvidas com base nos fundamentos teóricos para pesquisas qualitativas de Bardin (2011) e Strauss e Corbin (2008), permitindo a construção das seguintes categorias: autonomia, abordando a autonomia compartilhada e a delegação da autonomia; perda da autonomia, abordando a dependência; a saúde e a doença na velhice, abordando as percepções entre doença e envelhecimento e as terminologias usadas para designar o velho e a velhice; autonomia e finitude, abordando as Diretivas Antecipadas de Vontade e a relação do idoso com a equipe. Na categoria autonomia, considerando-se a diversidade e heterogeneidade da velhice e aceitando-se a interlocução de vários saberes, os resultados obtidos indicam que os idosos percebem a autonomia como a possibilidade de gerir aspectos da sua vida, indicando que suas escolhas são reconhecidas e respeitadas. Os familiares posicionam-se de maneira a respeitar as decisões dos idosos, permitindo que mantenham a autonomia, embora a idade seja apontada pelos profissionais da saúde como um argumento da família para a exclusão do idoso da tomada de decisão. Os profissionais da saúde afirmam que a autonomia deve ser mantida independentemente da idade, embora apontem critérios como cognição e ausência de transtorno mental grave para determinar sua manutenção. O relato de que a equipe às vezes comunica a família e exclui o idoso do processo decisório foi contraponto na entrevista de uma familiar. A categoria perda da autonomia configura a dependência como um fator impeditivo de exercer a autonomia, sendo temida pela maioria dos pacientes e percebida como diferente do fato de precisar ou pedir ajuda, ou seja, revela a mudança de um status. Quanto à categoria saúde e doença na velhice, o câncer não está associado à idade na percepção dos idosos entrevistados, mas aparece como um fator importante na concepção de familiares. O uso da nomenclatura “velho” indica algo negativo e pejorativo, enquanto “idoso” apresenta respeito e dignidade para com a pessoa. A categoria autonomia e finitude revelou que os pacientes e seus familiares desconhecem as Diretivas Antecipadas de Vontade, e o conhecimento da equipe de saúde é parcial, portanto, o dispositivo não é utilizado nesta instituição de saúde. Este estudo revela nuances entre a efetivação da autonomia do idoso e a percepção ideal apresentada pelos participantes da pesquisa; podendo a autonomia configurar-se de maneira autocentrada, compartilhada ou delegada, conforme contexto e necessidades

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Miranda, Ana Tereza Cavalcanti de. "Valores e atitudes de médicos e pacientes sobre o processo de decisão clínica: o caso da terapêutica hormonal no climatério." Universidade do Estado do Rio de Janeiro, 2005. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=8899.

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Situado no contexto da qualidade em saúde, este estudo versa sobre a decisão clínica e autonomia do paciente. Parte-se da premissa que, demais da competência técnica profissional e utilização de tecnologia adequada, o respeito aos direitos dos pacientes é atributo essencial à boa qualidade do atendimento médico. Tomando como exemplo a abordagem terapêutica do climatério, foi feita análise qualitativa do processo de decisão clínica, com base nas informações obtidas através de entrevistas semi-estruturadas com médico ginecologistas e com pacientes em fase de climatério. O propósito foi buscar apreender os valores dos médicos e dos pacientes e tentar compreender a lógica de seus comportamentos e atitudes, no que se refere especificamente aos papéis desempenhados por eles nesse processo. Com base nos resultados da análise, discute-se a complexidade da aplicação do princípio da autonomia na prática clínica e apresenta-se uma reflexão sobre a acreditação, como estratégia possível de contribuição a esse processo e à melhoria da qualidade do atendimento médico, por sua grande identificação como os aspectos relativos aos direitos dos pacientes, aos processos de educação permanente e à melhoria contínua da qualidade.
This research is set in the context of quality in health care. The object of the study was the patients role in clinical decision-making, considering that assuring good quality of clinical care requires respect to patients rights, as much as good technology. In order to study the decision process, we chose hormonal replacement therapy in the climacteric through qualitative analysis, based on non-structured interviews with gynecologists and postmenopausal women. The main purpose was the understanding of the values, attitudes and the reasoning employed by physicians and patients. The complexity of application of the bioethical principal of autonomy in daily clinical practice is discussed. The contribution of accreditation to these processes is examined, stressing the relevance of the functions related to patients rights, continuous education and continuous quality improvement.

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DeCaro, Daniel Anthony. "The Cost of Coercion: Decision Utility as a Function of both Decision Procedures and Outcomes." Miami University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=miami1281026603.

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Cohen, Cynthia S. "Leveraging the Power of Shared Governance." ScholarWorks, 2015. http://scholarworks.waldenu.edu/dissertations/1291.

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Shared governance (SG) creates an evidence-based framework to support decision making in healthcare organizations by encouraging nursing staff ownership of nursing practice issues. This project assessed the current state of shared governance at a community hospital through: (a) deployment of Hess's Index of Professional Nursing Governance (IPNG) and the National Database of Nursing Quality Indicators (NDNQI) nursing satisfaction surveys which were open to nurses working in areas included in the SG framework at the project site, and (b) retrospective review of Unit Practice Council (UPC) and Nursing Senate (NS) minutes and agendas. Kotter's theory of change and the logic model informed interventions aimed at creating an effective SG. IPNG data were analyzed using Hess' scoring guidelines to establish total governance and subscale scores. Mean IPNG scores of nurse leaders, clinical nurse managers, and staff nurses were compared using a 1-way ANOVA based on job title, education, employment status, and shift. NDNQI results were analyzed based on benchmarked Magnet objectives and comparison to previous year's surveys. Meeting agendas and minutes were analyzed for attendance and initiation of interventions. Outcomes of this project included successful creation of a UPC on a medical telemetry unit; alignment of meeting times to promote attendance; paid access to remote meeting attendance; standardization of meeting minutes and agendas; and unit-specific, outcomes-data dashboards. Implementation of this model to improve the effectiveness of SG can lead to positive social change through improvement in the decision-making process in the nation's healthcare institutions. Inclusion of all members of the healthcare team in the decisions that impact practice helps ensure comprehensive, evidence-based, and patient-centric care.

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Massof, Allison Emily. "The Demands of Partnership: A Normative Foundation for Shared Medical Decision-Making." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1534724963173141.

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Lins, Regina Dulce Barbosa. "The myth of local government autonomy : findings from the study of the municipal government of Maceio in Alagoas, Brazil, from 1986 to 1988." Thesis, University of Kent, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.344123.

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Emma, Lindqvist, and Strömer Johan. "Beslutsfattning och kontroll : En jämförande studie av lärares uppfattade professionella autonomi i tre svenska kommuner." Thesis, Uppsala universitet, Institutionen för pedagogik, didaktik och utbildningsstudier, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-353555.

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Denna studie är en del av det VR-finansierade forskningsprojektet ”Lärares autonomi i Sverige, Finland, Irland, England och Tyskland” och undersöker hur lärare i tre svenska kommuner upplever sin professionella autonomi i termer av kontroll och beslutsfattning. Autonomi betraktas vidare i denna studie som ett komplext och flerdimensionellt fenomen som kan ta olika form beroende på vilken del av lärarens arbete som berörs. Med hjälp av Wermke, Olason Rick och Salokangas analytiska modell, som delar upp lärares autonomi utifrån olika aspekter av arbetet, undersöks lärares autonomi inom de två nivåerna klassrum och skola samt de fyra domänerna utbildning, social, utveckling och administration. Studien baseras på en enkätundersökning som besvarats av 615 svenska lärare. Resultatet av studiens statistiska analyser visar hur lärares uppfattade autonomi skiljer sig mellan de tre kommunerna. Samtidigt varierar graden av autonomi mellan de olika nivåerna och domänerna på ett liknande sätt i samtliga kommuner, vilket skapar en bild över hur lärare i den svenska nationella kontexten uppfattar sin professionella autonomi. Högst autonomi tycks lärarna uppleva i utbildningsfrågor, medan de upplever att de har lägst autonomi i frågor gällande deras professionella utveckling.
This study is written as a part of the research project ”Teacher autonomy in Sweden, Finland, Ireland, England and Germany” and examines how teachers in three Swedish municipalities perceive their professional autonomy in terms of decision-making and control. In this study autonomy is seen as a complex and multidimensional phenomenon, that can take different forms in different aspects of teachers’ work. By using Wermke, Olason Rick and Salokangas’ analytical device, which sorts teacher autonomy into different aspects of work, teacher autonomy is examined in two levels, classroom and school, and in four domains, education, social, development and administration. The study is based on a survey taken by 615 Swedish teachers. The results show how teachers’ perceived autonomy differs between the three municipalities. The results also show how the degree of autonomy varies between the levels and domains in a similar manner across all three municipalities, which paints a picture of how teachers in the Swedish national context perceive their professional autonomy. The teachers perceive themselves as most autonomous in educational decisions and least autonomous in decisions regarding their professional development.

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Fellowes, Melanie. "The Indian woman's decision to sex-selectively abort : challenging the presumption of adaptive preference formation and absence of autonomy." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/20789/.

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Some women in India are making the decision to abort their foetus because it has been identified as female. One feminist intuition could be that those decisions are a result of false consciousness, that women have adapted their preferences in response to the social and gender oppression to which they are subjected. The presumption is also that the adaptive preference signifies an absence of autonomy. This thesis challenges that intuition and presumption, arguing that not all preferences made under oppressive conditions are to be regarded as non-autonomous. The motivation behind decisions is complex and a decision must be considered in the context of varied social, economic and cultural influences. The thesis uses three hypothetical case studies to facilitate a critical analysis of the concept of adaptive preference formation and different theories of autonomy from a feminist perspective: the content-neutral traditional procedural theory, content laden substantive theories and the relational theories which are re-conceptualised versions of the former accounts. This results in a theoretical analysis of which approach to autonomy best acknowledges the effect oppression may have on decision-making but is also able to recognise a woman’s autonomy where possible. This analysis is valuable as it reveals the difficulties in determining autonomy when such complex theories of autonomy are applied to real-life cases but also demonstrates that there is the possibility of the presence of autonomy even within a restricted choice environment. Although this focus on autonomy must not serve to detract from condemnation of a practice which perpetuates the denigration of women, condemnation alone is unlikely to result in a change in practice. I conclude that only when respect for bodily integrity is placed at the heart of medical decision-making in India will the right to self-determination and autonomy be realised for everyone.

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Moulias, Sophie. "Ethique, personne de confiance et maladie d'Alzheimer." Phd thesis, Université René Descartes - Paris V, 2012. http://tel.archives-ouvertes.fr/tel-00745279.

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La personne de confiance, créée par la loi du 4 mars 2002, permet au patient non communiquant, de transmettre sa parole au médecin, pour l'aider dans sa prise de décision. Dix ans après, la désignation de la personne de confiance reste rare, même en gériatrie, y compris pour les patients atteints de maladie d'Alzheimer. Plusieurs enquêtes par questionnaires et entretiens et une recherche-action ont été réalisés auprès des différents acteurs du soin gériatrique : patients, aidants, gériatres, médecins traitants et associations de patients, pour appréhender comment les professionnels de gériatrie se sont approprié la notion juridique de personne de confiance et ont modifié leurs pratique Les résultats montrent que les acteurs ne connaissent pas bien la loi et n'ont rien fait pour la mettre en œuvre, même s'ils en attendent beaucoup. Les équipes de soin peuvent cependant s'approprier le sujet et donner à la personne de confiance la place prévue par la loi. Des risques de dérives sont décrits : prise de pouvoir de la personne de confiance sur le patient, décharge de la responsabilité médicale, écartement des proches au profit de la seule personne de confiance, poids extrême pouvant peser sur cette dernière. Les professionnels trouvent que la procédure prend beaucoup de temps, qu'un document écrit n'est pas toujours adapté, que cela représente une charge supplémentaire, alors qu'ils sont déjà surchargés. Le manque de pratique entraine le manque d'utilisation. Les patients présentent parfois des difficultés de communication, limitant la possibilité de désigner. L'information sur la personne de confiance et sa désignation provoquent souvent une angoisse supplémentaire du patient face à sa possible mort prochaine. Il lui est parfois difficile de choisir entre ses enfants. Les professionnels pressentent que la personne de confiance n'a pas la même utilité pour tous. Elle est intéressante en soins d'urgence et de réanimation, mais les patients n'ont souvent pas le temps de la désigner avant d'en avoir besoin. Elle prend tout son sens dans les maladies chroniques, dont la maladie d'Alzheimer, pour lesquelles la désignation de la personne de confiance pourrait être anticipée par rapport à l'arrivée à l'hôpital. Il ne semble pas y avoir de limite, autre que celle de l'a priori moral des professionnels, à la possibilité de désigner une personne de confiance, même pour un patient atteint de maladie d'Alzheimer, la personne de confiance permettant alors au patient d'exprimer ses volontés au-delà de son handicap, en prenant au mieux en compte son ancienne personnalité et ses désirs actuels. Cette réflexion amène à certaines réserves éthiques. Le patient, sa personne de confiance et le médecin peuvent-ils conclure une alliance thérapeutique en médecine aiguë, alors que la patient est dépendant du médecin, par le fait même de sa maladie et de la proximité de la mort ? La logique des droits des patients a-t-elle une limite, puisque tous les patients n'ont pas accès à la désignation de leur personne de confiance ? Le risque de routinisation de la procédure est majeur, si le sens même de cette désignation n'est pas perçu par les différents acteurs. La réflexion autour de la prise de décision montre que le patient en semble souvent absent et pas toujours représenté par la personne de confiance. Le tuteur ne semble pas être le représentant idéal du patient, qui ne peut légalement plus désigner sa personne de confiance. Une amélioration du processus par le biais de bonnes pratiques de la désignation de la personne de confiance sont proposées : améliorer l'information de la population et des patients, former les professionnels aux conditions de désignation optimale pour le patient, informer la personne de confiance sur son rôle et sur sa responsabilité vis-à-vis du patient, de l'aidant familial et de la famille, extension de la procédure de désignation partout où il y a du soin.

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Diamond-Brown, Lauren Ashley. "Contingent Care: Obstetricians' Lived Experience and Interpretations of Decision-Making in Childbirth." Thesis, Boston College, 2017. http://hdl.handle.net/2345/bc-ir:107585.

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Thesis advisor: Sharlene N. Hesse-Biber
This dissertation seeks to understand obstetricians’ lived experience of decision-making in childbirth and investigate how the organizational context within which obstetricians work influences how they make treatment decisions. Understanding how obstetricians make decisions in childbirth is important because maternity care in the United States is in crisis. Our system is failing women on multiple accounts: between 1990 and 2013, maternal mortality more than doubled in the United States, and is higher than most other high-income countries. Furthermore, women continue to suffer from abusive practices by maternity care providers who dismiss their concerns and sometimes outright refuse to honor their self-determination in childbirth. Today multiple stakeholders acknowledge a need for maternity care reform; this creates new challenges for health care policy and opportunities for social science research. Obstetrician-gynecologists provide the majority of maternity care to American women, and this dissertation examines their lived experience of decision-making in birth and analyzes how a range of social forces affect this process. To investigate this phenomenon I performed 50 in-depth interviews with obstetricians from Massachusetts, Louisiana and Vermont about how they make patient care decisions in birth. The specific research questions and analysis for each chapter evolved through an iterative process that combined analytical grounded theory and template analysis. I present this in a three-article format. In article one I show how shift-work models of labor and delivery pose challenges to using a patient-centered approach to decision-making. Obstetricians either work shifts in labor and delivery or they work on-call for their patients’ births. The current thinking is that shifts are good because they allow work-life balance for doctors, reduce fatigue, and reduce convenience-based decisions. Shift work models assume that doctors and patients are interchangeable because doctors will follow protocols and standards of care produced by medical professional organizations. I argue shift work does not work in practice the way it does in theory. I explain how there are not standards for many decisions in birth, instead these decisions are characterized by medical uncertainty. In these cases, doctors rely on patient-centered approaches to make decisions. But shift work limits doctors’ ability to use patient-centered approaches. I found that shift-work models of hospital care do not provide doctors the opportunity to get to know their patients and understand their preferences. In practices that do not depend on shift work, the doctor patient relationship is far less fragmented and doctors tend to experience less conflict with their patients and are less likely to rely on stereotypes that reproduce social inequality. In article two I examine obstetricians’ understandings of convenience as a motivation in decision-making. Anecdotal evidence suggests that obstetricians sometimes make clinical care decisions less out of concern for their patients and more out of concern for their own time and schedule. This may be a particular problem in on-call models. In this paper I show doctors’ stories match anecdotal evidence: Some obstetricians make clinical decisions in birth based partially on their own convenience. Yet others actively resist the temptation of convenience, even in on-call care. A key dimension of this difference lies in doctors’ understandings of the nature of time in labor and the safety of interventions. Some doctors have a faster-the-better approach to birth and believe the routine use of interventions is the best way to practice in labor and delivery. These doctors frame their own convenience as legitimate because it overlaps with the idea that speeding up the labor is inherently good. Alternatively, other doctors believe time in labor is productive, and that interventions should be used judiciously because they increase risk of harm. These doctors cannot easily legitimize convenience because it conflicts with the reduction of interventions as a key dimension of this philosophy. I argue that because shift work poses serious challenges to patient-centered care, cultural change is a better avenue for reducing births of convenience. Article three addresses an ongoing question in medical sociology about whether physicians maintain control over their clinical work amidst challenges to their authority. Patient empowerment and standardization are two movements that sociologists have theorized in terms of weakening of doctors’ clinical discretion. I uncover how obstetricians draw on the conflicting nature of these approaches strategically to maintain their power in the face of a threat. Standards and patient empowerment act as countervailing powers; they drew on one to off set the challenge to their authority posed by the other
Thesis (PhD) — Boston College, 2017
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Sociology

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Niken, Prilandita. "Evaluation Framework for Autonomous Decision-Making Performance in Energy and Environmental Innovations." Kyoto University, 2017. http://hdl.handle.net/2433/218022.

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Kyoto University (京都大学)
0048
新制・課程博士
博士(エネルギー科学)
甲第20096号
エネ博第343号
新制||エネ||69(附属図書館)
33212
京都大学大学院エネルギー科学研究科エネルギー社会・環境科学専攻
(主査)教授手塚哲央, 教授下田宏, 准教授 MCLELLAN Benjamin
学位規則第4条第1項該当

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Lau, So-yee Sophie, and 劉素儀. "An analysis of bureaucratic power and agency autonomy: a case study of the Construction Industry TrainingAuthority." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B42576453.

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Yiou, Gong, and Ye Shaolin. "Employee Satisfaction Management on Job‐related Stress : The mechanism between middle level manager’s leadership and knowledge worker’s autonomy." Thesis, Linköpings universitet, Företagsekonomi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-72892.

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Background: Resource-based view emphasizes that the competitive advantage of organization is built on two elements: resources and capabilities/competences, which are related to employees within it. And job-related stress is a phenomenon in workplace and a problem in employee satisfaction management. Aim: How are decision-making latitude in terms of autonomy, as the need of knowledge worker, and his/her job-related stress related? How is knowledge worker autonomy affected by middle level manager’s authority? What is the mechanism between middle level manager’s leadership and knowledge worker’s stress? Definitions: Stress: the overall transactional process; Stressors: the events or properties of events (stimuli) that are encountered by individuals; Strain: the individual’s psychological, physical and behavioral responses to stressors; Outcomes: the consequences of strain at both the individual and the organizational levels. Completion & Results: The mechanism among elements in and between knowledge worker and middle level manager is identified and presented.

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Brown, Sarah-Jane. "Autonomy, the law, and ante-mortem interventions to facilitate organ donation." Thesis, University of Manchester, 2018. https://www.research.manchester.ac.uk/portal/en/theses/autonomy-the-law-and-antemortem-interventions-to-facilitate-organ-donation(1d8877ef-fa3c-4639-b2ec-6eacb923fe7a).html.

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Over the last few years, policies have been introduced in the UK which aim to improve organ transplantation rates by changing the way that potential organ donors are treated before death. Patients incapacitated due to catastrophic brain injury may now undergo ante-mortem donor optimisation procedures to facilitate deceased organ donation. As I identify in this thesis, the most significant ethical and legal problem with these policies is that they are not based on what the patient would have chosen for themselves in the specific circumstances. The policies identify and treat patients meeting certain clinical criteria as a group rather than the individuals, with their own viewpoints, that the law on best interests requires. They equate registration on the Organ Donation Register with ante-mortem donor optimisation procedures being in their best interests, despite registrants having neither been informed about nor given consent to ante-mortem interventions. The overarching claim I make in this thesis is that a system of specific advance consent is needed to provide a clear and unequivocal legal justification for ante-mortem donor optimisation procedures. The ethical foundation for this claim is autonomy, and this is the central theme running through all six chapters. I argue that autonomy should be incorporated into donor optimisation policy to promote the dignity and integrity of potential organ donors and to safeguard trust in the organ donation programme. I argue that a system of specific advance consent is needed as part of the duty of care owed to registrants on the Organ Donor Register and to facilitate the determination of the best interests of the potential organ donor. I argue that the state has not established the necessity of the current policy of non-consensual donor optimisation procedures and that they are under an ethical and legal obligation to introduce an autonomy-based framework for ante-mortem interventions to facilitate organ donation.

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Pinho, Jose Carlos M. R. "Control and autonomy of strategic marketing decisions : a study of the subsidiaries of financial services organisations in Portugal and Spain." Thesis, University of Warwick, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391882.

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Paton, Alexis Hannahson Collins. "Issues of autonomy and agency in oncofertility : a socio-bioethical exploration of British adult female cancer patients making oncofertility decisions." Thesis, University of Newcastle upon Tyne, 2015. http://hdl.handle.net/10443/2818.

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This thesis examines from a socio-bioethical perspective British premenopausal cancer patients’ experiences with making oncofertility decisions. It uses original empirical research into the experiences of a small group of patients to address social, clinical and ethical concerns about how patients make decisions in the medical context. Several North American studies have noted that the ways in which cancer and fertility concerns are addressed in the medical context may affect patient decision-making. This thesis focuses specifically on how these experiences are influenced by the medical encounters in the UK, by exploring how female cancer patients make decisions about their future fertility. The thesis also examines whether social and bioethical theories of autonomy and agency adequately capture how decisions are made in practice, using empirical data to interrogate existing theory. To address these questions, semi-structured interviews were conducted with premenopausal cancer patients. Data from the interviews were analysed using sociological and bioethical theories in order to improve understandings of how this patient group makes decisions, and how they feel this experience could be improved. This research therefore contributes to the growing body of literature seeking to identify how patients make decisions within the medical context and what types of support are necessary to address the needs identified by patients. Furthermore, the thesis demonstrates how sociology as a discipline can be seen as a constitutive part of bioethics, with this project serving as an example of one way that bioethical research can be conducted through a sociological lens.

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Gateau, Thibault. "Supervision de mission pour une équipe de véhicules autonomes hétérogènes." Thesis, Toulouse, ISAE, 2012. http://www.theses.fr/2012ESAE0038/document.

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Ces dernières années, les engins robotisés n’ont cessé d’améliorer leur autonomie dans le domaine de la décision. Désormais, pour ne citer que l’exemple de véhicules aériens, nombre de drones sont largement capables, sans intervention d’un opérateur humain, de décoller, suivre un itinéraire en activant divers capteurs à des moments précis, atterrir en un lieu spécifié, suivre une cible, patrouiller sur une zone... Une des étapes suivantes consiste à faire collaborer une équipe de véhicules autonomes, de nature hétérogène (aériens, terrestres, marins...) afin de leur permettre d’accomplir des missions plus complexes. L’aspect dynamique de l’environnement réel, la non disponibilité à tout instant des moyens de communication, la coordination nécessaire des véhicules,de conceptions parfois différentes, dans l’exécution de certaines parties d’un plan de mission, sont autant d’obstacles à surmonter. Ce travail tente non seulement d’apporter quelques éléments de réponse face à ces difficultés, mais consiste aussi en la mise en place concrète d’un superviseur haut niveau, capable de gérer l’exécution d’une mission par une équipe de véhicules autonomes hétérogènes, où le rôle de l’opérateur humain est volontairement réduit. Nous décrivons dans ce mémoire l’architecture distribuée que nous avons choisi de mettre en œuvre pour répondre à ce problème. Il s’agit d’un superviseur, réparti à bord des véhicules autonomes, interfacé avec leur architecture locale et en charge de l’exécution de la mission d’équipe. Nous nous intéressons également à la formalisation des connaissances nécessaires au déroulement de cette mission, afin d’améliorer l’interopérabilité des véhicules de l’équipe, mais aussi pour expliciter les relations entre modèles décisionnels abstraits et réalité d’exécution concrète. Le superviseur est capable de réagir face aux aléas qui vont se produire dans un environnement dynamique. Nous présentons ainsi dans un second temps les stratégies mises en place pour parvenir à les détecter au mieux, ainsi que la façon dont nous procédons pour réparer partiellement ou totalement le plan de mission initial, afin de remplir les objectifs initiaux. Nous nous basons notamment sur la nature hiérarchique du plan de mission, mais aussi sur celle de la structure de sous-équipes que nous proposons de construire. Enfin, nous présentons quelques résultats obtenus expérimentalement, sur des missions simulées et des scénarios réels, notamment ceux du Programme d’Etudes Amont Action dans lequel s’inscrivent ces travaux de thèse
Many autonomous robots with specific control oriented architectures have already been developed worldwide.The advance of the work in this field has led researchers wonder for many years to what extent robots would be able to be integrated into a team consisting of autonomous and heterogeneous vehicles with complementary functionalities. However, robot cooperation in a real dynamic environment under unreliable communication conditions remains challenging, especially if these autonomous vehicles have different individual control architectures.In order to address this problem, we have designed a decision software architecture, distributed on each vehicle.This decision layer aims at managing execution and at increasing the fault tolerance of the global system. The mission plan is assumed to be hierarchically structured. ln case of failure detection, the plan repair is done as locally as possible, based on the hierarchical organization.This allows us to restrict message exchange only between the vehicles concerned by the repair process. Knowledge formalisation is also a part of the study permitting the improvement of interoperability between team members. It also provides relevant information all along mission execution, from initial planning computation to plan repair in this multirobot context. The feasibility of the system has been evaluated by simulations and real experiments thanks to the Action project (http://action.onera.fr/welcome/)

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Xia, Chen. "Apprentissage Intelligent des Robots Mobiles dans la Navigation Autonome." Thesis, Ecole centrale de Lille, 2015. http://www.theses.fr/2015ECLI0026/document.

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Les robots modernes sont appelés à effectuer des opérations ou tâches complexes et la capacité de navigation autonome dans un environnement dynamique est un besoin essentiel pour les robots mobiles. Dans l’objectif de soulager de la fastidieuse tâche de préprogrammer un robot manuellement, cette thèse contribue à la conception de commande intelligente afin de réaliser l’apprentissage des robots mobiles durant la navigation autonome. D’abord, nous considérons l’apprentissage des robots via des démonstrations d’experts. Nous proposons d’utiliser un réseau de neurones pour apprendre hors-ligne une politique de commande à partir de données utiles extraites d’expertises. Ensuite, nous nous intéressons à l’apprentissage sans démonstrations d’experts. Nous utilisons l’apprentissage par renforcement afin que le robot puisse optimiser une stratégie de commande pendant le processus d’interaction avec l’environnement inconnu. Un réseau de neurones est également incorporé et une généralisation rapide permet à l’apprentissage de converger en un certain nombre d’épisodes inférieur à la littérature. Enfin, nous étudions l’apprentissage par fonction de récompenses potentielles compte rendu des démonstrations d’experts optimaux ou non-optimaux. Nous proposons un algorithme basé sur l’apprentissage inverse par renforcement. Une représentation non-linéaire de la politique est désignée et la méthode du max-margin est appliquée permettant d’affiner les récompenses et de générer la politique de commande. Les trois méthodes proposées sont évaluées sur des robots mobiles afin de leurs permettre d’acquérir les compétences de navigation autonome dans des environnements dynamiques et inconnus
Modern robots are designed for assisting or replacing human beings to perform complicated planning and control operations, and the capability of autonomous navigation in a dynamic environment is an essential requirement for mobile robots. In order to alleviate the tedious task of manually programming a robot, this dissertation contributes to the design of intelligent robot control to endow mobile robots with a learning ability in autonomous navigation tasks. First, we consider the robot learning from expert demonstrations. A neural network framework is proposed as the inference mechanism to learn a policy offline from the dataset extracted from experts. Then we are interested in the robot self-learning ability without expert demonstrations. We apply reinforcement learning techniques to acquire and optimize a control strategy during the interaction process between the learning robot and the unknown environment. A neural network is also incorporated to allow a fast generalization, and it helps the learning to converge in a number of episodes that is greatly smaller than the traditional methods. Finally, we study the robot learning of the potential rewards underneath the states from optimal or suboptimal expert demonstrations. We propose an algorithm based on inverse reinforcement learning. A nonlinear policy representation is designed and the max-margin method is applied to refine the rewards and generate an optimal control policy. The three proposed methods have been successfully implemented on the autonomous navigation tasks for mobile robots in unknown and dynamic environments

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Roca, Gregory. "La vie privée et familiale du majeur protégé." Thesis, Aix-Marseille, 2013. http://www.theses.fr/2013AIXM1034.

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Longtemps délaissé par les différents législateurs européens, le droit des incapacités fait l'objet d'une toute nouvelle attention depuis la fin des années 1990. Sous l'influence du Conseil de l'Europe, la France a entrepris des réformes qui se veulent davantage humanistes. Ces nouveaux textes doivent permettre de protéger les personnes les plus vulnérables tout en garantissant l'exercice de leur droit au respect de la vie privée et familiale. Ce double objectif peut sembler à la fois utopique et contradictoire, puisque toutes les mesures de protection entrainent des restrictions de la capacité et ont donc des répercutions sur les décisions les plus intimes du majeur protégé.Pourtant, que ce dernier vive dans la cité ou qu'il soit accueilli en établissement sanitaire ou social, la loi semble parvenir à un équilibre. Celui-ci résulte d'une place toute particulière accordée à la capacité naturelle, à la volonté mais également à l'autonomie de l'intéressé.Le système n'est toutefois pas parfait. Parfois, le législateur n'a pas eu l'audace d'aller au bout de sa démarche et maintient des incapacités de principe dans les domaines les plus intimes de la vie privée du protégé. D'autres fois, au contraire, il est allé trop loin, sacrifiant la protection sur l'autel de l'autonomie. Des améliorations sont donc nécessaires. À cette fin, il est possible d'envisager la suppression de ces dernières incapacités et de les remplacer par un dispositif de protection s'adaptant au degré d'inaptitude de l'intéressé. Il est également possible d'imaginer une généralisation de l'assistance, mécanisme idoine lorsque les décisions sont particulièrement liées à la personne
Neglected by the various European legislators for a long time, incapacity Law has been a primary focus since the late nineties. Influenced by the European Council, France has undertaken a more humanistic reform. The new legislation should help to protect the most vulnerable ones while ensuring the exercise of their fundamental rights, including the right for respect of privacy. This dual objective seems both unrealistic and contradictory at the same time since all protection measures lead to capacity restrictions and therefore impact the most intimate decisions the protected adult has to make.Yet, wherever the protected adult live, in the city or in an institution, the llaw seems to have found balance. This is the result of a particular importance given to the natural ability, the will but also the autonomy of the individual.However, the system is not perfect. Sometimes, the legislator did not dare to go further and maintains disabilities by principle in areas the most related to the protected person’s privacy. At other times however, it goes too far choosing autonomy over protection. Improvements are needed. To this end, it is possible to consider the removal of the remaining disabilities and replace them with a protection scheme adjusting to the degree of disability of the individual. It is also possible to imagine a generalization of the assistance which is appropriate when decisions are closely related to the person

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Luoto, M. (Markus). "Managing control information in autonomic wireless networking." Doctoral thesis, Oulun yliopisto, 2017. http://urn.fi/urn:isbn:9789526216454.

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Abstract As mobile Internet access traffic continues to grow at an explosive rate and wireless networks continue to diverge into multiple access technologies with partly overlapping sets of features, new solutions for efficient use of these networks are vital. Cognitive network management provides tools to tackle this challenge by automatically learning from past experience the characteristics and usage patterns of the connected devices, thus enabling autonomic optimization of those connections. Cognitive network management requires a vast amount of information in order to function effectively, making collaboration of the networked devices essential as the best sources of information are scattered throughout the network. This makes efficient information dissemination one of the key enablers for autonomic networking. This dissertation studies managing control information related to autonomic selection of access networks and adapting services in a heterogeneous wireless network environment. It presents a solution to simple and efficient information dissemination in the form of Distributed Decision Engine— a CEP-like system enabling the building of a highly scalable and dynamic messaging system enabling dissemination, analysis and control of the complex series of interrelated events in the network. The dissertation also presents results showing a clear benefit in using cross-layer and cross-domain information in a modern wireless environment and validates the final prototype implementation of DDE with laboratory measurements. Effective use of disseminated cross-layer information is another key element in autonomic wireless networking. This dissertation also focuses on intelligent decision-making based on cross-layer information by presenting test results which attest that the performance of an autonomic wireless networking system can be improved by using cognitive techniques in its management algorithms, and that hierarchy and coordination can be utilized to minimize the effect of conflicting decisions of the system
Tiivistelmä Mobiilin Internet-liikenteen räjähdysmäinen kasvu ja langattomien verkkojen jatkuva jakautuminen useisiin tekniikoihin vaativat uusia ratkaisuja näiden verkkojen tehokkaaseen käyttöön. Kognitiivinen verkon hallinta mahdollistaa oppimisen, minkä avulla laitteiden yhteyksiä voidaan optimoida autonomisesti aiemman kokemuksen perusteella. Tällainen optimointi vaatii kuitenkin valtavan määrän verkosta ja laitteista kerättyä tietoa, mikä tekee tehokkaasta tiedonjakelusta keskeisen elementin autonomisessa verkon hallinnassa. Tässä väitöskirjassa tutkitaan verkon valintaan ja palveluiden sopeuttamiseen vaadittavan tiedon välittämistä ja hallintaa autonomisissa langattomissa verkoissa. Ratkaisuna yksinkertaiseen ja tehokkaaseen tiedonvälitykseen esitellään hajautettu Distributed Decision Engine -komponentti, joka mahdollistaa skaalautuvan tiedon jakelu-, analysointi- ja hallintajärjestelmän rakentamisen. Lisäksi väitöskirjassa kuvataan myös tuloksia, jotka osoittavat, että verkkokerrosten välisen tiedon käyttämisellä voidaan saavuttaa selvää etua, sekä tuloksia, jotka vahvistavat DDE-prototyyppitoteutuksen toimivuuden laboratoriomittauksin. Verkkokerrosten välisen tiedon tehokas hyödyntäminen on toinen keskeinen tekijä autonomisessa langattomien verkkojen hallinnassa. Väitöskirjassa käsitellään myös älykästä päätöksentekoa kyseisen informaation pohjalta sekä esitellään tuloksia, jotka osoittavat, että päätöksentekoa autonomisessa langattomien verkkojen hallinnassa voidaan parantaa kognitiivisilla tekniikoilla. Lisäksi esitetyt tulokset osoittavat, että hierarkialla sekä koordinoinnilla voidaan minimoida ristiriitaisten päätösten vaikutukset järjestelmään

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47

Rasoal, Dara. "Dödshjälp- ett hot mot välfärden eller en möjlighet?" Thesis, Umeå universitet, Institutionen för idé- och samhällsstudier, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-175311.

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In parallel with medical developments, the debate on euthanasia has gained new momentumin the Western world. Many countries have now legalized various forms of euthanasia, whileothers are investigating the issue. Euthanasia has been described as a difficult issue with manydimensions and worldwide there is no consensus among philosophers. The question ofeuthanasia may be relevant in the various cases where patients suffer and experienceunnecessary pain due to various diseases. The consequence of a bodily pain can lead toexistential thoughts about the meaning of life in these people. People who cannot find ameaningful continuation with their lives can express a wish to end their lives througheuthanasia. A literature review has been undertaken and various databases have been used inorder to search for scientific articles, debates and philosophical books. The purpose of thisthesis is to describe the state of knowledge about euthanasia and whether we should alloweuthanasia in Sweden. Four main arguments for and against euthanasia have been identified:1) the right to life, 2) the principle of autonomy, 3) the patient's best interests, and 4)euthanasia as a substitute for palliative care and the slippery slope argument.It is true that euthanasia poses a direct threat to the right to life and the sanctity of life. At thesame time the right to life can also be interpreted as having self-determination to end one's lifeat any time. A ban on euthanasia may benefit the right to life but it could mean an unwantedlife for many patients who suffer. A ban could also lead to a violation of personal integrity ofthe patient where they may experience not being taken seriously.There are, of course, several concerns and criticisms directed to a legalization of euthanasia.For example, patients who request euthanasia may be in a vulnerable position due to theirillness and/or lack of social or economic resources and therefore choose euthanasia. It canalso be that people would be pressured to request euthanasia. Another concern is that thelegalization of voluntary euthanasia could risk leading to the legalization of non-voluntaryeuthanasia, which means including other people in the euthanasia decision without their ownconsent. These risks are worth reflecting on and it is always difficult to balance the benefitsagainst risks concerning euthanasia. The best interests of the patient should be a guidingprinciple in decision-making in euthanasia and one should always try to reduce unnecessarysuffering.

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Razmgah, Pardis. "Utbildning, träning och konsumtion : Hur ungdomar blir nöjda med sina beslut." Thesis, Mälardalen University, School of Sustainable Development of Society and Technology, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-10180.

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Vi fattar dagligen beslut. Ungdomar har mindre möjlighet än vuxna att fatta självständiga beslut. Ungdomar påverkas av sina föräldrar och vänner när de står inför olika val. När ungdomar väl fattar självständiga beslut så utvecklas de psykologiskt. Syftet med studien var att se hur ungdomars tilltro till den egna förmågan, öppenhet, autonomi och föräldrars stöd påverkar deras nöjdhet med beslut som de tidigare har fattat inom ett av tre områden: utbildning, träning eller konsumtion. 120 enkäter delades ut till gymnasieelever och 92 enkäter besvarades. Resultaten visade att ungdomar lägger stor vikt vid sin autonomi och är därmed mer nöjda då de får fatta ett beslut på egen hand. Föräldrarnas stöd påverkade också ungdomars nöjdhet med beslutet; ju mer föräldrarna stöttade beslutet desto nöjdare var ungdomarna. Det är därför viktigt att föräldrar stöttar ungdomarna när de ska fatta beslut och uppmuntrar autonomi så att de blir nöjda med besluten.

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Chehaibar, Graziela Zlotnik. "Bioética e crença religiosa: estudo da relação médico-paciente Testemunha de Jeová com potencial risco de transfusão de sangue." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-27082010-142544/.

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As Testemunhas de Jeová têm preceitos religiosos que sustentam a recusa da transfusão de sangue e, frequentemente, vivenciam situações nas quais essa recusa pode ser sustentada por aspectos científicos, legais e bioéticos. Este estudo teve como objetivo analisar a relação médico-paciente Testemunha de Jeová, sob a potencial recomendação de transfusão de sangue durante a internação hospitalar. Além disso, também buscou investigar o momento e a forma da identificação do paciente Testemunha de Jeová; analisar a conduta dos médicos frente a um eventual impasse na relação com os pacientes e analisar as escolhas dos pacientes na relação com os médicos; verificar as condutas realizadas após o processo de tomada de decisão entre médico e seu paciente; e verificar se os médicos conhecem o parecer n.º 007/2004 - \"Orientação sobre Recusa de Transfusão de Sangue da Testemunha de Jeová\", da Comissão de Bioética (CoBi) do Hospital das Clínicas da FMUSP. A pesquisa foi realizada no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) no período de fevereiro de 2007 a maio de 2009. Foram selecionados 46 pacientes e 48 médicos, buscando-se entrevistar o paciente e seu respectivo médico. Trata-se de um estudo de caso exploratório, em pesquisa clínica, com abordagem qualitativa e com uso de dados quantitativos. A análise dos dados revelou que 89,6% passaram por cirurgia e 29,2% estiveram em iminente risco de morte. Foram transfundidos 12,5%, e 8,3% chegaram a óbito. Ao se analisar as posturas dos médicos e pacientes entrevistados, quanto à maneira de lidar com a questão das escolhas foi possível identificar cinco categorias de dados, sendo 3 delas para os médicos - deliberador, pragmático e autonomista e 2 para os pacientes Testemunhas de Jeová - liberal e ortodoxo. Os dados revelaram que existe uma busca genuína dos médicos em disponibilizar técnicas alternativas para evitar a transfusão, porém, quando se trata de iminente risco de morte, a decisão é pela transfusão. Observou-se que a identificação dos pacientes como TJ ocorre tardiamente (79,2% somente após a internação) e, em situações de impasse, sempre que envolvido iminente risco de morte, a maioria dos médicos afirmou que optariam pela transfusão, mesmo sem o consentimento do paciente (91,7%). Também foi identificado que há um conhecimento limitado dos médicos sobre as leis e sobre o parecer 007/2004, sendo que 50% dos médicos entrevistados declararam conhecer a comissão de bioética, enquanto e 64,6 % declaram não conhecem o parecer. A maioria dos médicos (72,9%) é favorável a uma conduta padronizada para os pacientes Testemunhas de Jeová. Além disso, outros dados revelaram que pacientes e médicos fazem uso de documentos para salvaguardar suas decisões. Entretanto, na prática, esses documentos se mostram ineficazes, já que não evitam processos contra médicos, nem transfusões em pacientes. Salvar a vida do seu paciente é o principal compromisso da maior parte dos médicos.
Jehovah\"s Witnesses have religious beliefs that support their refusal to blood transfusion which frequently lead them to experience situations in which such refusal may be based on scientific, legal and bioethical principles. The goal of this study is to analyze the relation between physician and Jehovah\"s Witness patient under the potential recommendation of blood transfusion during hospitalization. Besides this goal, the study also sought to investigate the moment and the manner of identifying a Jehovah\"s Witness patient as so; to analyze the physicians\" procedures when facing an impasse in their relation with patients and analyze the patients\" choice in their relation with the physician; analyze the procedures performed after the decision-making process between the physician and his patient; and establish whether physicians know Recommendation No. 007/2004 \"Guidelines about refusal of blood transfusion by Jehovah\'s Witness patients\", from the Bioethics Committee (CoBi) of Hospital das Clínicas da FMUSP. This research was carried out at Clínicas Hospital of University of São Paulo Medical School (HCFMUSP) between February 2007 and May 2009.A total of 46 patients and 48 physicians were interviewed, always trying to interview the patient and his/her respective physician. It is a case-study of exploratory nature in clinical research using a qualitative approach with quantitative data. Data analysis revealed 89.6% of patients underwent surgery and 29.2% were under life threat. A total of 12.5% received blood and 8.3% died. When analyzing physicians`and patient` postures in relation to way they dealt with the issue of choices, five categories were found : three for physicians - deliberator, pragmatic, autonomist - and two for Jehovah\'s Witness patient - liberal and orthodox. The analysis of scientific aspects showed there is a genuine pursuit by the doctors to make alternative techniques available to avoid transfusion, but if there is an imminent risk of death the decision is to use transfusion. Results show the patients identification as JW happens late in the admission process (79.2% only after admission) and, in an impasse, whenever there is an imminent risk of death the majority of the doctors state they would choose to use transfusion even without the patient\'s consent (91.7%). Data also revealed a limited knowledge of doctors about laws and about Recommendation No. 007/2004, with 50% of interviewed doctors affirming they did not know the bioethics committee, and 64.6% did not know the recommendation. Most physicians (72.9%) favor a standard procedure to deal with Jehovah\'s Witnesses patients. Other data show patients and doctors use documents to secure their decisions.However, in practical termos these documents prove to be inefficient as they neither prevent lawsuits against physicians nor transfusions in patients.Saving the patient\'s life is the main commitment for the majority of doctors

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Paganini, Maria Cristina. "As situações de final de vida na unidade de terapia intensiva: o enfermeiro no processo de exercer a sua autonomia." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/83/83131/tde-19102011-125834/.

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Este estudo teve como objetivos: compreender como se dá o processo de o enfermeiro exercer sua autonomia nas decisões de final de vida vivenciadas em UTI adulto; identificar os significados que ele atribui à experiência de tomar decisões e de exercer sua autonomia nas situações de final de vida dos pacientes internados na UTI adulto; construir uma teoria substantiva sobre a compreensão de exercer a sua autonomia nas tomadas de decisão em situações de final de vida dos pacientes na UTI adulto. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada em Dados. A análise comparativa dos dados possibilitou desvendar o significado de exercer autonomia do enfermeiro com pacientes em final de vida internados na UTI adulto. Foi possível serem identificados três fenômenos que compõem esta experiência. O primeiro,Trabalhando num ambiente de pressão, representa a etapa inicial da experiência do enfermeiro, agrega não somente o contexto que permeia o seu trabalho na UTI, mas também os aspectos clínicos do paciente, as interações com os outros profissionais e com a família nas tomadas de decisão de final de vida. O segundo,Buscando empoderar-se para poder decidir, mostra o movimento, no qual o enfermeiro cria estratégias para ampliar as oportunidades a fim de poder exercer autonomia. O terceiro,Revendo os espaços para exercer autonomia, reconsidera outros espaços onde possa atuar no processo de final de vida, em relação ao planejamento do cuidado ao paciente, no acolhimento das famílias nas tomadas de decisão ou, ainda, na interface com os membros da equipe e a instituição. A articulação destes fenômenos permitiu identificar a categoria central AMPLIANDO AS OPORTUNIDADES PARA EXERCER A AUTONOMIA, que representa o processo vivido pelo enfermeiro na busca de espaços de poder de decisão e de ação ao assumir seu papel nos cuidados no processo de final de vida.
The purpose of this study is to: understand the process of autonomy exercised by nurses when making decisions related to end-of-life situations they in the adult ICU; to identify the meanings that nurses attribute to the experience of making decisions and of exercising their autonomy in end-of-life situations of adult patients in ICU; to construct a theoretical model about the process of understanding the exercise of their autonomy in decision-making relating to end-of-life situations of adult patients in the ICU. The study used as a theoretical reference the Symbolic Interactionism, and as methodological reference, the Grounded theory. The comparative analysis of the data has permitted the understanding of the meaning of nurses experience in exercising autonomy relating to life-ending adult patients in the ICU. Three phenomena that compose this experience have been identified: The first, \"Working in an environment of pressure,\" represents the initial phase of nurses experience, adding not only the features that exist within the ICU where the work is done, but also the clinical aspects of patients interaction with other professionals and family in end of life decision-making. The second, \"Seeking to gain power in order to be allowed to make decisions,\" shows the movement in which nurses create strategies for expanding opportunities in order to exercise autonomy. The third phenomena, \"Reviewing the spaces to exercise autonomy,\" reconsiders other spaces where nurses can act in end-of-life situations regarding planning of patient care, supporting families on their decision making and interface with health team members and the institution. The articulation of these phenomena has permitted the identification of the central category EXPANDING-THE-OPPORTUNITIES-FOR-EXERCISE AUTONOMY, based on which it has been possible to propose a theoretical model that explains the experience. It represents the process experienced by nurses in seeking spaces of power regarding decision making and action to assume the care role in end-of-life process.

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Dissertations / Theses on the topic 'Decisional autonomy'

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