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Journal articles on the topic 'Decisional autonomy'
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1
Levin, Paul E. "Patient Autonomy and Decisional Capacity." Journal of Bone and Joint Surgery-American Volume 84, no. 11 (November 2002): 2105–6. http://dx.doi.org/10.2106/00004623-200211000-00035.
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Capozzi, James D., and Rosamond Rhodes. "Patient Autonomy and Decisional Capacity." Journal of Bone and Joint Surgery-American Volume 84, no. 11 (November 2002): 2106. http://dx.doi.org/10.2106/00004623-200211000-00036.
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Ingrand, Félix, Simon Lacroix, Solange Lemai-Chenevier, and Frederic Py. "Decisional autonomy of planetary rovers." Journal of Field Robotics 24, no. 7 (2007): 559–80. http://dx.doi.org/10.1002/rob.20206.
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Dimopoulos, Georgina. "A theory of children's decisional privacy." Legal Studies 41, no. 3 (April 5, 2021): 430–53. http://dx.doi.org/10.1017/lst.2021.16.
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AbstractDecisional privacy offers individuals the freedom to act and to make important decisions about how they live their lives, without unjustifiable interference from other individuals or the state. Children's perceived vulnerability, incapacity for rational decision-making and dependence on adults have been used to justify depriving children of decisional privacy rights and subjecting them to the exercise of adult power over the conditions of their lives. The aim of this paper is to articulate a theory of children's decisional privacy. It is argued that decisional privacy is valued as a condition that enables individual autonomy. A relational, gradual conception of autonomy is advanced, to explain how children can be recognised as having the capacity for autonomy, and in some circumstances, actual autonomy. This paper presents four fundamental principles of a children's rights approach to decisional privacy, which collectively serve to enhance children's meaningful participation in decision-making about their best interests, consistently with children's evolving capacities and the receipt of appropriate parental direction and guidance. The theory developed in this paper presents an opportunity for adult decision-makers to reflect upon how they make decisions for and about children, and how children can play a meaningful role in those decision-making processes.
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Celen, Nermin, Figen Cok, Harke A. Bosma, and H. Zijsling Djurre. "Perceptions of decisional uutonomy of Turkish adolescents and their parents." Paidéia (Ribeirão Preto) 16, no. 35 (December 2006): 349–63. http://dx.doi.org/10.1590/s0103-863x2006000300006.
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This study attempted to investigate decisional autonomy in Turkish adolescents from 12 to 18 years. The Perspectives on Adolescent Decision Making (PADM) questionnaire was administered to 372 middle class adolescents who attend middle and high schools and to their parents. The PADM assess if adolescents decide for themselves, or parents impose restrictions or adolescents and parents have arguments about the topic. MANOVA analyzes were used. Results showed that affirmative answers increased with age. From adolescent and parents' perspectives adolescent decisional autonomy grows with age, parental control decreases, conflicts between them tended to decrease, on the perspective of parents. There was minor gender differences: girls have higher level of decisional autonomy; boys experience more conflict. Adolescents' decisional autonomy expectations tended to be higher than those of parents. Fathers' and mothers' perspectives on decisional autonomy were very similar. The results support the new family model proposed by Kaðýtçýbaþý.
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Giralt, Georges. "Mobile Robots: Decisional and Operational Autonomy." IFAC Proceedings Volumes 29, no. 4 (October 1996): 63–70. http://dx.doi.org/10.1016/s1474-6670(17)44686-6.
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Kassirer, Samantha, and Celia Gaertig. "The Costs of Autonomy: Decisional Autonomy Undermines Advisees' Judgements of Experts." Academy of Management Proceedings 2019, no. 1 (August 1, 2019): 15721. http://dx.doi.org/10.5465/ambpp.2019.15721abstract.
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Kassirer, Samantha, Emma E. Levine, and Celia Gaertig. "Decisional autonomy undermines advisees’ judgments of experts in medicine and in life." Proceedings of the National Academy of Sciences 117, no. 21 (May 7, 2020): 11368–78. http://dx.doi.org/10.1073/pnas.1910572117.
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Over the past several decades, the United States medical system has increasingly prioritized patient autonomy. Physicians routinely encourage patients to come to their own decisions about their medical care rather than providing patients with clearer yet more paternalistic advice. Although political theorists, bioethicists, and philosophers generally see this as a positive trend, the present research examines the important question of how patients and advisees in general react to full decisional autonomy when making difficult decisions under uncertainty. Across six experiments (N= 3,867), we find that advisers who give advisees decisional autonomy rather than offering paternalistic advice are judged to be less competent and less helpful. As a result, advisees are less likely to return to and recommend these advisers and pay them lower wages. Importantly, we also demonstrate that advisers do not anticipate these effects. We document these results both inside and outside the medical domain, suggesting that the preference for paternalism is not unique to medicine but rather is a feature of situations in which there are adviser–advisee asymmetries in expertise. We find that the preference for paternalism holds when advice is solicited or unsolicited, when both paternalism and autonomy are accompanied by expert guidance, and it persists both before and after the outcomes of paternalistic advice are realized. Lastly, we see that the preference for paternalism only occurs when decision makers perceive their decision to be difficult. These results challenge the benefits of recently adopted practices in medical decision making that prioritize full decisional autonomy.
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Hostiuc, S., I. Negoi, and E. Drima. "Decisional capacity in patients with acute delirium. A Rawlsian approach." European Psychiatry 41, S1 (April 2017): S581. http://dx.doi.org/10.1016/j.eurpsy.2017.01.872.
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Delirium is characterized by a temporary, usually reversible, cause of mental alteration; it can occur at any age, but affect most often the elderly. Delirium patients may also present acute psychotic episodes, which might make them decisionally incompetent. In order to assess decisional capacity, Fan et al developed a two-stage approach, which tries to analyse:– the presence of delirium, using the Confusion Assessment Method;– a proper analysis of the decisional capacity.Often, in patients with decreased decisional capacity, physicians must assess which ethical principle should respect first – the principle of autonomy, whose practical implementation is informed consent, or beneficence – the good of the patient, irrespective of the its declared wishes. In this poster, we will look at the issue of decisional capacity in patients with acute delirium from a Rawlsian point of view, and will try to give an answer based on what is just – to respect the autonomy of the patient, or the moral duty to do good to the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Owen, Gareth S., Fabian Freyenhagen, Genevra Richardson, and Matthew Hotopf. "Mental Capacity and Decisional Autonomy: An Interdisciplinary Challenge." Inquiry 52, no. 1 (February 2009): 79–107. http://dx.doi.org/10.1080/00201740802661502.
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Mendz, George L., and David W. Kissane. "Agency, Autonomy and Euthanasia." Journal of Law, Medicine & Ethics 48, no. 3 (2020): 555–64. http://dx.doi.org/10.1177/1073110520958881.
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Agency is the human capacity to freely choose one’s thoughts, motivations and actions without undue internal or external influences; it is distinguished from decisional capacity. Four well-known conditions that can deeply affect agency are depression, demoralization, existential distress, and family dysfunction. The study reviews how they may diminish agency in persons whose circumstances may lead them to consider or request euthanasia or assisted suicide. Since agency has been a relatively neglected dimension of autonomous choice at the end of life, it is argued that to respect the autonomy of individuals, it is essential to establish their agency.
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Castelo, Noah, Peter B. Reiner, and Gidon Felsen. "Balancing Autonomy and Decisional Enhancement: An Evidence-Based Approach." American Journal of Bioethics 12, no. 2 (February 2012): 30–31. http://dx.doi.org/10.1080/15265161.2011.634951.
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Wright, Megan S. "Dementia, Healthcare Decision Making, and Disability Law." Journal of Law, Medicine & Ethics 47, S4 (2019): 25–33. http://dx.doi.org/10.1177/1073110519898040.
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Persons with dementia often prefer to participate in decisions about their health care, but may be prevented from doing so because healthcare decision-making law facilitates use of advance directives or surrogate decision makers for persons with decisional impairments such as dementia. Federal and state disability law provide alternative decision-making models that do not prevent persons with mild to moderate dementia from making their own healthcare decisions at the time the decision needs to be made. In order to better promote autonomy and wellbeing, persons with dementia should be accommodated and supported so they can make their own healthcare decisions.
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Campbell, Amy T. "Adolescent Decisional Autonomy in Research: Issues in Translating Research into Policy." American Journal of Bioethics 5, no. 5 (September 2005): 78–80. http://dx.doi.org/10.1080/15265160500246384.
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Dimitrakopoulos, Dionyssis G. "The Transposition of EU Law: ‘Post-Decisional Politics’ and Institutional Autonomy." European Law Journal 7, no. 4 (December 2001): 442–58. http://dx.doi.org/10.1111/1468-0386.00137.
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GILBERT, FREDERIC, TERENCE O’BRIEN, and MARK COOK. "The Effects of Closed-Loop Brain Implants on Autonomy and Deliberation: What are the Risks of Being Kept in the Loop?" Cambridge Quarterly of Healthcare Ethics 27, no. 2 (March 6, 2018): 316–25. http://dx.doi.org/10.1017/s0963180117000640.
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Abstract:A new generation of implantable brain–computer interfaces (BCI) devices have been tested for the first time in a human clinical trial, with significant success. These intelligent implants detect specific neuronal activity patterns, such as an epileptic seizure, and provide information to help patients to respond to the upcoming neuronal events. By forecasting a seizure, the technology keeps patients in the decisional loop; the device gives control to patients on how to respond and decide on a therapeutic course ahead of time. Being kept in the decisional loop can positively increase patients’ quality of life; however, doing so does not come free of ethical concerns. There is currently a lack of evidence concerning the various impacts of closed-loop system BCIs on patients’ decisionmaking processes, especially how being in the decisional loop impacts patients’ sense of autonomy. This article addresses these gaps by providing data that we obtained from a first-in-human clinical trial involving patients implanted with advisory brain devices. This article explores ethical issues related to the risks involved in being kept in the decisional loop.
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Cohn, Jennifer M., Kenneth R. Ginsburg, Nancy Kassam-Adams, and Joel A. Fein. "Adolescent Decisional Autonomy Regarding Participation in an Emergency Department Youth Violence Interview." American Journal of Bioethics 5, no. 5 (September 2005): 70–74. http://dx.doi.org/10.1080/15265160500246319.
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Decaluwé, Bernard. "Le système monétaire européen : Où en sommes-nous?" Études internationales 12, no. 3 (April 12, 2005): 445–63. http://dx.doi.org/10.7202/701232ar.
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The decisions of the Council of Europe on December 5"', 1978, that would lead to the establishment of the European Monetary System, raise a multitude of questions. Among these, the creation of a European currency unit, the ECU, and the announcement of the establishment in the near future of a European Monetary Fund, the E.M.F., are the most symbolic decisions in terms of public opinion as well as the most important in their economic and political implications. In this article, we will show that the development of the ECU and the creation of a E.M.F. with substantial decisional autonomy are the two conditions necessary for strengthening the European monetary union.
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Kjelsvik, Marianne, Ragnhild J. Tveit Sekse, Asgjerd Litleré Moi, Elin M. Aasen, Per Nortvedt, and Eva Gjengedal. "Beyond autonomy and care: Experiences of ambivalent abortion seekers." Nursing Ethics 26, no. 7-8 (January 10, 2019): 2135–46. http://dx.doi.org/10.1177/0969733018819128.
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Background: While being prepared for abortions, some women experience decisional ambivalence during their encounters with health personnel at the hospital. Women’s experiences with these encounters have rarely been examined. Objective: The objective of this study was to explore ambivalent abortion-seeking women’s experiences of their encounters with health personnel. Research design: The data were collected in individual interviews and analysed with dialogical narrative analyses. Participants and research context: A total of 13 women (aged 18–36 years), who were uncertain of whether to terminate their pregnancies during the first trimester, were interviewed before and after they made their decisions. The participants were recruited at six Norwegian outpatient clinics. Ethical considerations: Approval was granted by the Regional Committee for Medical and Health Research Ethics. Findings: The ambivalent pregnant women sought to make autonomous decisions while simultaneously involving their closest confidants and health personnel in the process. The following three types of narratives of women’s experiences with encounters with health personnel were identified: the respected women; the identified women; and the abandoned women. Discussion: The findings are discussed in terms of the ambivalent pregnant woman’s autonomous responsibility in considering an abortion and how her autonomy can be enabled or impaired during encounters with health personnel. Conclusion and implication: Although the women considered themselves autonomous and responsible for their final decisions, they wished health personnel were involved in their situations. The health personnel contributed by enabling or disabling the possibility of decision-making in accordance with the women’s values. The findings indicate that health personnel who care for women considering abortions must be trained in dialogical competence.
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Rari, Eirini, and Véeronique Fournier. "Strengths and limitations of considering patients as ethics ‘actors’ equal to doctors: reflections on the patients’ position in a French clinical ethics consultation setting." Clinical Ethics 4, no. 3 (September 2009): 152–55. http://dx.doi.org/10.1258/ce.2009.009021.
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The Clinical ethics centre in Paris offers its services equally to doctors and patients/proxies. Its primary goal is to re-equilibrate doctor-patient roles through giving greater voice to patients individually in medical decisions. Patients are present at virtually all levels, initiating consults, providing their point of view and receiving feedback. The implications of patients’ involvement are threefold. At an operational level, decision-making is facilitated by repositioning the debate on ethical grounds and introducing a dynamic of decisional partnership, although contact with patients can make it difficult to deny their demands and set the limits of our role. Ethically, it reinforces patients’ autonomy and grants them a place of veritable ethics ‘actors’, with the danger that this may become excessively autonomy oriented. Finally, at a collective level, the programme fulfils its political purpose in promoting patients’ rights and the ideal of démocratie sanitaire, but complicates balancing individual demands with collective values.
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Klann, Elyssa M., and Y. Joel Wong. "A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy." Psychology of Women Quarterly 44, no. 2 (June 2020): 170–86. http://dx.doi.org/10.1177/0361684320904321.
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Empirical data from the past 50 years have illuminated some of the factors that influence pregnancy decision-making. Yet, formal models of pregnancy decision-making are uncommon and rarely incorporate cultural perspectives. In order to address this gap in the literature, we propose the Pregnancy Decision-Making Model (PDMM), a comprehensive model of the factors that are likely to affect pregnancy decisions in the context of unintended pregnancy, with special attention to relational and intersectional components of pregnancy decisions. The PDMM begins with three primary Evaluation factors: Evaluation of Capital, Evaluation of Values, and Evaluation of Narratives. Barriers to Access are proposed to be a key factor in limiting agency and autonomy and determining pregnancy outcomes. Social Influences are also hypothesized to influence Evaluation factors and their relationship with outcome variables, which include the Pregnancy Outcome, Decisional Certainty, and Decisional Satisfaction. As the PDMM is designed to be flexible in its prediction of a variety of outcomes, we consider a number of possible permutations of the model. Finally, we discuss the utility of the PDMM for inspiring future research, as well as the practical implications of the model.
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High, Dallas M. "All in the Family: Extended Autonomy and Expectations in Surrogate Health Care Decision-Making1." Gerontologist 28, Suppl (June 1, 1988): 46–51. http://dx.doi.org/10.1093/geront/28.suppl.46.
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Abstract Examined were elderly persons' preferences and expectations for advance directives and surrogate health care decision-making in the event of decisional incapacity. Exploratory findings are presented from in-depth interviews of a sample of men and women aged 67 to 91 (n = 40). The view that elderly people have a strong expectation for familial decision-making in the event of long term care and perceive this reliance as a means of extended autonomy was supported by the findings.
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Teshale, Salom M., Ivan R. Molton, and Mark P. Jensen. "Associations among decisional autonomy, fatigue, pain, and well-being in long-term physical disability." Rehabilitation Psychology 64, no. 3 (August 2019): 288–97. http://dx.doi.org/10.1037/rep0000279.
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Stefanita, Anastasia. "Elements of Local Autonomy and New Technology in Urban Revitalization Process." Central and Eastern European eDem and eGov Days 331 (July 11, 2018): 57–68. http://dx.doi.org/10.24989/ocg.v331.5.
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The article aims to present the concept of the urban revitalization in relation with the new information technologies. The actuality of the topic relates from the importance of information tools in all processes of human activity, including the administrative and participatory one. The urban revitalization is presented as a dimension of the decisional local autonomy of public authorities of the cities/municipalities. The paper is based on the on-going activities of the bilateral Polish - Moldavian ”Revitalization Project”. The e-tools become a new dimension of the classical ”renewal” concept, transforming in this way the revitalization process in a modern one and upgrading it to a higher level. Because of the rapid development of the information society, the revitalization processes undergo changes and gains new meaning. The expectations of citizens as well as the activities of local public authorities imply new standards, especially in terms of information technologies.
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HYUN, INSOO. "Conceptions of Family-Centered Medical Decisionmaking and Their Difficulties." Cambridge Quarterly of Healthcare Ethics 12, no. 2 (April 2003): 196–200. http://dx.doi.org/10.1017/s0963180103002111.
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Over the past decade or so, the predominant patient-centered ethos in American bioethics has come under attack by critics who claim that it is morally deficient in certain respects, particularly when viewed in the context of acute-care decisionmaking. One line of criticism has been that the current ethic of patient autonomy gives an individual competent patient far too much decisional authority over the terms of his own treatment so that the patient is at complete liberty to neglect the ways in which his medical decisions can drastically and negatively affect the lives of other family members. Given that family members must help shoulder the financial, emotional, and rehabilitative burdens involved in the patient's care, it has been argued that they too have a legitimate interest in choosing what sort of medical treatment the patient eventually receives. Another closely related line of criticism is that the prevailing focus on patient autonomy gives short shrift to the moral significance of the family as a genuine community. Echoing a view of the person advanced by most communitarian political theorists, some commentators have argued that the patient comes to the clinic so thoroughly embedded in a complex web of familial relationships and obligations that it does not make sense to identify him as the only person in the family to make decisions about treatment.
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Whitler, June M. "Ethics of Assisted Autonomy in the Nursing Home: Types of Assisting Among Long-Term Care Nurses." Nursing Ethics 3, no. 3 (September 1996): 224–35. http://dx.doi.org/10.1177/096973309600300305.
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Twenty-five long-term care nurses in eight nursing homes in central Kentucky were inter viewed concerning ways in which they might assist elderly residents to preserve and enhance their personal autonomy. Data from the interviews were analysed using grounded theory methodology. Seven specific categories of assisting were discovered and described: personalizing, informing, persuading, shaping instrumental circumstances, considering, mentioning opportunities, and assessing causes of an impaired capacity for decision-making. The ethical implications of these categories of assisting for clinical prac tice are examined. Although nurses recognized the importance of resident autonomy, the majority of them failed consistently to employ the categories of assistance to foster resi dent self-determination and most of them held an inadequate understanding of the con cepts of consent and decisional capacity. To assure confidentiality, pseudonyms are used in the following cases and discussions for all names of nurses, residents and facilities.
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BOYLE, GERALDINE. "The role of autonomy in explaining mental ill-health and depression among older people in long-term care settings." Ageing and Society 25, no. 5 (August 23, 2005): 731–48. http://dx.doi.org/10.1017/s0144686x05003703.
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This paper examines the extent of mental ill-health and probable depression among older people in long-term care. It presents selected findings from a study in Greater Belfast, Northern Ireland, that compared the quality of life, autonomy and mental health of older people living in nursing and residential homes with those of older people living in private households who were receiving domiciliary care. Structured interviews were conducted with 214 residents in institutions and 44 older people receiving domiciliary care. The study found that those in private households were more severely physically-impaired and had a higher level of mental ill-health than the residents of institutional homes. It is suggested, however, that the mental ill-health effects were associated less with physical impairments than with the restrictions placed on the older person's decisional autonomy, and that long-term care environments that constrain the older person's autonomy contribute to the development of depression. Although the UK National Service Framework for Older People specified that those with depression should be given treatment and support, priority should also be given to preventing the depression associated with living in long-term care settings.
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Xu, Kai Jun. "Decisional Autonomy of Approach and Landing Phase for Civil Aviation Aircraft using Dual Fuzzy Neural Network." Advanced Materials Research 476-478 (February 2012): 936–39. http://dx.doi.org/10.4028/www.scientific.net/amr.476-478.936.
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This paper presents the dual fuzzy neural network, designed the decisional autonomy flight controller for civil aviation aircraft in approach and landing phase. Real-time learning method was applied to train the neural network using the gradient-descent of an error function to adaptively update weights. Adaptive learning rates were obtained through the analysis of Lyapunov stability to guarantee the convergence of learning. Conventional automatic landing system (ALS) can provide a smooth landing, which is essential to the comfort of passengers. However, these systems work only within a specified operational safety envelope. When the conditions are beyond the envelope, such as turbulence or wind shear, they often cannot be used. The objective of this paper is to investigate the use of dual fuzzy neural network in ALS and to make that system more intelligent.
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Cohn, Jennifer M. "Response to Commentary on “Adolescent Decisional Autonomy Regarding Participation in an Emergency Department Youth Violence Interview”." American Journal of Bioethics 5, no. 5 (September 2005): W14. http://dx.doi.org/10.1080/15265160500334024.
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Prictor, Megan, Megan A. Lewis, Ainsley J. Newson, Matilda Haas, Sachiko Baba, Hannah Kim, Minori Kokado, et al. "Dynamic Consent: An Evaluation and Reporting Framework." Journal of Empirical Research on Human Research Ethics 15, no. 3 (November 15, 2019): 175–86. http://dx.doi.org/10.1177/1556264619887073.
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Dynamic consent (DC) is an approach to consent that enables people, through an interactive digital interface, to make granular decisions about their ongoing participation. This approach has been explored within biomedical research, in fields such as biobanking and genomics, where ongoing contact is required with participants. It is posited that DC can enhance decisional autonomy and improve researcher–participant communication. Currently, there is a lack of evidence about the measurable effects of DC-based tools. This article outlines a framework for DC evaluation and reporting. The article draws upon the evidence for enhanced modes of informed consent for research as the basis for a logic model. It outlines how future evaluations of DC should be designed to maximize their quality, replicability, and relevance based on this framework. Finally, the article considers best-practice for reporting studies that assess DC, to enable future research and implementation to build upon the emerging evidence base.
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Chenneville, Tiffany, Kimberly Sibille, and Debra Bendell-Estroff. "Decisional Capacity Among Minors With HIV: A Model for Balancing Autonomy Rights With the Need for Protection." Ethics & Behavior 20, no. 2 (March 15, 2010): 83–94. http://dx.doi.org/10.1080/10508421003595901.
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Gainer, Ryan A., Janet Curran, Karen J. Buth, Jennie G. David, Jean-Francois Légaré, and Gregory M. Hirsch. "Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives." Medical Decision Making 37, no. 5 (November 2, 2016): 600–610. http://dx.doi.org/10.1177/0272989x16675338.
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Objectives. Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients’ values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. Methods. Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. Results. We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. Conclusions. Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention early in the decision process, the use of individualized decision aids that employ graphic risk presentations, and a dedicated decisional coach were identified by patients and providers as approaches with a high potential for success. The impact of such a formalized shared decision making process in cardiac surgery on decisional quality will need to be formally assessed. Given the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.
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Biswas, Tonmoy. "Ethics of Clinical Research Involving Adults with Impaired Decision-Making Capacity." Bangladesh Journal of Bioethics 7, no. 1 (August 15, 2016): 17–26. http://dx.doi.org/10.3329/bioethics.v7i1.29302.
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Background: Proper decision making capacity, adequate disclosure and voluntary decisions are basic constituents of informed consent which is required in surgical procedures, any interventions, any tissue collection, or any research involving the human participants. But, it becomes more hectic if the participants or patients are physically or mentally impaired for proper understanding or rational decision making. Time has gone by assembling or regulating effective laws for research involving persons with impaired decision making capacity. Still, question arises, is it ethical to enroll an incompetent person who is not physically or mentally fit to make a decision in risky research or interventional trials? If it is, how the informed consent and ethical measures can be taken? Method: Extensive literature review was done in Google scholar, PubMed and national or institutional websites with the corresponding keywords to summarize the cases of impaired decision making and regulation of informed consent and ethical measures in those cases. Results: Decision making capacity requires three level of capacities and four levels of abilities. If a person has factual understanding, implies a certain level of rational belief, knows to manipulate information to arrive at a choice and remains stable on the choice, is known to be capacitated in decision making. Impaired decision making capacity is more common in Alzheimers disease and schizophrenia research. Although a definite line between decisional capacity and incapacity is still in question, many assessment tools are available to conclude it. Moreover, decisional incapacity has been found as a significant ratio in general or psychiatric hospitals and nursing homes regarding psychological disorders or critically ill conditions. But, these conditions should not prevent anyone from understanding, choosing, or accepting any intervention as sometimes they may have some preserved abilities too. As per accepted ethics, respect for persons incorporates at least two ethical convictions. First, the individual should be treated as an autonomous agent and second, the person with diminished autonomy is entitled to protection. Thats why, in case of severe psychiatric diseases and Alzheimers diseases, surrogate consent is recommended. But surrogacy should be reviewed by the institutional review board (IRB). Multimedia consent process, advanced consent directives, rational consent waiver and many other processes are practiced in case of ethical research involving decisional incapacitate persons which are discussed in the paper. Conclusion: It should be clarified by the IRB whether involvement of impaired subjects has beneficial scientific aim or not. Capacity assessment system should be in an organized and systemic way. Threshold for capacity and recognition of persons able to conduct this process should be fixed. Role of surrogacy and involvement of IRB to align it in a proper manner is always a matter of concern. Consideration of risk management, subjects autonomy and assent-dissent issues should be clarified in research.
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Susanto, Andry. "Strategi Partai Perindo jelang pemilu 2019." Jurnal Ilmiah Ilmu Pemerintahan 3, no. 2 (January 22, 2019): 123. http://dx.doi.org/10.14710/jiip.v3i2.3882.
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Penelitian ini bertujuan untuk mengetahui strategi Partai Perindo jelang pemilu 2019. Strategi tersebut dilihat berdasarkan strategi pendekatan yang dilakukan di internal dan eksternal partai. Penelitian ini menggunakan metode studi kasus yang memfasilitasi eksplorasi dari fenomena yang terjadi melalui proses wawancara, dokumentasi, dan kajian literasi. Penelitian menggunakan konsep teori Huntington terkait pelembagaan partai politik, yang dikembangkan kembali oleh Vicky Randall dan Lars Svasand dengan menjelaskan aspek eksternal - internal dan struktural - kultural. Kesimpulan utama, Partai Perindo menggunakan strategi yang sesuai dengan derajat kesisteman (systemness), derajat identitas nilai (value infusion), derajat otonomi (decisional autonomy), dan citra publik (reification). Pemilu 2019 menjadi pertaruhan bagi Partai Perindo, figur ketua umum Hary Tanoesoedibjo (HT) menjadi penentu, karena sepakterjangnya otomatis berimbas pada keberlangsungan partai.
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Van Petegem, Stijn, Wim Beyers, Maarten Vansteenkiste, and Bart Soenens. "On the association between adolescent autonomy and psychosocial functioning: Examining decisional independence from a self-determination theory perspective." Developmental Psychology 48, no. 1 (January 2012): 76–88. http://dx.doi.org/10.1037/a0025307.
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Moore, Nadia, Karen M. Detering, Tessa Low, Linda Nolte, Scott Fraser, and Marcus Sellars. "Doctors’ perspectives on adhering to advance care directives when making medical decisions for patients: an Australian interview study." BMJ Open 9, no. 10 (October 2019): e032638. http://dx.doi.org/10.1136/bmjopen-2019-032638.
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ObjectiveAdvance care planning (ACP) assists people to identify their goals, values and treatment preferences for future care. Ideally, preferences are documented in an advance care directive (ACD) and used by doctors to guide medical decision-making should the patient subsequently lose their decision-making capacity. However, studies demonstrate that ACDs are not always adhered to by doctors in clinical practice. We aim to describe the attitudes and perspectives of doctors regarding ACD adherence and the utility of ACDs in clinical practice.DesignFace-to-face semistructured interviews were conducted using three case-based vignettes to explore doctors’ decision-making and attitudes towards ACDs. Transcripts were analysed using a thematic analysis.SettingDoctors from a variety of medical specialties and with varying experience levels were recruited from a large tertiary hospital in Melbourne, Australia.ParticipantsA total of 21 doctors were interviewed, 48% female (10/21). Most (19/21) reported having experience using ACDs.ResultsFour themes were identified: aligning with patient preferences (avoiding unwanted care, prioritising autonomy and anticipating family opposition), advocating best interests (defining futile care, relying on clinical judgement, rejecting unreasonable decisions and disregarding legal consequences), establishing validity (doubting rigour of the decision-making process, questioning patients’ ability to understand treatment decisions, distrusting outdated preferences and seeking confirmation) and translating written preferences into practice (contextualising patient preferences, applying subjective terminology and prioritising emergency medical treatment).ConclusionsACDs provide doctors with opportunities to align patient preferences with treatment and uphold patient autonomy. However, doctors experience decisional conflict when attempting to adhere to ACDs in practice, especially when they believe that adhering to the ACD is not in the patients’ best interests, or if they doubt the validity of the ACD. Future ACP programmes should consider approaches to improve the validity and applicability of ACDs. In addition, there is a need for ethical and legal education to support doctors’ knowledge and confidence in ACP and enacting ACDs.
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Motoc, Adrian. "Romanian family business branding: contextual factors of influence of decisional processes." Proceedings of the International Conference on Business Excellence 14, no. 1 (July 1, 2020): 607–16. http://dx.doi.org/10.2478/picbe-2020-0057.
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AbstractDespite the difficulties of the economic environment and the challenges encountered, family businesses in Romania are drivers of economic growth. The tumultuous history and the cultural differences have impacted the way businesses are conducted and how decisions are made, especially in family-run companies, influencing how the family aspect is being portrayed and turned into a competitive advantage. The purpose of this paper is to determine how these contextual factors are influencing the promotion of the family aspect in the family business brand. The methodology of this paper is the exploratory qualitative interview-based study. Empirical data has been collected by way of in-depth semi-structured interviews with eleven Romanian family business owners or managers selected through non-probability purposive sampling, further analysed using content analysis technique. Results suggest that Romania’s cultural background directly affects family businesses and the way they promote their family image, identity and reputation. Although this has a positive effect, few Romanian family businesses are active and promote themselves on the marketplace as a family business. Romanian families have a high degree of autonomy and accountability in relation to local communities which can help or impede the development of a family brand because both families and communities require transparency and there is a high degree of uncertainty which can impact both the business and the family owners. The reference to current literature primarily relates to the position of the family in the business but most notably to branding. The role of family members is drawn to limit actions in certain aspects of promotion and branding, as a direct result of high-conservative views.
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Dwyer, Andrew A., Hongjie Shen, Ziwei Zeng, Matt Gregas, and Min Zhao. "Framing Effects on Decision-Making for Diagnostic Genetic Testing: Results from a Randomized Trial." Genes 12, no. 6 (June 20, 2021): 941. http://dx.doi.org/10.3390/genes12060941.
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Genetic testing is increasingly part of routine clinical care. However, testing decisions may be characterized by regret as findings also implicate blood relatives. It is not known if genetic testing decisions are affected by the way information is presented (i.e., framing effects). We employed a randomized factorial design to examine framing effects on hypothetical genetic testing scenarios (common, life-threatening disease and rare, life-altering disease). Participants (n = 1012) received one of six decision frames: choice, default (n = 2; opt-in, opt-out), or enhanced choice (n = 3, based on the Theory of Planned Behavior). We compared testing decision, satisfaction, regret, and decision cognitions across decision frames and between scenarios. Participants randomized to ‘choice’ were least likely to opt for genetic testing compared with default and enhanced choice frames (78% vs. 83–91%, p < 0.05). Neither satisfaction nor regret differed across frames. Perceived autonomy (behavioral control) predicted satisfaction (B = 0.085, p < 0.001) while lack of control predicted regret (B = 0.346, p < 0.001). Opting for genetic testing did not differ between disease scenarios (p = 0.23). Results suggest framing can nudge individuals towards opting for genetic testing. These findings have important implications for individual self-determination in the genomic era. Similarities between scenarios with disparate disease trajectories point to possible modular approaches for web-based decisional support.
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Gilligan, T. D., M. W. Kennedy, E. Olson, A. Gerberick, A. Wilson-Glover, and J. D. Allen. "Prostate-cancer (CaP) screening decision aid for black men designed to enhance shared decision-making." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 6059. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.6059.
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6059 Background: The high CaP incidence and mortality of black men combined with their relatively low rate of CaP screening and their elevated risk of presenting with advanced disease has led to their being identified as a high-priority group for screening. The benefit of screening, however, is uncertain. Most guidelines recommend that men make an individualized screening decision in consultation with their doctor. Motivating and preparing men to actively participate in this difficult decision remains a challenge. This is particularly relevant regarding black Americans given their historical alienation from the health care system. Methods: A CaP screening decision aid designed to promote shared decision-making was tested in 5 small group sessions of black men at community sites in Boston. The decision aid was preceded by a brief didactic presentation on CaP screening. The decision aid included a graphical depiction of all potential major outcomes that may follow a decision for or against screening. Vignettes about the decision-making and outcomes of hypothetical men with different life circumstances and priorities were presented to enhance values clarification by the participants. Endpoints measured before and after the intervention included self efficacy (SE)[Decision Self Efficacy Scale], decisional conflict (DC) [Decisional Conflict Scale], desire for autonomy (DFA) [Control Preferences Scale], and prostate cancer knowledge (PCK) [Prostate Cancer Knowledge and Prostate Cancer Screening Knowledge scales]. Pre- and post-intervention scores were compared using a Wilcoxon Matched-Pairs Signed Rank test. Results: 64 men were accrued over 4 months during 2005. Significant changes were seen in all measures. Average scores improved 16% on SE (p<.001) and 17% on DC (p<.004). DFA increased, with the proportion of men wanting to play a dominant role in health care decisions rising from 62% to 81% (p<.001). PCK more than doubled on both scales (p<.001). Focus groups held after the intervention reinforced these findings. Conclusions: Men were better informed, felt better prepared to actively participate in CaP screening decisions, and wanted to play a stronger role in decisions about their health care following exposure to our decision aid. No significant financial relationships to disclose.
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Carnevale, Franco A. "The Birth of Tragedy in Pediatrics: a Phronetic Conception of Bioethics." Nursing Ethics 14, no. 5 (September 2007): 571–82. http://dx.doi.org/10.1177/0969733007080203.
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Accepted standards of parental decisional autonomy and child best interests do not address adequately the complex moral problems involved in the care of critically ill children. A growing body of moral discourse is calling for the recognition of `tragedy' in selected human problems. A tragic dilemma is an irresolvable dilemma with forced terrible alternatives, where even the virtuous agent inescapably emerges with `dirty hands'. The shift in moral framework described here recognizes that the form of conduct called for by tragic dilemmas is the practice of phronesis. The phronetic agent has acquired a capacity to discern good agency in tragic circumstances. This discernment is practiced through the artful creation of moral narratives: stories that convey that which is morally meaningful in a particular situation; that is, stories that are `meaning making'. The phronetic agent addresses tragic dilemmas involving children as a narrator of contextualized temporal embodied human (counter)stories.
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Henkin, Alan B., Carolyn L. Wanat, and James H. Davis. "Social Skills of Principals: A Profile in Context." Journal of School Leadership 6, no. 4 (July 1996): 399–423. http://dx.doi.org/10.1177/105268469600600403.
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A study context related to social communications in restructured school environments frames this investigation of social communications skills of principals. Responses of 709 public school principals to the Social Skills Inventory (SSI) constitute the data source. The instrument, a self-report inventory demonstrating positive relationships with several measures of social effectiveness, yields a global indicator of social skills defined as social competence. Results suggested generally marginal social skills among these principals. Positive associations were found between social competence and gender (female), higher levels of education, larger school size, urban school locus, and administrative decisional autonomy. Older, more experienced respondents with more extended positional longevity and tenure as administrators revealed significantly lower social communications skills as measured by the SSI. Findings are discussed in terms of the stewardship role of the principal, and the need for social skills training for work in open systems with multiple stakeholders.
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Jacob, Steve. "L'institutionnalisation de l'évaluation des politiques publiques en Belgique : entre balbutiements et incantations." Res Publica 46, no. 4 (December 31, 2004): 512–34. http://dx.doi.org/10.21825/rp.v46i4.18415.
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Since a few decades, policy evaluation is a main topic in Western democracies. lt identifies, measures and appreciates effects, outcomes and impacts of a policy. Yet, there is not a common way to institutionalise that policy instrument; one can observe many differences in terms of its intensity and maturity, as well as a diversity of institutional device. Compared to other countries, Belgium is characterized by a low visibility and weak decisional impact of evaluation. Public demand for enlightening state action rarely takes the form of a demand for evaluation. The word 'Evaluation' is frequently pronounced, but most often in a political sense.In this article three types of arguments can be put forward to explain this Jack of evaluation: a lacking commitment of Parliament and political staff, the fragmentation and weak autonomy of the civil service and the domination of political parties upon the Belgian political and administrative system.
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Schweda, Mark, and Eike Buhr. "The Value of Privacy in Smart Dementia Care: Empirical and Ethical." Studia Universitatis Babeş-Bolyai Bioethica 66, Special Issue (September 9, 2021): 180. http://dx.doi.org/10.24193/subbbioethica.2021.spiss.123.
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"To protect people with dementia (PwD) from harm, smart technologies are developed to monitor their everyday life and activities and to intervene if necessary. For example, such technologies comprise wearables or video sensors that rely on human-machine interaction. In the ethical and political debate, such monitoring devices are usually discussed under the aspect of privacy. Generally, privacy is understood as a right that entails an active and deliberate control over one’s own decisional, informational and topological concerns. In short, the right to privacy is closely connected to personal autonomy. However, this conception raises problems when applied to PwD. Due to cognitive decline, they lose the ability to actively control their own concerns so that it might seem as though they also forfeit their right to privacy. Yet, this contradicts common moral intuitions as well as empirical studies which suggest that PwD value privacy as an important part of their quality of life (Dichter 2016). Against this backdrop, our contribution explores the “value of privacy” (Rössler 2001) in the context of smart dementia care. First, we determine the limits of common understandings of privacy when applied to PwD. Starting from empirical studies on the subjective experience of PwD, we then discuss how the moral significance of privacy can be spelled out without tying it explicitly and exclusively to autonomy. On this basis, we discuss preconditions of privacy for PwD in smart dementia care settings, formulating recommendations for future technology development and smart dementia care. "
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Bennett, Katelyn G., Annie K. Patterson, Kylie Schafer, Madeleine Haase, Kavitha Ranganathan, Noelle Carlozzi, Christian J. Vercler, Steven J. Kasten, Steven R. Buchman, and Jennifer F. Waljee. "Decision-Making in Cleft-Related Surgery: A Qualitative Analysis of Patients and Caregivers." Cleft Palate-Craniofacial Journal 57, no. 2 (August 5, 2019): 161–68. http://dx.doi.org/10.1177/1055665619866552.
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Objective: Preference-sensitive surgical decisions merit shared decision-making, as decision engagement can reduce decisional conflict and regret. Elective cleft-related procedures are often preference sensitive, and therefore, we sought to better understand decision-making in this population. Design: Semistructured interviews were conducted to elicit qualitative data. A hierarchical codebook was developed through an iterative process in preparation for thematic analysis. Thematic analysis was performed to examine differences between patients and caregivers. Setting: Multidisciplinary cleft clinic at a tertiary care center. Participants: Patients with cleft lip aged 8 and older (n = 31) and their caregivers (n = 31) were purposively sampled. Inability to converse in English, intellectual disability, or syndromic diagnoses resulted in exclusion. Main Outcome Measures: Preferences surrounding surgical decision-making identified during thematic analysis. Results: Mean patient age was 12.7 (standard deviation: 3.1). Most had unilateral cleft lip and palate (43.8%). Three themes emerged: Insufficient Understanding of Facial Difference and Treatment, Diversity of Surgical Indications, and Barriers to Patient Autonomy. Almost half of caregivers believed their children understood their clefts, but most of these children failed to provide information about their cleft. Although many patients and caregivers acknowledged that surgery addressed function and/or appearance, patients and caregivers exhibited differences regarding the necessity of surgery. Furthermore, a large proportion of patients believed their opinions mattered in decisions, but less than half of caregivers agreed. Conclusions: Patients with clefts desire to participate in surgical decisions but have limited understanding of their facial difference and surgical indications. Cleft surgeons must educate patients and facilitate shared decision-making.
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Chiong, Winston, Amy Y. Tsou, Zachary Simmons, Richard J. Bonnie, and James A. Russell. "Ethical Considerations in Dementia Diagnosis and Care." Neurology 97, no. 2 (July 12, 2021): 80–89. http://dx.doi.org/10.1212/wnl.0000000000012079.
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Alzheimer disease and other dementias present unique practical challenges for patients, their families, clinicians, and health systems. These challenges reflect not only the growing public health effect of dementia in an aging global population, but also more specific ethical complexities including early loss of patients' capacity to make decisions regarding their own care, the stigma often associated with a dementia diagnosis, the difficulty of balancing concern for patients' welfare with respect for patients' remaining independence, and the effect on the physical, emotional, and financial well-being of family caregivers. Caring for patients with dementia requires respecting patient autonomy while acknowledging progressively diminishing decisional capacity and continuing to provide care in accordance with other core ethical principles (beneficence, justice, and nonmaleficence). Whereas these ethical principles remain unchanged, neurologists must reconsider how to apply them given changes across multiple domains including our understanding of disease, clinical and legal tools for addressing manifestations of illness, our expanding awareness of the crucial role of family caregivers in providing care and maintaining patient quality of life, and societal conceptions of dementia and individuals' personal expectations for aging. This revision to the American Academy of Neurology's 1996 position statement summarizes ethical considerations that often arise in caring for patients with dementia; although it addresses how such considerations influence patient management, it is not a clinical practice guideline.
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Khaitan, Tarunabh, and Jane Calderwood Norton. "The right to freedom of religion and the right against religious discrimination: Theoretical distinctions." International Journal of Constitutional Law 17, no. 4 (October 2019): 1125–45. http://dx.doi.org/10.1093/icon/moz087.
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Abstract This article argues that while they are often conflated, the right to freedom of religion and the right against religious discrimination are in fact distinct human rights. Religious freedom is best understood as protecting our interest in religious adherence (and non-adherence), understood from the committed perspective of the (non)adherent. This internal, committed perspective generates a capacious and realistic conception of religious adherence, which reflects the staggering plurality of forms of religiosity (or lack thereof) as extant in contemporary societies. The right against religious discrimination is best understood as protecting our non-committal interest in the unsaddled membership of our religious group. Thus understood, the two rights have distinct normative rationales. Religious freedom is justified by the need to respect our decisional autonomy in matters of religious adherence. The prohibition on religious discrimination is justified by the need to reduce any significant (political, sociocultural, or material) advantage gaps between different religious groups. These differences reveal a complex map of two overlapping, but conceptually distinct, human rights which are not necessarily breached simultaneously.
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Parthasarathy, Malavika. "Integrating Mental Health Perspectives into the Legal Discourse on Reproductive Justice in India." Journal of National Law University Delhi 6, no. 1 (June 2019): 21–38. http://dx.doi.org/10.1177/2277401719870643.
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The reproductive justice framework envisions a world where all women, including those situated at the intersection of multiple structures of oppression such as class, caste, sexual orientation, disability and mental health, are able to exercise their right to decisional and reproductive autonomy. S. 3(4)(a) of the Medical Termination of Pregnancy Act, 1971, provides that an abortion cannot be performed on a mentally ill woman without the consent of her guardian. I analyse the Indian Supreme Court’s decision in Suchita Srivastava v. Chandigarh Administration [(2009) 9 SCC 1] in light of contemporary legal developments in the field of disability law and mental health law. The first argument that I make in this paper is that the Rights of Persons with Disabilities Act, 2016, covers persons with mental illness, with the rights in the Act applicable to those with mental illness as well. The second argument rests on the Mental Healthcare Act, 2017, which recognizes the right to privacy and dignity of mentally ill persons, including their capacity to make decisions affecting healthcare. I argue that the judgment, while path-breaking in its recognition of the reproductive rights of disabled women, is inimical to the rights of mentally ill women, perpetuating dangerous stereotypes about their ability to exercise choices, and dehumanizing them. It is imperative for the reproductive justice framework to inform legal discourse and judicial decision-making, to fully acknowledge the right to self-determination and bodily integrity of mentally ill persons.
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Rahman, Humyun Fuad, Mukund Nilakantan Janardhanan, and Peter Nielsen. "An integrated approach for line balancing and AGV scheduling towards smart assembly systems." Assembly Automation 40, no. 2 (January 22, 2020): 219–34. http://dx.doi.org/10.1108/aa-03-2019-0057.
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Purpose Optimizing material handling within the factory is one of the key problems of modern assembly line systems. The purpose of this paper is to focus on simultaneously balancing a robotic assembly line and the scheduling of material handling required for the operation of such a system, a topic that has received limited attention in academia. Manufacturing industries focus on full autonomy because of the rapid advancements in different elements of Industry 4.0 such as the internet of things, big data and cloud computing. In smart assembly systems, this autonomy aims at the integration of automated material handling equipment such as automated guided vehicles (AGVs) to robotic assembly line systems to ensure a reliable and flexible production system. Design/methodology/approach This paper tackles the problem of designing a balanced robotic assembly line and the scheduling of AGVs to feed materials to these lines such that the cycle time and total tardiness of the assembly system are minimized. Because of the combination of two well-known complex problems such as line balancing and material handling and a heuristic- and metaheuristic-based integrated decision approach is proposed. Findings A detailed computational study demonstrates how an integrated decision approach can serve as an efficient managerial tool in designing/redesigning assembly line systems and support automated transportation infrastructure. Originality/value This study is beneficial for production managers in understanding the main decisional steps involved in the designing/redesigning of smart assembly systems and providing guidelines in decision-making. Moreover, this study explores the material distribution scheduling problems in assembly systems, which is not yet comprehensively explored in the literature.
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Köpke, S., J. Kasper, P. Flachenecker, H. Meißner, A. Brandt, B. Hauptmann, G. Bender, et al. "Patient education programme on immunotherapy in multiple sclerosis (PEPIMS): a controlled rater-blinded study." Clinical Rehabilitation 31, no. 2 (July 10, 2016): 250–61. http://dx.doi.org/10.1177/0269215516639734.
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Objective: To investigate the effectiveness of a multi-component evidence-based education programme on disease modifying therapies in multiple sclerosis. Design: Controlled trial with two consecutive patient cohorts and a gap of two months between cohorts. Setting: Three neurological rehabilitation centres. Subjects: Patients with multiple sclerosis within rehabilitation. Interventions: Control group (CG) participants were recruited and received standard information. Two months later, intervention group (IG) participants were recruited and received a six-hour nurse-led interactive group education programme consisting of two parts and a comprehensive information brochure. Main measures: Primary endpoint was “informed choice”, comprising of adequate risk knowledge in combination with congruency between attitude towards immunotherapy and actual immunotherapy uptake. Further outcomes comprised risk knowledge, decision autonomy, anxiety and depression, self-efficacy, and fatigue. Results: A total of 156 patients were included (IG=75, CG=81). The intervention led to significantly more participants with informed choice (IG: 47% vs. CG: 23%, P=0.004). The rate of persons with adequate risk knowledge was significantly higher in the IG two weeks after the intervention (IG: 54% vs. CG: 31%, P=0.007), but not after six months (IG: 48% vs. CG: 31%, P=0.058). No significant differences were shown for positive attitude towards disease modifying therapy (IG: 62% vs. CG: 71%, P=0.29) and for disease modifying therapy status after six months (IG: 61.5% vs CG: 68.6%, P=0.39). Also no differences were found for autonomy preferences and decisional conflict after six months. Conclusion: Delivering evidence-based information on multiple sclerosis disease modifying therapies within a rehabilitation setting led to a marked increase of informed choices.
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Suryana, Nanang, Ari Ganjar Ardiansyah, and Firman Manan. "Pelembagaan Partai Politik: Studi Pada Partai Solidaritas Indonesia (PSI) Kota Bandung Tahun 2019." Jurnal Civic Hukum 5, no. 1 (May 30, 2020): 52. http://dx.doi.org/10.22219/jch.v5i1.10677.
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Penelitian ini bertujuan menganalisis proses pelembagaan Partai Solidaritas Indonesia (PSI) Kota Bandung. Penelitian ini didesain dengan menggunakan metode kualitatif. Bertolak dari kerangka teoritik pelembagaan partai politik, penelitian ini menghasilkan beberapa temuan yang berfokus pada empat derajat pelembagaan. Hasil penelitian memperlihatkan derajat kesisteman (systemness) dalam proses pelembagaan di tubuh PSI Kota Bandung masih jauh dari kata ideal. Faktor-faktor seperti penggunaan aturan, prosedur, dan mekanisme yang disepakati dan ditetapkan dalam konstitusi partai belum mampu diterjemahkan PSI Kota Bandung dalam menajemen keorganisasian. Di level derajat identitas nilai (value infusion), PSI Kota Bandung konsisten mengusung nilai yang menjadi landasan partai. Namun, secara prakis beberapa narasi yang diusung partai tidak terlalu mendatangkan insentif secara elektoral. Di level decisional autonomy, kondisi PSI Kota Bandung yang hanya mengandalkan sumber pembiayaan partai dari sumber internal, kendati kondisi ini memberikan keleluasaan dan derajat otonomi suatu partai dalam pembuatan keputusan, namun keterbatasan kemampuan keuangan berdampak pada efektifitas jalannya organisasi. Di level value infusion, narasi dan isu yang dibawa parrtai menjadikan mereka dekat dengan segmen pemilih dari kelompok minoritas, baik dari kelompok keagamaan maupun etnis. Di level keempat (reification), diferensiasi identitas yang dibawa partai nampak belum membumi di tengah publik Kota Bandung.