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Walker, Nancy L. Hamilton. "The relationship between patient perceptions of informed consent and recall of information received during the informed consent process." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/865959.
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Informed consent is a requirement by law. Informed consent is a two part process: giving the patient sufficient information so that an educated choice can be made and obtaining assent in writing (Coy, 1989; Fiesta 1991; Sweeney, 1991;). The purpose of this study is to determine the ability to recall information and the perception of patients about the process of receiving information after signing a consent to participate in a large research trial. Patients signing consents for participation in the Breast Cancer Prevention Trial were asked to complete the surveys. Thirty three patients were asked to complete the questionnaires. Twenty - four (72%) of the respondents returned the completed questionnaires. Confidentiality will be maintained since no names or identifying markers will be used.A modified Patient Recall Survey (Casselith, Zupkis, Sutton - Smith, & March, 1980) and a modified Consent Form Survey (Casselith et al, 1980) were used. The significance of the study is that the results will assist in improving the type of information given to patients and how that information is provided. By increasing patients awareness about the need for and rights of giving informed consent patients will be more knowledgeable health care consumers. Imogene King(1981) provides the theoretical framework for this study using the concept of perceptions as the basis.The first research question illustrated that the majority of the respondents were able to recall at least three risks or complications of participation in the Breast Cancer Prevention Trial. The second research question revealed eighty - seven percent of the patients agreed that informed consents are necessary. However, 27.8 % of the respondents perceived the informed consent as a legal document to protect the physician rights, while only 19.6 % felt that the consent represented a legal document to protect patient rights. Eighty three percent of the respondents understood that a consent did not have to be signed. However, responses to a second question revealed only 21.3 % understood that the informed consent was a chance to refuse or change treatment. Results to research question 3 illustrated that patients felt that informed consents are necessary. Finally, 79.2 % of patients reported that nurses provided the majority of informed consent information. When patients are able to understand and participate in health care decisions, patients will feel more control in determining outcomes.School of Nursing
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Barit, Avi. "The doctrine of informed consent in South African medical law." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/60104.
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Morin, Sophie. "La place des droits du patient à l'intérieur de la conception actuelle de l'obligation de renseigner en matière médicale /." Thesis, McGill University, 1999. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=30319.
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This thesis deals with the concept of the medical duty to inform focusing on the rights of the patient. It emerges that the notions governing medical responsibility do not adequately address the question of the protection and application of the rights of the patient. Existing conceptions of the notions of dereliction, causality and damage are analysed in order to point out the many inadequacies with the rights of the patient, source of the obligation to inform. Particular emphasis is given to the situation in Quebec and to the eventual place that could be occupied by conception of the duty to inform that is more sensitive to the situation and rights of the patient.
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Cai, Yinghong. "The legal rights in informed consent form for treatment in China." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38478730.
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Lashley, Myrna. "Informed proxy consent : communication between surgeons and surrogates about surgery." Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=29068.
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Professionals whose job it is to counsel patients must be cognizant of the role played by communication in the establishment of a trusting working relationship. This is no less true for those within the medical community who must obtain informed consent for surgical interventions than it is for those working within the area of mental health. In order to determine what role communication plays in the obtaining of informed consent within a pediatrics setting, a qualitative study was conducted of 20 surrogates (those individuals giving consent on behalf of legally incompetent children) and of 5 surgeons performing surgical interventions on those children. Two sets of questionnaires were administered in order to elicit information pertaining to how surgeons communicate information to surrogates and to investigate how that information is received and processed by the surrogate. Results showed that while the obtaining of signed informed consent itself may not be a major problem, there are some difficulties in the communication between surgeons and surrogates in this domain. Based on the findings, recommendations for improved communication between surgeons and surrogates are proposed.
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Gibb, Winna. "Informed consent : a liberal perspective." Thesis, Queensland University of Technology, 1998.
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Pease-Carter, Cheyenne Minton Casey Barrio. "Preferences among student counselors regarding informed consent practices within counselor education." [Denton, Tex.] : University of North Texas, 2008. http://digital.library.unt.edu/permalink/meta-dc-6066.
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Cai, Yinghong, and 蔡映紅. "The legal rights in informed consent form for treatment in China." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39724347.
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Pease-Carter, Cheyenne. "Preferences among student counselors regarding informed consent practices within counselor education." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc6066/.
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The purpose of this study was to investigate student preferences for content, timing, and method of informed consent within counselor education programs. Participants included 115 students enrolled in counseling internship courses at six counseling programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP). Participants completed the Informed Consent Preferences Questionnaire (ICPQ), an instrument designed specifically for this study through systematic instrumentation development. Descriptive statistics highlighted participants' moderate to high ratings of perceived importance for an array of suggested content pieces for student informed consent. Participants varied among themselves and between items in relation to preferred timing of informed consent, and they consistently reported a desire for student informed consent to be facilitated through a combination of both oral and written methods. Results of exploratory factor analysis revealed a simple eight-factor structure within the ICPQ and suggested strong internal reliability. Correlations for participant scale scores for the eight factors revealed a variety of small to medium correlations. Results from t-test and one-way analysis of variances (ANOVA) indicated that participant preferences did not vary according to demographic variables. Finally, participants' qualitative responses revealed high levels of support for student informed consent. Findings of this study may aid counselor educators in evaluating current program informed consent practices. As a result of evaluation, counselor educators can affirm existing, and/or design new informed consent practices that accurately reflect the needs and desires of counseling students. Future researchers may also utilize the results to guide additional studies related to the practice of student informed consent.
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Kious, Brent Michael. "The evidentiary account of consent's moral significance." Diss., Restricted to subscribing institutions, 2009. http://proquest.umi.com/pqdweb?did=1930280011&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.
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Kerner, David Neal. "Impact of a decision aid videotape on young women's attitudes and knowledge about hormone replacement therapy /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 1998. http://wwwlib.umi.com/cr/ucsd/fullcit?p9901432.
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Tomita, Kiyomi. "Informed consent and the right to refuse medical treatment : a comparative study of common-law Canada and Japan." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=61156.
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Common law in Canada recognizes the rights to self-determination and autonomy and the right of competent persons to decide for themselves on medical treatment which includes the right to refuse all treatment. The legal profession has caused Japanese law to begin to recognize these basic rights, however professional and societal factors combine to accord the Japanese physician a wide discretion to determine what information to disclose, especially in the case of cancer. This thesis examines the similarities and differences existing between Canada and Japan in the controversial area of informed consent and the patient's right to refuse treatment and as well as the current attitudes within the legal and medical professions in Japan toward recognition and enforcement of these rights.
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Bourne, Katie. "Determining capacity to consent in people with learning disabilities." Thesis, n.p, 2000. http://ethos.bl.uk/.
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Anthony, John. "The justfiable limitations of patient autonomy in contemporary South African medical practice." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/2859.
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Thesis (MPhil (Philosophy))--University of Stellenbosch, 2009.ABSTRACT: The European Enlightenment secured man’s freedom from doctrinal thought. Scientific progress and technological innovation flourished in the 18th Century, radically changing the lives of all. Man’s mastery and transformation of his environment was matched by revolutionary political reform, resulting in the dissolution of empire and the transfer of power into the hands of the people. Social transformation saw the city-states of pre-modern man supplanted by a globalized community whose existence grew from time and space distantiation facilitated by the new technologies and the development of symbolic forms. These sweeping social, political and ideological changes of the 18th Century fostered the belief that man’s transformative authority was indeed his to command. Man believed he had a right to self-governance and to autonomous decision-making. Kant described moral autonomy as the freedom men have to show rational accountability for their actions and he saw in men a dignity beyond all price because of this moral autonomy. Personal autonomy is seen as the expression of the free will of individuals and is justifiably constrained by the need to respect the interests and agency of others. The principle of autonomy, in the context of medical practice, was not clearly articulated until the early 20th century. Prior to this, the ethical practice of medicine relied upon the beneficent intentions of the practitioners. The limits to patient autonomy have been delineated largely by issues of social justice based upon the need to share scarce resources fairly among members of society. However, autonomy remains a dominant principle and is most clearly exemplified by the process of informed consent obtained prior to any medical intervention. This thesis provides a conceptual analysis of autonomy in the context of informed consent. Following this, several different clinical scenarios are examined for evidence of justifiable limitations to patient autonomy. Each scenario is examined in the light of different moral theories including deontology, utilitarianism, communitarianism and principlist ethical reasoning. Kantian ethical reasoning is found to be resilient in rejecting any limitation to the autonomy principle whereas each of the other theories allow greater scope for morally-justified curtailment of individual autonomy. The thesis concludes with reflection on post-modern society in which the radicalization of what began with the European Enlightenment sees the transformation of pre-modern society into a global community in which epistemological certainty is no longer available. In this environment, the emerging emphasis on global responsibility requires ethical accountability, not only when individuals secure transactions between one another but also between individuals and unknown communities of men and women of current and future generations. The thesis concludes that patient autonomy is justifiably limited in South African medical practice because of issues related to social justice but that the impact of the new genetic technologies and post-modernity itself may in future set new limits to individual patient autonomy.
OPSOMMING: Die Europese Verligting het die mensdom bevry van verstarde, dogmatiese denke. Wetenskaplike en tegnologiese ontwikkelinge het tydens the 18de Eeu die lewens van almal radikaal verander. Die mens se bemeestering en transformasie van sy omgewing het gepaard gegaan met revolusionêre politieke hervormings wat gelei het tot die ontbinding van tradisionele politieke ryke en die oordrag van mag aan die mens. Sosiale transformasie het veroorsaak dat die politieke ordeninge van voor-moderne mense deur ‘n globale gemeenskap vervang is wat ontstaan het as gevolg van onder meer die ontkoppeling van tyd en plek (Giddens), en wat deur nuwe tegnologiese ontwikkelings en die ontstaan van simboliese vorms moontlik gemaak is. Hierdie uitgebreide ontwikkelinge het die idee laat ontstaan dat niks vir die 18de Eeuse mens onmoontlik is nie. Die mens het geglo dat hy ‘n reg het op self-bestuur en outonome besluite. Kant het die morele outonomie van die mens beskou as sy vryheid om verantwoordlikheid te neem vir sy eie rasioneel-begronde handelinge en verder het hy ‘n besondere waardigheid in die mens geïdentifiseer vanweë sy morele outonomie. Omdat ‘n mens hierdie eienskap besit, beskik hy oor ‘n hoër waardigheid as alle alle ander lewensvorme. Persoonlike outonomie is die uitoefenimg van die vrye wil van die individu en word om geregverdigde redes beperk deur die regte van ander mense. Die beginsel van outonomie met verwysing na mediese etiek het nie voor die begin van die 20ste eeu prominent geword nie. Voor hierdie tyd het mediese etiek staatgemaak op die goeie voorneme van die praktisyn. Die grense van individuele outonomie word nou bepaal deur die noodsaak van sosiale geregtigheid. Al is dit die geval, bly die beginsel van outonomie die belangrikste beginsel in die etiese debat en word meestal gesien as ‘n deel van die proses van ingeligte toestemming. Hierdie tesis verskaf ‘n omvattende ontleding van outonomie met betrekking tot ingeligte toestemming. Daarna word verskillende kliniese gevalle beskryf en ontleed, en verskeie etiese teorieë gebruik om die wyse waarop pasiënt outonomie reverdigbaar ingekort behoort te word, te bespreek. Die teorie van Kant is in staat om enige inkorting van outonomie in alle gevalle the weerstaan. Elkeen van die ander teorieë verskaf redes waarom die outonomie van individuele pasiënte legitiem ingekort mag word. Hierdie werk sluit af met besinning oor die post-moderne gemeenskap wat ‘n globale samelewing moet aanvaar sowel as die ontoereikenheid van enige kenteoretiese sekerheid. Die ontwikkelende verantwoordelikheid vir die totale mensdom in hierdie wêreld veroorsaak dat individue nie meer slegs moet besluit oor die morele verhouding met sy medemens nie, maar ook oor sy verhouding met mense van gemeenskappe wat geskei is in tyd en ruimte, insluitend sy verhouding met die mense van toekomstige generasies. Hierdie werk sluit af met die gevolgtrekking dat pasiënt outonomie regverdigbaar beperk word in die Suid Afrikaanse mediese praktyk deur die noodsaaklikheid van sosiale geregtigheid. Die verwagte impak van nuwe genetiese tegnologieë en die ontwikkeling van ‘n post-moderne gemeenskap mag nuwe beperkings bring vir pasiënt outonomie.
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Kettle, Nancy M. "Informed consent: its origins, purpose, problems, and limits [electronic resource] / by Nancy M. Kettle." University of South Florida, 2002. http://purl.fcla.edu/fcla/etd/SFE0000041.
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Thesis (M.A.)--University of South Florida, 2002.
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ABSTRACT: The doctrine of informed consent, defined as respect for autonomy, is the tool used to govern the relationship between physicians and patients. Its framework relies on rights and duties that mark these relationships. The main purpose of informed consent is to promote human rights and dignity. Some researchers claim that informed consent has successfully replaced patients&softsign; historical predispositions to accept physicians' advice without much explicit resistance.
Although the doctrine of informed consent promotes ideals worth pursuing, a successful implementation of these ideals in practice has yet to occur. What has happened in practice is that attorneys, physicians, and hospital administrators often use consent forms mainly to protect physicians and medical facilities from liability. Consequently, ethicists, legal theorists, and physicians need to do much more to explain how human rights and human dignity relate to the practice of medicine and how the professionals can promote them in practice.
This is especially important because patients' vulnerability has increased just as the complexity and power of medical science and technology have increased. Certain health care practices can shed light on the difficulties of implementing the doctrine of informed consent and explain why it is insufficient to protect patients' rights and dignity. Defining a normal biological event as a disease, and routinely prescribing hormone drug therapy to menopausal women for all health conditions related to menopause, does not meet the standards of free informed consent.
Clinicians provide insufficient disclosure about risks related to long-term use of hormone therapies and about the absence of solid evidence to support their bias toward hormone therapies as a treatment of choice for menopause related health conditions. The contributing problem is women's failure to act as autonomous agents because they either choose not to take an active part in their own therapy or because they fear to question physicians' medical authority. To insure that patients' autonomy and free choice are a part of every physician-patient interaction, physicians and patients need actively to promote them as values that are absolutely indispensable in physicians' offices, clinics, and hospitals.
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Hicks, Michelle B. "Informed Consent in Obstetric Anesthesia: The Effect of the Amount, Timing and Modality of Information on Patient Satisfaction." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9771/.
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Using mainly quantitative methods of evaluation, as well as patient comment assessment, this study evaluated whether changing the current informed consent process for labor epidural analgesia to a longer, more informational process resulted in a more satisfied patient. Satisfaction with the labor epidural informed consent process was evaluated using a questionnaire that was mailed and also available online. Half of the patient population was given a written labor epidural risk/benefit document at their 36-week obstetric check up. All patients received the standard informed consent. Survey responses were evaluated based on three independent variables dealing with the modality, timing, amount of informed consent information and one dependent variable, whether the patient's expectations of the epidural were met, which is equated with satisfaction. Patients in this study clearly indicated that they want detailed risk/benefit information on epidural analgesia earlier in their pregnancy. A meaningfully larger percentage of patients who received the written risk/benefit document were satisfied with the epidural process as compared to those who did not receive the document.
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Hicks, Michelle B. Wheeler Maurice B. "Informed consent in obstetric anesthesia the effect of the amount, timing and modality of information on patient satisfaction /." [Denton, Tex.] : University of North Texas, 2008. http://digital.library.unt.edu/permalink/meta-dc-9771.
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Rossouw, Theresa Marie. "Identity, personhood and power : a critical analysis of the principle of respect for autonomy and the idea of informed consent, and their implementation in an androgynous and multicultural society." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/19906.
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Thesis (PhD)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Autonomy and informed consent are two interrelated concepts given much prominence in contemporary biomedical discourse. The word autonomy, from the Greek autos (self) and nomos (rule), originally referred to the self-governance of independent Hellenic states, but was extended to individuals during the time of the Enlightenment, most notably through the work of Immanuel Kant and John Stuart Mill. In healthcare, the autonomy model is grounded in the idea of the dignity of persons and the claim people have on each other to privacy, self-direction, the establishment of their own values and life plans based on information and reasoning, and the freedom to act on the results of their contemplation. Autonomy thus finds expression in the ethical and legal requirement of informed consent. Feminists and multiculturalists have however argued that since autonomy rests on the Enlightenment ideals of rationality, objectivity and independence, unconstrained by emotional and spiritual qualities, it serves to isolate the individual and thus fails to rectify the dehumanisation and depersonalisation of modern scientific medical practice. It only serves to exacerbate the problematic power-differential between doctor and patient. Medicine is a unique profession since it operates in a space where religion, morality, metaphysics, science and culture come together. It is a privileged space because health care providers assume responsibility for the care of their patients outside the usual moral space defined by equality and autonomy. Patients necessarily relinquish some of their autonomy and power to experts and autonomy thus cannot account for the moral calling that epitomizes and defines medicine. Recognition of the dependence of patients need not be viewed negatively as a lack of autonomy or incompetence, but could rather reinforce the understanding of our shared human vulnerability and that we are all ultimately patients. There is however no need to abandon the concept of autonomy altogether. A world without autonomy is unconceivable. When we recognise how the concept functions in the modern world as a social construct, we can harness its positive properties to create a new form of identity. We can utilise the possibility of self-stylization embedded in autonomy to fashion ourselves into responsible moral agents that are responsive not only to ourselves, but also to others, whether in our own species or in that of another. Responsible agency depends on mature deliberators that are mindful of the necessary diversity of the moral life and the complex nature of the moral subject. I thus argue that the development of modern individualism should not be rejected altogether, since we cannot return to some pre-modern sense of community, or transcend it altogether in some postmodern deconstruction of the self. We also do not need to search for a different word to supplant the concept of autonomy in moral life. What we rather need is a different attitude of being in the world; an attitude that strives for holism, not only of the self, but also of the moral community. We can only be whole if we acknowledge and embrace our interdependence as social and moral beings, as Homo moralis.
AFRIKAANSE OPSOMMING: Outonomie en ingeligte toestemming is twee nou verwante konsepte wat beide prominensie in moderne bioetiese diskoers verwerf het. Die woord outonomie, van die Grieks autos (self) en nomos (reël), het oorspronklik verwys na die selfbestuur van onafhanklike Griekse state, maar is in die tyd van die Verligting uitgebrei om ook na individue te verwys, grotendeels deur die werk van Immanuel Kant en John Stuart Mill. In medisyne is die outonomie model gegrond op die idee van die waardigheid van die persoon en die beroep wat mense op mekaar het tot privaatheid, selfbepaling, die daarstelling van hulle eie waardesisteem en lewensplan, gebasseer op inligting en redenasie, en die vryheid om op die uitkoms van sulke redenasie te reageer. Outonomie word dus vergestalt in die etiese en wetlike bepaling van ingeligte toestemming. Feministe en multikulturele denkers beweer egter dat, siende outonomie gebasseer is op die Verligting ideale van rasionaliteit, objektiwiteit en onafhanklikheid, sonder die nodige begrensing deur emosionele en spirituele kwaliteite, dit die individu noodsaaklik isoleer en dus nie die dehumanisering en depersonalisering van moderne wetenskaplike mediese praktyk teenwerk nie. As sulks, vererger dit dus die problematiese magsverskil tussen die dokter en pasiënt. Die beroep van medisyne is ‘n unieke professie aangesien dit werksaam is in die sfeer waar geloof, moraliteit, metafisika, wetenskap en kultuur bymekaar kom. Dit is ‘n bevoorregde spasie aangesien gesondheidswerkers verantwoordelikheid vir die sorg van hulle pasiënte aanvaar buite die gewone morele spasie wat deur gelykheid en outonomie gedefinieer word. Pasiënte moet noodgedwonge van hulle outonomie en mag aan deskundiges afstaan en outonomie kan dus nie genoegsaam die morele roeping wat medisyne saamvat en definieer, vasvang nie. Bewustheid van die afhanklikheid van pasiënte hoef egter nie in ‘n negatiewe lig, as gebrek aan outonomie of onbevoegtheid, beskou te word nie, maar moet eerder die begrip van ons gedeelde menslike kwesbaarheid en die wete dat ons almal uiteindelik pasiënte is, versterk. Dit is verder nie nodig om die konsep van outonomie heeltemal te verwerp nie. ‘n Wêreld sonder outonomie is ondenkbaar. Wanneer ons bewus word van hoe die konsep in die moderne wêreld as ‘n sosiale konstruk funksioneer, kan ons die positiewe aspekte daarvan inspan om ‘n nuwe identiteit te bewerkstellig. Ons kan die moontlikheid van self-stilering, ingesluit in outonomie, gebruik om onsself in verantwoordelike morele agente te omskep sodat ons nie slegs teenoor onsself verantwoordelik is nie, maar ook teenoor ander, hetsy in ons eie spesie of in ‘n ander. Verantwoordelike agentskap is afhanklik van volwasse denkers wat gedagtig is aan die noodsaaklike diversiteit van die morele lewe en die komplekse aard van die morele subjek. Ek voer dus aan dat die ontwikkeling van moderne individualisme nie volstrek verwerp moet word nie, siende dat ons nie na ‘n tipe premoderne vorm van gemeenskap kan terugkeer, of dit oortref deur ‘n postmoderne dekonstruksie van die self nie. Ons het verder ook nie ‘n nuwe woord nodig om die konsep van outonomie in die morele lewe mee te vervang nie. Ons het eerder ‘n ander instelling van ons menswees in die wêreld nodig; ‘n instelling wat streef na volkomendheid, nie net van onsself nie, maar ook van die morele gemeenskap. Ons kan slegs volkome wees wanneer ons ons interafhanklikheid as sosiale en morele entiteite, as Homo moralis, erken en aangryp.
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Fausset, Cara Bailey. "Comprehension of health risk probabilities: the roles of age, numeracy, format, and mental representation." Diss., Georgia Institute of Technology, 2012. http://hdl.handle.net/1853/44832.
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Probabilities, an essential dimension of risk communication, can be presented in various formats including frequencies (e.g., 1 in 10), percentages (e.g., 10%), or verbal phrases (e.g., unlikely); the literature is mixed concerning which format best supports comprehension. Additionally, it is not well understood how people who vary in their level of numeracy understand those probabilities. The goal of the present three-phase within-participant study was to understand how the factors of format and numeracy influence comprehension and mental representations of probabilities for younger and older adults. Overall, the results of this research clearly indicated that comprehension and mental representation of health risk probabilities are influenced by format, age, and numeracy. To best support comprehension and comparison of health risk probabilities for younger adults and healthy older adults with varying numeracy, percent format should be used.
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Wenz, Vera. "Forschung mit einwilligungsunfähigen Personen aus der Perspektive des deutschen und englischen Rechts /." Göttingen : Cuvillier, 2006. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=015040630&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Radau, Wiltrud Christine. "Die Biomedizinkonvention des Europarates : Humanforschung - Transplantationsmedizin - Genetik - Rechtsanalyse und Rechtsvergleich /." Berlin [u.a.] : Springer, 2006. http://www.gbv.de/dms/spk/sbb/recht/toc/511240961.pdf.
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Hutchison, Catherine B. "A randomised controlled trial of an audiovisual patient information intervention in cancer clinical trials." Thesis, University of Stirling, 2008. http://hdl.handle.net/1893/442.
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Introduction and background Recruitment to cancer clinical trials needs to be improved, as does patient understanding about clinical trials, to enable patients to make an informed choice about whether or not to take part. The main reason that clinically eligible patients do not take part in clinical trials is because they refuse; poor understanding of the research has been associated with patient refusal. Audiovisual patient information (AVPI) has been shown to improve knowledge/understanding in various areas of practice but there is limited information about its effect in the cancer clinical trial setting, particularly in relation to recruitment rates. Understanding the research is necessary for informed consent, and it was hypothesised that if patient understanding about clinical trials was increased with AVPI, then this could result in a reduction in the number of patients refusing clinical trials, and therefore provide an ethical approach to improving recruitment. This study aimed to test the impact of an audiovisual patient information intervention on recruitment to randomised cancer clinical trials (refusal rates), patient understanding of the information given, and levels of anxiety. Reasons for patients’ decisions about trial participation were also assessed. Method An AVPI intervention was developed that aimed to address the common misconceptions associated with randomisation and clinical equipoise, as well as improve patient understanding generally of randomised cancer trials, and of other core clinical trial informational requirements, such as voluntariness. Patients were randomised to receive either AVPI in addition to the standard trial-specific written information, or the written information alone. A new questionnaire was developed to assess patient understanding (also referred to as knowledge) in the randomised trial setting and, following testing with patients and research nurses, this was shown to be reliable and valid. Patients completed self-report questionnaires to assess their understanding (new knowledge questionnaire) and anxiety (Spielberger State-Trait Anxiety Inventory), at baseline and after they had made their decision about clinical trial entry, when their perceptions of the intervention, as well as factors contributing to their decision were also determined (this tool incorporated Jenkins and Fallowfield’s (2005) questionnaire which assessed reasons for accepting and declining randomised cancer trials). Results A total of 173 patients with breast cancer (65%), colorectal cancer (32%) and lung cancer (3%) were entered into the main study. The median age was 60 (range 37-92 years). There was no difference in clinical trial recruitment rates between the two groups: 72.1% in the AVPI group and 75.9% in the standard information group. The estimated odds ratio for refusal (intervention/no intervention) was 1.19 (95% ci 0.55-2.58, p=0.661). Knowledge scores increased more in the intervention group compared to the standard group (U= 2029, p=0.0072). The change in anxiety score between the arms was also statistically significant (p=0.011) with anxiety improving in the intervention arm more than in the no-intervention arm. The estimated difference in the median anxiety change score between the groups is –4.6 (95% ci –7.0 to –2.0). Clinical trial entry was not influenced by tumour type, stage of cancer, age, educational qualifications or previous research experience, however, there was a modest association with deprivation status (p=0.046) where more affluent patients were the least likely to consent to a trial. Educational qualifications and stage of cancer were independently associated with knowledge: patients who were better educated had higher levels of knowledge about randomised trials, and patients who had limited stage of cancer had higher baseline knowledge than patients with advanced cancer. Acceptability of the intervention was high with 93% of those who watched it finding it useful, and 42% stating that it made them want to take part in the clinical trial. Personal benefit and altruism were key motivating factors for clinical trial participation, with reasons for refusal being less clear. Discussion and conclusions Although the potential for AVPI to increase clinical trial recruitment rates was highlighted in the literature, in this study, AVPI was not shown to have any effect on refusal rates to randomised cancer trials. However, by improving patient understanding prior to decision making, AVPI was shown to be a useful addition to the consent process for randomised cancer trials. AVPI addresses the fundamental ethical challenges of informed consent by improving patient understanding, and supports the ethical framework integral to Faden and Beauchamp’s (1986) theory of informed consent. The new knowledge questionnaire was shown to be a sensitive and effective instrument for measuring understanding of randomised clinical trials in the cancer setting, although it would benefit from further testing. The AVPI appears to reduce anxiety at the decision making time point and has been shown to be an acceptable medium for patients. This study confirms existing findings from studies assessing factors affecting decision making, with personal benefit and altruism being key motivating factors, and reasons for refusal being less clear. The need for further qualitative work in this area is highlighted to gain a deeper understanding of what is important to patients, in terms of why they refuse clinical trial participation. Implications for practice and further research Several implications for practice have been identified, including using AVPI as part of the standard information package for patients considering randomised cancer trials, and focussing on patient and staff education in this area. The knowledge questionnaire could be introduced to routine practice as a tool to determine patient understanding prior to decision making, allowing clinicians the opportunity to correct any misconceptions prior to consent. Further research focussing on AVPI specific to individual trials would be helpful, to determine if a more customised approach would be of benefit in terms of clinical trial recruitment. The importance of studying other aspects of the consent process such as the interaction between the clinician and the patient, in addition to more detailed exploration of the factors affecting patients’ decisions were highlighted.
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Carmack, Heather J. "How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program." Ohio : Ohio University, 2008. http://www.ohiolink.edu/etd/view.cgi?ohiou1209039528.
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Kelly, Katherine Patterson Ganong Lawrence H. "Stepping up, stepping back, being pushed, and stepping away the process of making treatment decisions for children with cancer by parents who no longer live together /." Diss., Columbia, Mo. : University of Missouri-Columbia, 2008. http://hdl.handle.net/10355/6867.
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The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on April 1, 2010). Vita. Thesis advisor: Lawrence H. Ganong. "May 2008" Includes bibliographical references
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Lecoq, Nathalie. "Évaluation critique du régime juridique québécois en matière de consentement aux soins pour le majeur inapte." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=82662.
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Le regime juridique instaure par le legislateur quebecois en matiere de consentement aux soins pour le majeur inapte merite d'etre revise. La determination de cette inaptitude produit des effets importants. Le constat d'inaptitude prive la personne majeure de son droit de prendre une decision a l'egard de sa sante, une des spheres les plus personnelles et privees de sa vie. Cette these utilise une approche transdisciplinaire, puisant a la fois dans le droit et la bioethique, pour evaluer de facon critique: l'encadrement de la determination de cette inaptitude, la determination juridique de cette inaptitude et les dispositions pertinentes du Code civil du Quebec qui s'appliquent en matiere de consentement aux soins lorsque cette inaptitude est constatee par le medecin. L'auteur conclut que l'objectif vise par le legislateur quebecois, le respect de la personne, n'est que partiellement atteint.
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Gauthier, Isabelle. "Analyse de la norme sociale comme contrainte au consentement : l'exemple de la recherche biomédicale en situation d'urgence." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31052.
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This thesis seeks to demonstrate, by way of a multidisciplinary study, that consent is, despite its legal definition which refers to the free and enlighted expression of individual will, in fact, at times limited if not eliminated, by social considerations, arising from the medical, economic and legal context. These considerations reflect what one might call the social norm. An appropriate understanding of consent serves, therefore, to express the social norm as a constraint, which, in turn, acts as a measure of what it means to belong in society. Thus, while consent is often presented as the fundamental principle to be respected in biomedical research, it is in reality, merely one principle to respect among others. These limitations connected to consent are exacerbated in emergency situations where consent is sometimes reduced to mere signature, and in some cases it has been recognized that research can be undertaken without the subject's prior consent.
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Kruszewski, Zita. "The use of patient-derived tissue in biomedical research." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/MQ43899.pdf.
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Fiorillo-Buonomano, Daniela. "Das Zustimmungserfordernis bei der Patentierung von biotechnologischen Erfindungen unter Verwendung menschlichen Materials." Bern Stämpfli, 2007. http://deposit.d-nb.de/cgi-bin/dokserv?id=3013860&prov=M&dok_var=1&dok_ext=htm.
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Le, Roux-Kemp Andra. "A legal perspective on the power imbalances in the doctor-patient relationship." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/1330.
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Thesis (LLD (Public Law))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: The unique and intimate relationship that exists between a medical practitioner and his/her client is possibly one of the most important relationships that can come into being between any two people. This relationship is characterised and influenced by the qualities and attributes specific to the nature and historical development of medical care, as well as medical science in general. The doctor-patient relationship is also influenced by the social dynamics of a particular community, environmental factors, technological advances and the general social and commercial evolution of the human race. With regard to medical care and health service delivery, the doctor-patient relationship is furthermore vital to the quality of the care provided, as well as to the outcomes and relative success of the specific medical intervention or treatment. One of the distinct characteristics of the doctor-patient relationship is the power imbalance inherent in this relationship. The medical practitioner has expert knowledge and skill, while the patient finds himself or herself in an unusually dependent and vulnerable position. It is because of this important role that the doctor-patient relationship still plays in health service delivery today; the susceptibility of the relationship to a variety of influences, and the characteristic power imbalances inherent in this relationship, that a study of the doctor-patient relationship in South African medical- and health law is necessary. The characteristic power imbalances will be considered from a legal perspective in this dissertation. This study provides a comprehensive source of the doctor-patient relationship from a legal perspective. Where relevant, references are made to theories and principles from other disciplines, including sociology, economy and medical ethnomethodology. The prevalence and consequences of power imbalances in the doctor-patient relationship are identified and discussed with the aim of bringing these to the attention of both the legal fraternity, and medical practitioners. Specific problem areas are identified and solutions are offered, including the following: • The adverse consequences of power imbalances inherent in the doctor-patient relationship on the medical decision-making process are considered from various perspectives. With regard to these adverse consequences, the doctrine of informed consent is analysed and evaluated in great detail. • The influence of paternalistic notions in health service delivery; the business model of health service delivery and the effects of managed care and consumer-directed health care on the doctor-patient relationship and health service delivery in general are also analysed from a legal perspective, and specifically with regard to the power imbalances inherent in this relationship. • The role of autonomy, self-determination and dignity, as well as the principles of beneficence in medical practice, are reconsidered in an attempt to provide a solution for redressing the power imbalances inherent in the doctor-patient relationship. • The fiduciary nature of the doctor-patient relationship and the special role of trust in the relationship are emphasised throughout the dissertation as the focal point of departure in the doctor-patient relationship and the main constituent in any legal endeavor to redress the power imbalances inherent in it.
AFRIKAANS OPSOMMING: Die unieke en intieme verhouding wat bestaan tussen ‘n mediese praktisyn en ‘n pasiënt is wêreldwyd waarskynlik een van die belangrikste verhoudings wat tussen twee persone tot stand kan kom. Hierdie verhouding word gekenmerk en beïnvloed deur kwaliteite en eienskappe eie aan die besonderse aard en historiese ontwikkeling van gesondheidsorg, sowel as die mediese wetenskap in die algemeen. Die dokter-pasiënt verhouding word verder beïnvloed deur die sosiale dinamika van ‘n bepaalde gemeenskap, omgewingsfaktore, tegnologiese vooruitgang en die algemene sosiale en kommersiële ontwikkeling van die mensdom. Op die terrein van gesondheidsorg en mediese dienslewering is die dokter-pasiënt verhouding voorts ook sentraal tot die kwaliteit van die mediese sorg wat verskaf word, sowel as die uitkomste en relatiewe sukses van die spesifieke mediese behandeling. Een van die kenmerkende eienskappe van die dokter-pasiënt verhouding is die magswanbalans wat daar tussen dokter en pasiënt bestaan. Die mediese praktisyn beskik oor deskundige kennis en vaardighede, terwyl die pasiënt hom- of haarself in ‘n ongewone, afhanklike en kwesbare posisie bevind. Dit is dan veral weens die besondere rol wat hierdie verhouding steeds in hedendaagse gesondheidsorg speel, die beïnvloedbaarheid van hierdie verhouding deur ‘n verskeidenheid faktore, sowel as die kenmerkende magswanbalans inherent in die verhouding, dat ‘n ondersoek na die dokter-pasiënt verhouding in die Suid-Afrikaanse mediese reg noodsaaklik is. Hierdie kenmerkende magswanbalans sal vanuit ‘n regsperspektief verder in hierdie proefskrif ondersoek word. Hierdie studie bied ‘n omvattende bron van die dokter-pasiënt verhouding benader vanuit ‘n regsperspektief, terwyl verwysings na teorieë en beginsels van ander dissiplines soos die sosiologie, ekonomie en mediese etnometodologie ook waar nodig ingesluit word. Die voorkoms en gevolge van ‘n magswanbalans in die dokter-pasiënt verhouding word verder geïdentifiseer en bespreek ten einde dit onder die aandag te bring van beide regslui en medici. Spesifieke probleemareas wat geïdentifiseer is en die oplossings wat daarvoor aan die hand gedoen is sluit die volgende in: • Die nadelige gevolge van die bestaan van ‘n magswanbalans in die dokter-pasiënt verhouding op die mediese-besluitnemingsproses word bespreek vanuit verskillende persepktiewe. Met betrekking tot hierdie nadelige gevolge, word die leerstuk van ingeligte toestemming in besonder geanaliseer en geëvalueer. • Die invloed van ‘n paternalistiese benadering tot gesondheidsorg, die besigheids-model van gesondheidsorg, en die effek van bestuurde- en verbruikersgedrewe gesondheidsorg inisiatiewe op die dokter-pasiënt verhouding en die verskaffing van gesondheidsdienste in die algemeen word ook vanuit ‘n regsperspektief ge-analiseer. Spesifieke aandag word in dié verband gegee aan die invloede van hierdie benaderings en perspektiewe op die magswanbalans inherent aan die dokter-pasiënt verhouding. • Die besondere rol van autonomie, selfbeskikking en menswaardigheid, asook die beginsels van weldadigheid in gesondheidsorg, word heroorweeg in ‘n poging om ‘n meer gelyke distribusie van mag in die dokter-pasiënt verhouding te verseker. • Die fidusiêre aard van die dokter-pasiënt verhouding en die besondere rol wat vertroue in hierdie verhouding speel, word in hierdie proefskrif beklemtoon en word voorts as die basis van die dokter-pasiënt verhouding beskou. Vertroue, as ‘n kenmerk van die dokter-pasiënt verhouding, behoort ook die fokuspunt te wees van enige poging om die magswanbalans in die dokter-pasiënt verhouding aan te spreek.
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溫靜. "試論醫方的告知說明義務 = Talk about the obligations to inform the patients." Thesis, University of Macau, 2009. http://umaclib3.umac.mo/record=b2120094.
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Le, Roux Rhonddie. ""Acts of disclosing" : an enthnographic investigation of HIV/AIDS disclosure grounded in the experiences of those living with HIV/AIDS accessing Paarl Hospice House seeking treatment." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/16610.
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Thesis (MPhil)--University of Stellenbosch, 2005.ENGLISH ABSTRACT: Paarl, in the Western Cape, has been identified as one of the 15 national sites where antiretroviral treatment (ARVs) would be made available to people living with HIV/AIDS. Paarl Hospice initiated a support group for people to deal with this disease in 2003. Since February 2004 Paarl Hospice has been recruiting people from the surrounding informal settlements for ARVs. By means of participant observation I explored how HIV/AIDS-related disclosure experiences unfolded in places, spaces and events associated with the support group in the context of factors enabling and preventing people from accessing Hospice House. I did this by considering the insights drawn from an anthropological approach. I found the meanings of disclosure in the majority of studies to be limited and restricted. Available studies approached disclosure in a top-down fashion by regarding the definition of disclosure as the announcement of HIV-positivity at the time of diagnosis only. These studies have not considered social differences relating to disclosure neither did they focus on the actual process of disclosure. By means of a constructivist approach to grounded theory I seek to broaden the definition of disclosure to account for the range of ways in which disclosure practices take place. I found that disclosure could not be separated from the situational context in which it occurs and that it can only be understood in relation to the circumstances and relationships in which it takes place. In this study, disclosure was an ongoing process, situated somewhere between active, public announcement of an HIV-status and complete secrecy and somewhere between voluntary and involuntary revealing of the disease.
AFRIKAANSE OPSOMMING: Paarl in die Wes-Kaap is geïdentifiseer as een van die 15 nasionale areas waar antiretrovirale medikasie beskikbaar gestel sou word aan mense wat leef met MIV/VIGS. Paarl Hospice het gedurende 2003 ʼn ondersteuningsgroep geїnisieer om aan MIV/VIGS aandag te gee. Sedert Februarie 2004 is Paarl Hospice in die proses om mense te werf uit die omliggende informele behuisingsgebiede vir antiretrovirale behandeling. Met behulp van antropologiese insigte en deelnemende waarneming kon ek nagaan hoe verskillende maniere van MIV/VIGS-verwante bekendmaking ontvou in plekke, ruimtes en gebeurtenisse wat verband hou met die ondersteuningsgroep. MIV/VIGSverwante bekendmaking is ondersoek te midde van inhiberende en fasiliterende faktore wat mense verhoed of aanhelp om Paarl Hospice te besoek. Ek het bevind dat die definisie van bekendmaking in die meeste navorsing gebrekkig is. Beskikbare navorsing het bekendmaking volgens ‘n bo-na-onder-wyse benader as die openbare bekendmaking van ‘n MIV-status na afloop van diagnose alleenlik. Met behulp van ‘n konstruktiewe benadering van die begronde teorie het ek gepoog om die definisie van bekendmaking uit te bou om sodoende die verskeidenheid maniere waarop bekendmaking plaasvind te akkommodeer. Ek het vasgestel dat bekendmaking onlosmaakbaar deel is van die situasionele konteks waarin dit plaasvind en dat dit slegs begryp kan word in verband tot die verhoudings en omstandighede waarin dit plaasvind. In hierdie studie was bekendmaking ʼn voortdurende proses, gesitueer tussen aktiewe openbare bekendmaking en volledige geheimhouding van ʼn MIVstatus, asook tussen volkome vrywillige en onvrywillige bekendmaking van ʼn MIVstatus.
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Mkosi, Barbara Nomsa. "Confidentiality as value in the management of HIV/AIDS in South Africa." Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51663.
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Thesis (M.Phil.)--Stellenbosch University, 2000.ENGLISH ABSTRACT: AIDS is the most important threat to world health. Recent years have seen a dramatic spread of HIVand AIDS in South Africa. Health education directed at modifying risk behaviour appears to be the only way in which the disease can be contained. Controlling AIDS is not only by controlling the virus, but also involves tackling social, economic and political issues and putting AIDS into the broader context of sexuality and gender roles. This requires a broader understanding of this aspect of HIV-AIDS ranging from population dynamics, through to research on individual behaviour and its socio-economic impact; so that we can dispel the myths and rumours that surround AIDS and answer searching questions that will be asked by the community. In South Africa, HIV-AIDS remains a stigmatized disease. There have been calls from courageous and influential people for those who are living with HIV-AIDS to be open about their status and to destigmatise the disease. Institutions too have been drawn into the controversy about whether to remain silent or speak out. Southern African Anglican bishops, as well as some politicians declared their intention to undergo testing for HIV status in order to sensitise the public to the seriousness of the epidemic. Were AIDS not regarded as intolerable, the entire issue of confidentiality would fall away. Calls to destigmatise the disease through openness cannot stand alone. Government must put effective treatment programmes in place. In the absence of treatment, AIDS may represent only frustration and hopelessness to those who test positive; and fear, danger and resultant animosity to those who are HIV negative. The text is in four chapters. Chapter 1 focuses on confidentiality as an important principle in the management of disease. In HIV -AIDS, confidentiality is a more sensitive issue as AIDS is particularly viewed as a social stigma, accompanied by discrimination and harassment. The chapter also addresses HIV infection, transmission, counseling and screemng. Chapter 2 deals with the principles of biomedical ethics namely, autonomy, to enable the patient to determine his/her course of treatment; informed consent, designed to protect the interests of patients from exploitation and harm, and encourage health professionals to act responsibly; beneficence and nonmaleficence, to protect the welfare of others; and justice, to ensure access to health care for all. It also highlights the aspects of and limitations to confidentiality. Chapter 3 discusses broadly the ethical dilemmas pertammg to professional-patient relationships, women and HIV-AIDS, religion, prisoners and employer-employee relationships. When the AIDS epidemic started, very few people suffered from the disease, and the disease was treated with great caution and confidentiality. Today, AIDS is a pandemic and emphasis should shift from the ethic of autonomy and confidentiality, to a social ethic, which emphasizes the responsibility of minimizing the risk of spread of infection. The chapter also examines the role of the Department of Health, the participation of health professional bodies and the legal aspects relating to confidentiality in HIV-AIDS. Chapter 4 attempts to construct an argument to destigmatise HIV-AIDS by arguing the responsibility of the government to make sufficient resources available for the treatment and control of the pandemic. Health professionals are challenged to engage their expertise and skills in the service of the sick with dignity and respect. The community is encouraged to support the drive towards controlling the spread of HIV infection and enable people living with AIDS to disclose their status without fear of harassment.
AFRIKAANSE OPSOMMING: Vigs is die gevaarlikste bedreiging van wéreldgesondheid. Die afgelope paar jaar het 'n dramatiese verspreiding van mv en VIGS in Suid-Afrika plaasgevind. Gesondheidsopvoeding wat gemik is op die verandering van risiko-gedrag is skynbaar die enigste metode wat die siekte kan beheer. Die kontrolering van VIGS is nie net die kontrolering van die virus nie, maar dit betref ook herbesinning oor sosiale, ekonomiese en politiese en geslagsrolle. Dit vereis 'n omvattender verstaan van hierdie aspek van HIV-VIGS, wat strek vanaf van bevolkingspatrone tot by die navorsing oor individuele gedrag en die sosio-ekonomiese impak van 19. So kan ons hopelik help om die mites rondom VIGS te besweer. In Suid-Afrika bly mV-VIGS 'n gestigmatiseerde siekte. Daar rus 'n veranbtwoordelikheid op invloedryke mense wat met mV-VIGS leef en wat as rolmodelle sou kon dien, om hul mv -status te openbaar en sodoeonde te help om die siekte te destigmatiseer. Instansies is ook by hierdie twispunt betrek om vas te stelof die mense moet praat of swyg. Suider-Afrikaanse Anglikaanse Biskoppe, asook somige politici het hulle intensies aangekondig om die mv -toets te ondergaan om sodoende die publiek te help opvoed oor die gevaar van hierdie epidemie. Oproepe om die siekte te destigmatiseer deur openbaarheid kan nie in isolasie funksioneer nie. Die staat moet effektiewe kuratiewe en voorkomingsprogramme hier rondom loods en kontinueer. In die afwesigheid van 'n geneesmiddel, sal VIGS slegs frustrasie, hopeloosheid, en vrees skep by diegene wat positief getoets is, sowel as vyandigheid onder diegene wat nie mv positief is nie. Die teks het vier hoofstukke. Hoofstuk 1 fokus op vertroulikheid as 'n belangrike beginsel in die bestuur van die siekte. In mV-VIGS is vertroulikheid 'n meer sensitiewe beginsel aangesien VIGS in die besonder as 'n sosiale skandvlek, aangevreet deur diskriminasie, gesien word. Die hoofstuk bespreek ook mv -infeksie, transmissie, raadgewing en toetsing. Hoofstuk 2 gaan oor die beginsels van die biomediese etiek, naamlik, outonomie, waaronder ingeligte toetstemming, ontwerp om die belange van die pasiente te beskerm teen eksploitasie en gevaar: om gesondheids professionele aan te moedig om hulle op 'n verantwoordelike manier te gedra. Ander beginsels is goedwilligheid en niekwaadwiligheid om die welsyn van ander te beskerm, asook geregtigheid, om toegang tot gesondheidshulp vir almal te verseker. Dit beklemtoon ook die aspekte verwant aan beperkinge tot vertroulikheid. Hoofstuk 3 bespreek breedweg die etiese dilemmas met betrekking tot die verhouding tussen pasiënye en professionele gesondheidswerkers, vrouens en mV-VIGS, godsdiens, gevangenes en werkgewer-werker verhoudings. Toe die VIGS-epidemie begin het, het min mense aan die siekte gely, en die siekte is met groot sorg en vertroulikheid behandel. Vandag is VIGS 'n pandemie en die klem moet geskuif word vanaf outonomie en vetrouilikheid na 'n sosiale etos wat verantwoordlikheid en die vermindering van die risiko van die verspreiding van die infeksie beklemtoon. Die hoofstuk kyk ook na die rolle van gesondheidsdepartmente, deelname van gesondheids professionele organisasies en die juridiese aspekte met betrekking tot vertroulikheid van HIV-VIGS. Hoofstuk 4 poog om 'n argument te ontwikkel wat daartoe sou kon bydra dat HIV-VIGS gedestigmatiseer sal word. Klem word gelê op die verabtwoordelikheid van die staat om soveel moontlike bronne beskikbaar te stel vir die behandeling van en beheer oor hierdie pandemie. Gesondheids professionele word uitgedaag om hulle deskundigheid en bekwaamheid in die diens van die siekes met waardigheid en respek te gebruik. Die gemeenskap word aangemoedig om die poging tot die beheer van die verspreiding van die HIV -infeksie te ondersteun en om die mense wat met VIGS leef in staat te stelom hul status sonder die dreigement van stigmatisering bekend te maak.
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De, Villiers Suzanne. "The principle of respect for autonomy and the sterilization of people with intellectual disabilities." Thesis, Stellenbosch : Stellenbosch University, 2002. http://hdl.handle.net/10019.1/53148.
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Thesis (MPhil)--University of Stellenbosch, 2002.ENGLISH ABSTRACT: The implementation of eugenic policies reached its peak during the zo" century when thousands of people with intellectual disabilities and other "undesirable qualities" were involuntary sterilized. Although most of the eugenic policies have been removed, countries such as South Africa, still make legally provision for the involuntary sterilization of people with intellectual disabilities. Torbjërn Tannsjë (1998) used the "argument from autonomy" to argue that involuntary sterilization practices are wrong because it involves compulsion. According to him, society should never interfere with people's reproductive choices and people should never be required to qualify for the right to have children. The aim of this assignment was to systematically assess the "argument from autonomy" as far as the policy of involuntary sterilization of people with intellectual disabilities is concerned. To this end, the concept of autonomy and the principle of respect for autonomy are discussed and applied to the intellectually disabled. It is argued that autonomy and respect for autonomy are useful concepts to apply to some people with intellectual disabilities. These individuals should not be automatically assumed to be incompetent, but their competence needs to be determined on an individual level, with reference to the complexity of the decision to be made. Special effort is needed from health care professionals to obtain (where possible) informed consent from people with intellectual disabilities. The application of the principle of respect for autonomy to matters of reproduction leads to the conclusion that people with severe to profound levels of disability, are unable to provide informed consent for sexual intercourse. Therefore some form of paternalistic protection is needed for these individuals. People with mild to moderate intellectual disabilities who are however competent to consent to sexual intercourse should never be prohibited from procreation by means of involuntary sterilization. State interference in matters of reproduction should be limited to interventions where (i) children are seriously harmed by parents and (ii) to protect those who are incompetent to consent to sexual interactions with others. Apart from these exceptions, the intellectually disabled is entitled to the same procreative rights as all other citizens.
AFRIKAANSE OPSOMMING: Die implementering van eugenetiese beleid het gedurende die 20 ste eeu 'n hoogtepunt bereik met die onwillekeurige sterilisering van duisende persone met intellektuele gestremdhede en ander "ongewensde kwaliteite". Alhoewel meeste van die eugenetiese wetgewing verwyder is, maak lande soos Suid-Afrika steeds wetlik voorsiening vir die onwillekeurige sterilisasie van persone met intellektuele gestremdhede. Torbjërn Tannsjo (1998) maak gebruik van die "outonomie argument" om te argumenteer dat onwillekeurige sterilisasie praktyke onaanvaarbaar is omdat dit dwang bevat. Hy voer aan dat die samelewing nooit in die reproduktiewe keuses van mense behoort in te meng nie en dat dit nooit vir mense nodig moet wees om vir ouerskap te kwalifiseer nie. Die doel van hierdie werkstuk was om sistematies die "outonomie argument" te analiseer ten opsigte van die beleid van die onwillekeurige sterilisasie van persone met intellektuele gestremdhede. Met hierdie doel voor oë word die konsep outonomie en die beginsel van respek vir outonomie bespreek en toegepas op die intellektueel gestremde persoon. Daar word aangevoer dat outonomie en respek vir outonomie nuttige beginsels is om in ag te neem in kwessies rakende intellektueel gestremdes. Hierdie individue moet nie outomaties as onbevoeg beskou word nie, maar hul bevoegdheid moet eerder op 'n individuele basis beoordeel word, inaggeneem die kompleksiteit van die besluit wat geneem moet word. Voorts word daar van gesondheidsorgpersoneel verwag om moeite te doen met die verkryging van oorwoê toestemming (waar moontlik) by persone met intellektuele gestremdhede. Die toepassing van die beginsel van respek vir outonomie op aspekte rakende reproduksie, lei tot die gevolgtrekking dat persone met ernstige intellektuele gestremdhede nie in staat is om toestemming tot seksuele omgang te verleen nie. Dus, is 'n vorm van paternalistiese beskerming in hierdie gevalle aangedui. Persone met intellektuele gestremdhede wat egter wel bevoeg is om toestemming tot seksuele omgang te verleen, moet nooit weerhou word van voortplanting deur middel van onwillekeurige sterilisering nie. Inmenging deur die staat in kwessies rakende reproduksie moet beperk word tot intervensies waar (i) kinders ernstige skade berokken word en (ii) die beskerming van persone wat onbevoeg is om toestemming tot seksuele interaksies met ander te verleen, benodig word. Afgesien hiervan, is die intellektuele gestremde persoon geregtig op dieselfde reproduktiewe regte as alle ander landsburgers.
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Busquets, Surribas Montserrat. "Autonomía e información en el proceso de atención sanitaria a mujeres con cáncer de mama y hombres con enfermedad coronaria." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/404279.
Full textAbstract:
Esta tesis profundiza en la relación entre la información sanitaria y la autonomía de la persona enferma. La autonomía implica reconocer el derecho de la persona a tomar las decisiones relativas a su salud y, por ello, el derecho al acceso a la información clínica de forma veraz y adaptada. En el marco teórico la tesis analiza la aportación de la bioética al respeto por la autonomía de la persona y, desde la discusión de diferentes formas de comprender la autonomía y la atención sanitaria, plantea diferentes formas y contenidos de la información que proporcionan los profesionales. Sin embargo el debate sobre la información al enfermo, su utilidad, los momentos adecuados para realizarla, la participación de las familias, el significado de la veracidad, etc., no es solo una cuestión teórica, ni está zanjado. Por ello es necesario contar con la experiencia de personas enfermas al respecto.
Con el objetivo investigar la experiencia de personas respecto a la información recibida durante todo su proceso de atención sanitaria la tesis plantea tres preguntas: ¿cuál es el significado y la utilidad que tiene la información para las personas atendidas, que dan los profesionales de la salud?, ¿cuáles son las ayudas o dificultades para la obtención y comprensión de la información?, ¿cuál la experiencia respecto a información que se recibe de asociaciones de pacientes y grupos de autoayuda?. Para su respuesta se realizaron 20 entrevistas en profundidad y 2 grupos focales, a mujeres con cáncer de mama y hombres con enfermedad coronaria. Ambas enfermedades conllevan malas noticias, precisan cantidad de información, plantean difíciles decisiones y implican cambios de vida. Los resultados se agruparon en torno a 3 dimensiones: el proceso de información, las ayudas y barreras y el papel de los grupos de autoayuda, que se desmenuzan en 9 categorías y 27 subcategorías.
La información fue señalada como un aspecto clave para comprender y dar sentido a la experiencia de vida que implica la enfermedad y como esencial para tomar decisiones y afrontar la vida cotidiana con seguridad. Los informantes quisieron recibir información y participar activamente en su proceso de tratamiento y cuidado, expresaron el beneficio de la participación de la familia pero rechazaron ser substituidos por ellos en la información y decisiones. Expresaron que en general la información que obtuvieron fue estandarizada, centrada en la enfermedad y focalizada en el consentimiento informado. Las enfermeras tuvieron un papel ambiguo, muy condicionado al tipo de organización sanitaria. Como actitudes profesionales que favorecían la comprensión señalaron la disponibilidad y escucha, la simpatía y la demostración de interés, como actitudes negativas definieron las manifestaciones de poder y el uso de tecnicismos, la no escucha, no dar importancia a las emociones y la necesidad de tener que preguntar para obtener información. Los informantes señalaron la influencia de gestión en la relación clínica, sobre todo en la escasez de profesionales y su movilidad.
El trabajo plantea 7 conclusiones:
1. La necesidad de avanzar en la comprensión de la autonomía relacional.
2. La relevancia de la veracidad como norma en la información.
3. La escasa validez ética actual del consentimiento informado que plantea dudas sobre su obtención y sobre la utilidad de los documentos de consentimiento.
4. La necesidad de comprender mejor papel de la familia en tanto que acompañante pero no substituta de las decisiones.
5. La centralidad de la conducta profesional como vehículo de los valores y principios éticos.
6. La responsabilidad ética de las instituciones en compaginar la eficiencia del sistema con la necesidad de ayuda de las personas.
7. La fiabilidad de la información que dan las asociaciones y grupos de autoayuda.This thesis analyses the contribution of bioethics in respect to patient autonomy and patient rights to the health care information received. The influence of different ways of understanding autonomy and health care in the forms and contents of information and clinical relationship is discussed. With the objective of researching the experience of the patients, the thesis proposes three questions: what is the meaning and the usefulness of information given by health care professionals? what are the aids or benefits and the difficulties in obtaining and understand this information? what is the information received from patients associations?. 20 extensive interviews and 2 focus groups were performed in which participants were women with breast cancer and men with coronary disease. Both diseases carry bad news, the patients need a big amount of information, they bring up difficult decisions and they imply daily life changes. The results were classified in 3 groups, 9 categories and 27 sub categories. The participants pointed out the utility of the information to understand and give sense to their experience, and underlined its importance to face daily life and the possibility for them to be able to take safe decisions. The participants wanted to receive the information and they participated actively and refused to be replaced by family members. However in general, the information obtained was standardized, focused on the disease and on obtaining informed consent. As positive professional attitudes, patients pointed out aspects such as the availability of the professionals, being listened to, the friendliness and the demonstrated interest. As negative professional attitudes they pointed out manifestations of power, the use of technical language, the professionals not listening to the patient, and not giving information. The participants pointed out the influence of the management on the clinic relation, specifically in the short number of professionals and there mobility. The work raises 7 conclusions: 1. The need to advance in the understanding of relational autonomy. 2. The relevance of veracity as a rule in information. 3. The current low ethical validity of informed consent raises doubts about the obtaining and utility or such consent documents. 4. The need to better understands the role of the patient's family whit an accompaniment role, and not letting them take the decisions for the patient. 5. The importance of professional conduct that demonstrate ethical values and principles. 6. The ethic responsibility of the institutions combining the efficiency of the system with the need of people's help. 7. The reliability of information provided by associations and self-help groups.
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Vico, Fernández Gema. "Régimen jurídico del tratamiento forzoso del trastorno psíquico." Doctoral thesis, Universitat de Barcelona, 2015. http://hdl.handle.net/10803/378028.
Full textAbstract:
En los internamientos involuntarios aparece incluido un derecho de la personalidad, la libertad personal, que tiene la consideración no sólo de derecho fundamental en el artículo 17 de la Constitución, sino también de principio supremo de nuestro sistema social y democrático de derecho.
A partir de la Ley 13/1983, de 24 de octubre, de Reforma del Código Civil en materia de tutela, se instauró un sistema de control judicial de los internamientos frente al sistema anterior de mero control administrativo.
El artículo 211 del Código Civil reformado por Ley Orgánica 1/1996, de 15 de enero, de Protección Jurídica del Menor, reguló expresamente el internamiento de los menores de edad.
La Ley 1/2000, de 7 de enero, de Enjuiciamiento Civil, derogó, a su vez, el artículo 211 del Código Civil, pasando a regular “el internamiento por razón de trastorno psíquico”, en su artículo 763. La sentencia del Tribunal Constitucional 132/2010 declaró la inconstitucionalidad de la parte de este precepto que posibilita la decisión del internamiento no voluntario por razón de trastorno psíquico, dado que, al ser constitutivo de una privación de libertad, debería haberse regulado mediante ley orgánica, de conformidad con lo dispuesto en el artículo 81 de la Constitución, instando al legislador a regular esta materia mediante ley orgánica.
El tratamiento jurídico de los internamientos involuntarios guarda una estrecha relación con el de los tratamientos médicos realizados sin contar con la voluntad de las personas afectadas. El Tribunal Constitucional considera que el consentimiento del paciente a cualquier intervención sobre su persona forma parte de su derecho fundamental a la integridad física, reconocido en el artículo 15 de la Constitución.
La Ley 41/2002, de 14 de noviembre, básica reguladora de la autonomía del paciente y de los derechos y obligaciones en materia de información y documentación clínica regula el consentimiento informado en los artículos 8 y siguientes, que prevén también los casos en que los facultativos pueden intervenir sin el consentimiento del paciente y aquellos en que el consentimiento se otorgará por representación respecto de los menores de edad y de personas que no tengan capacidad para prestar el consentimiento.
El artículo 10.2 de la Constitución establece que las normas relativas a los derechos fundamentales y las libertades que la Constitución reconoce se interpretarán de conformidad con los tratados y acuerdos internacionales sobre las mismas materias ratificados por España.
Dentro de estos tratados, podemos destacar el Convenio Europeo de Derechos Humanos de 1950 y la jurisprudencia del Tribunal Europeo de Derechos Humanos que lo interpreta, la Convención de Derechos del Niño de 1989, el Convenio de Oviedo de 1997 y la Convención Internacional de los Derechos de las personas con discapacidad de 2006. De acuerdo con la legislación aplicable, así como con la jurisprudencia, podemos destacar la necesidad de su reforma para adecuarla a la Constitución, cumpliendo el requerimiento que efectuó el Tribunal Constitucional en la sentencia 132/2010, y que exige asimismo la adecuación a los Convenios Internacionales firmados por España.The right to personality and personal freedom are included in involuntary internments. These are not only governed by a fundamental right under Article 17 of the Spanish Constitution, but also by the supreme principle according to our system of social and democratic right. According to the Law 13/1983, effective October 24 of the Reform of the Civil Code regarding matters of guardianship, a system of judicial internment control was established with respect to mere previous administrative checks. The 211 article of the Civil Code reformed by the Organic Law 1/1996, effective January 15 on the Legal Protection of Children, expressly regulated the commitment of minors. The 1/2000 Law of January 7 on civil prosecution repealed, in turn, the 211 article of the Civil Code, and started to regulate the “internment due to psychiatric illness” by Article 763. The Constitutional Court’s ruling 132/2010 declared the unconstitutionality on the part of this precept that enables the decision of involuntary internments due to mental disorder, considering that it is constitutive of a deprivation of liberty, should have been regulated by organic law, as agreed upon in Article 81 of the Constitution, and urges the legislator to regulate this matter by means of organic law. The legal treatment of involuntary interments connects with those of medical treatments made without considering the will of the affected persons. The Constitutional Court considers that the patient’s consent in any event regarding its own person is part of its fundamental right to integrity recognized in Article 15 of the Constitution. The 41/2002 Law, effective November 14 , on basic regulation on the autonomy of the patient and of rights and obligations in matters of information and clinical documentation regulates the informed consent in the Articles 8 and the following, which also covers the cases in which doctors can act without the patient’s consent and those in which the consent is given by the representation in relation to minors and people who does not have the capability to provide it. Article 10.2 of the Constitution establishes that the rules regarding fundamental rights and liberties recognized by the Constitution are interpreted in accordance with the international treaties and agreements thereon ratified by the Spanish State. Among these treaties prevail the 1950 European Convention of human rights and the jurisprudence of the European Court of Human Rights which also interpret them; the 1989 Convention on the Rights of Children; the 1997 Oviedo Treaty, and the 2006 Convention on the Rights of persons with disabilities. According to the applicable law, as well as jurisprudence, the need is stressed to upgrade it in order to adapt it to the Constitution this way fulfilling the requirements the Constitutional Court made in the sentence 132/2010 and that at the same time demands the adaptation of the international agreements signed by the Spanish State.
En els internaments involuntaris s’inclou un dret de la personalitat, la llibertat personal, que rep la consideració no només de dret fonamental a l’article 17 de la Constitució espanyola, sinó també de principi suprem segons el nostre sistema de dret social i democràtic. A partir de la Llei 13/1983, del 24 d’octubre, de Reforma del Codi Civil en matèria de tutela, s’instaurà un sistema de control judicial dels internaments enfront el sistema anterior de mer control administratiu. L’article 211 del Codi Civil reformat per la Llei orgànica 1/1996, del 15 de gener, de protecció jurídica del menor, va regular expressament l’internament dels menors d’edat. La Llei 1/2000 del 7 de gener, de processament civil, va derogar, al seu torn, l’article 211 del Codi Civil, i va passar a regular “l’internament per raó de trastorn psíquic” per l’article 763. La sentència del Tribunal Constitucional 132/2010 va declarar la inconstitucionalitat de la part d’aquest precepte que possibilita la decisió de l’internament no voluntari per raó de trastorn psíquic, ja que, com que és constitutiu d’una privació de llibertat, hauria d’haver estat regulat mitjançant llei orgànica, de conformitat amb el que disposa l’article 81 de la Constitució, i insta el legislador a regular aquesta matèria mitjançant llei orgànica. El tractament jurídic dels internaments involuntaris manté una relació molt estreta amb el dels tractaments mèdics que es fan sense considerar la voluntat de les persones afectades. El Tribunal Constitucional considera que el consentiment del pacient a qualsevol intervenció en la seva persona forma part del seu dret fonamental a la integritat reconegut a l’article 15 de la Constitució. La Llei 41/2002, del 14 de novembre, bàsica, reguladora de l’autonomia del pacient i dels drets i obligacions en matèria d’informació i documentació clínica regula el consentiment informat en els articles 8 i següents, que preveuen també els casos en què els facultatius poden intervenir sense el consentiment del pacient i aquells en què el consentiment s’atorga per representació amb relació als menors d’edat i persones que no tinguin capacitat per prestar-lo. L’article 10.2 de la Constitució estableix que les normes relatives als drets fonamentals i les llibertats que la Constitució reconeix s’han d’interpretar de conformitat amb els tractats i acords internacionals sobre les mateixes matèries que l’Estat espanyol hagi ratificat. Entre aquests tractats destaquen el Conveni europeu de drets humans de 1950 i la jurisprudència del Tribunal Europeu de Drets Humans que també l’interpreta; la Convenció de drets del nen de 1989; el Conveni d’Oviedo de 1997, i la Convenció internacional dels drets de les persones amb discapacitat de 2006. D’acord amb la legislació aplicable, així com amb la jurisprudència, hi destaca la necessitat de reformar-la a fi i efecte d’adequar-la a la Constitució complint així el requeriment que va efectuar el Tribunal Constitucional en la sentència 132/2010 i que al mateix temps exigeix l’adequació als convenis internacionals signats per l’Estat espanyol.
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Willemyns, Amanda Jo-Anne. "Under the carpet : the politics and trauma of patient harm." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/46266/1/Amanda_Willemyns_Thesis.pdf.
Full textAbstract:
Few studies have investigated iatrogenic outcomes from the viewpoint of patient experience. To address this anomaly, the broad aim of this research is to explore the lived experience of patient harm. Patient harm is defined as major harm to the patient, either psychosocial or physical in nature, resulting from any aspect of health care. Utilising the method of Consensual Qualitative Research (CQR), in-depth interviews are conducted with twenty-four volunteer research participants who self-report having been severely harmed by an invasive medical procedure. A standardised measure of emotional distress, the Impact of Event Scale (IES), is additionally employed for purposes of triangulation. Thematic analysis of transcript data indicate numerous findings including: (i) difficulties regarding patients‘ prior understanding of risks involved with their medical procedure; (ii) the problematic response of the health system post-procedure; (iii) multiple adverse effects upon life functioning; (iv) limited recourse options for patients; and (v) the approach desired in terms of how patient harm should be systemically handled. In addition, IES results indicate a clinically significant level of distress in the sample as a whole.
To discuss findings, a cross-disciplinary approach is adopted that draws upon sociology, medicine, medical anthropology, psychology, philosophy, history, ethics, law, and political theory. Furthermore, an overall explanatory framework is proposed in terms of the master themes of power and trauma. In terms of the theme of power, a postmodernist analysis explores the politics of patient harm, particularly the dynamics surrounding the politics of knowledge (e.g., notions of subjective versus objective knowledge, informed consent, and open disclosure). This analysis suggests that patient care is not the prime function of the health system, which appears more focussed upon serving the interests of those in the upper levels of its hierarchy.
In terms of the master theme of trauma, current understandings of posttraumatic stress disorder (PTSD) are critiqued, and based on data from this research as well as the international literature, a new model of trauma is proposed. This model is based upon the principle of homeostasis observed in biology, whereby within every cell or organism a state of equilibrium is sought and maintained. The proposed model identifies several bio-psychosocial markers of trauma across its three main phases. These trauma markers include: (i) a profound sense of loss; (ii) a lack of perceived control; (iii) passive trauma processing responses; (iv) an identity crisis; (v) a quest to fully understand the trauma event; (vi) a need for social validation of the traumatic experience; and (vii) posttraumatic adaption with the possibility of positive change.
To further explore the master themes of power and trauma, a natural group interview is carried out at a meeting of a patient support group for arachnoiditis. Observations at this meeting and members‘ stories in general support the homeostatic model of trauma, particularly the quest to find answers in the face of distressing experience, as well as the need for social recognition of that experience. In addition, the sociopolitical response to arachnoiditis highlights how public domains of knowledge are largely constructed and controlled by vested interests. Implications of the data overall are discussed in terms of a cultural revolution being needed in health care to position core values around a prime focus upon patients as human beings.
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OLIVEIRA, Nuno Manuel Pinto. "O direito geral de personalidade e a "solução do dissentimento" : Ensaio sobre um caso de "constitucionalização" do direito civil." Doctoral thesis, 2000. http://hdl.handle.net/1814/25956.
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CHIEN, KUAN-YI, and 錢冠頤. "Re-examining 「Informed Consent」 in Medical Criminal Law." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/2q94r4.
Full textAbstract:
碩士國立臺北大學
法律學系一般生組
105
To protect patients’ self-determination (autonomy), informed consent imposes a duty upon physicians to share information with their patients before getting consent. When a physician doesn’t obtain a patient’s consent or even goes against the patient’s medical will in violation of the doctrine of informed consent, the physician maybe will be subject to criminal accusation, and there is a huge gap between the legal and medical professions. First, this thesis discusses the meaning of medical behaviors, analyzes the position of medical behaviors in criminal law and the relation between medical behaviors and justification. Second, this thesis introduces the history of patients’ self-determination and has relations with informed consent. And then analyzing the physician’s obligation to explain and the patients’ consent. At last, some important judgments have indicated that the physicians who have not implement their duty to warn, before they start invasive medical treatments, will commit the criminal duty. But the violation of informed consent is still a controversial issue, so this thesis try to Re-examining the 「Informed Consent」 in Medical Criminal Law.
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JHU, YU-CHEN, and 朱育辰. "The Inapplicability of Informed Consent to Medical Criminal Law - The Position of Patients’ Consent in Medical Criminal Law." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/azwej4.
Full textAbstract:
碩士國立臺北大學
法律學系一般生組
106
The development of informed consent is to guarantee the right of patients’ self-determination. It is generally accepted by the general public that doctors should obtain patients’ consent by informing the medical treatment. And doctors’ explanation of medical behaviors to patients is also called doctors’ duty of disclosure. With the bad communication between doctors and patients is lead to the increasing of the medical lawsuits. Especially, doctors will be subject to criminal accusation by violating the doctrine of informed consent. However, whether doctors violate the right of patients’ self-determination or not, it doesn’t necessary to commit an intention or negligent crime. In order to establish a correct value, this thesis will based on related academic studies, and recent judgements by the Supreme Court. Furthermore, this thesis will in Chapter II & III to discuss the meaning of medical behaviors and informed consent. Second in Chapter IV & V, this thesis will analyze the position of patients’ consent in medical criminal law and explain the reasons about informed consent isn’t apply for medical criminal law. Last but not least, well doctor-patient relationship and communication is the best way to protect patients’ autonomy, rather than wants to put doctors to the jail.
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Kettle, Nancy M. "Informed consent : its origin, purpose, problems, and linits." 2002. http://purl.fcla.edu/fcla/etd/SFE0000041.
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Lee, Guan-Yi, and 李冠儀. "Informed Consent of the Minors and the Abuse of Parental Rights in Medical Law." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/u62333.
Full textAbstract:
碩士國立臺灣大學
法律學研究所
106
This thesis, written through methods of literature reviews, comparative analysis, and case studies, focuses on the medical decision-making concerning minors, trying to discuss minors’ rights of self-determination in medical field and to discuss the limits of parental rights in each case. The medical decision-making of minors involves several interested parties, including parents, state, and minor him or herself. Parents can make medical decisions for their minor children because of their parental right. Parental right is a right of altruism. The reason of the existence of parental right is to maintain family autonomy, and to let the minors be raised in family, which is the best place for one to develop his or her own personality. The reason the state intrudes into the medical decision concerning minors is due to the concept of “parens patriae”. Because minors can’t defend their own rights, when they are infringed by a third party, state must intrude to provide protection for minors, otherwise the rights of minors written in statutes can’t be carried out. As to whether a minor can make medical decision for him or herself, it still remains a controversial issue, since the medical law in our country doesn’t admit the right of self-determination of the minors. However, self-determination is the core concept of human dignity, so the minors shouldn’t be deprived of this right. And from the perspective of comparative law, both the British law and the American law admit the medical decision-making right of minors who have enough understanding, intelligence and maturity, with British law developing the concept of “Gillick competence” and American law developing the principle of “mature minors” through case laws. Through the cases of the refuse of blood transfusion of Jehovah’s witnesses, male circumcision of infants, and live donation, this thesis tries to figure out whether a minor can make his or her own medical decision? How to define competence? Whether parents’ conducts constitute abuse? Can the state limit the rights of parents? How to coordinate the different opinions of these interested parties? What exactly is the content of the best interest of minors? Hoping that through this study, a more comprehensive protection of the rights of minors can be given, and a better direction of improvement both in the field of court practices and legislation can be pointed out.
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Gasa, Nolwazi Bright Khanyisile. "Cultural conceptions of research and informed consent." Thesis, 1999. http://hdl.handle.net/10413/5843.
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AIDS has had a negative impact on developing countries. Because most developing countries
cannot afford the new antiretroviral drug therapies, it has been suggested that preventive
vaccines might reduce the spread of the HIV/AIDS epidemic (Bloom, 1998). The clinical
trials of AIDS vaccines do, however, present with complex ethical issues such as informed
consent. Informed consent is primarily grounded on the Western principle of respect for
individuals as autonomous agents. This may be at variance, however, with African societies'
emphasis on the social embeddedness of the individual.
The current study forms part of the HIVNET vaccine trials to be conducted in Hlabisa, in
Northern Zululand, under the auspices of the South African Medical Research Council. The
main aim of the study was to explore key informants' cultural conceptions of research and
informed consent in order to facilitate community consultation and cultural sensitivity.
Maximum variation sampling was used to select twenty-three key informants, who are in
leadership positions within Hlabisa. An interview guide was used to facilitate narrative
disclosure of cultural conceptions of research and informed consent. Perceptions of research,
conceptions of the informed consent process, and projected motivations for why individuals
agree to participate in studies were explored during interviews.
Results suggest that members of the Hlabisa community have a limited understanding of the
Western research process. Community education about research is therefore warranted.
Informants indicated that community members would value the establishment of a
relationship characterised by mutual respect for cultural differences between researchers and
participants. This was perceived as likely to facilitate shared decision-making, and the
reduction of the power differentials that exist between researchers and participants. While the
involvement of key community leaders and family members was recommended by most
informants, a few informants felt that participants could also make individual decisions about
participation. The theoretical implications of the study are considered last.Thesis (M.A.)-University of Natal, Pietermaritzburg, 1999.
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Chima, Sylvester Chidi. "An investigation of informed consent in clinical practice in South Africa." Thesis, 2018. http://hdl.handle.net/10500/24545.
Full textAbstract:
This study was designed to evaluate the quality of informed consent practiced by healthcare
professionals in South Africa using an empirical quantitative methodology combined with medicolegal
analysis to produce an interdisciplinary thesis on bioethics and medical law. Informed
consent is an ethical and legal doctrine derived from the principle of respect for autonomy,
whereas the rights to bodily integrity, privacy and human dignity are constitutionally protected in
South Africa. The National Health Act 61 of 2003 codified requirements for informed consent by
stipulating that healthcare providers must inform healthcare users about diagnosis, risks, benefits,
treatment options, and the right of refusal, while taking into consideration users language and
literacy levels. However, African communities are inherently challenged by problems of poverty,
poor education, power asymmetry, and unfamiliarity with libertarian rights-based autonomy, which
could affect informed consent practice. An empirical study was conducted at randomly selected
public hospitals in EThekwini metropolitan municipality involving 927 participants; comprising 168
medical doctors, 355 professional nurses, and 404 patients. The study showed that healthcare
professionals had limited knowledge regarding ethical and legal requirements for informed
consent, and were partially compliant with current informed consent regulations. Barriers to
informed consent identified were language, poor education, workload, and lack of interpreters.
Most patients attending public hospitals were indigent, but preferred full information disclosure,
and a shift from informed to shared-healthcare decision-making. The study recommends that a
corps of trained interpreters should be introduced at public hospitals. This will improve providerpatient
communications and minimize workloads, increase job satisfaction, and the overall quality
of healthcare service delivery. Analysis of recent South African case law on informed consent
revealed vacillations between the “reasonable doctor” and “prudent patient” standards of
information disclosure which are inconsistent with the jurisprudence from comparative foreign
common law jurisdictions. Therefore, South African court judgments on informed consent ought
to be re-evaluated to establish a uniform standard of information disclosure consistent with
international jurisprudence, current legislation, and constitutional protections relating to human
dignity and security of the person.Jurisprudence
LL. D.
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Turrell, Sheri Lynn. "Capacity to consent to treatment in adolescents with anorexia nervosa." 2004. http://link.library.utoronto.ca/eir/EIRdetail.cfm?Resources__ID=94692&T=F.
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VanLandschoot, Toby W. "Orthognathic surgery patient values and professional judgments : a thesis submitted in partial fulfillment ... for the degree of Master of Science in Orthodontics ... /." 2004. http://catalog.hathitrust.org/api/volumes/oclc/68962661.html.
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Lo, Yuan-Hsiu, and 羅元秀. "A Study on The Relation Between "Informed Consent" and "Arbitrarily Medical Behavior" Applied to The Criminal Law." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/45225298104809021418.
Full textAbstract:
碩士國立臺北大學
法律學系一般生組
102
In the the medical field , patient autonomy get more and more attention nowadays, and have been carried out on the doctrine of informed consent which were included in medical law. However, before performing medical practices, we are not sure whether physicians do not fulfilling "the doctrine of informed consent" will affect their criminal responsibility, which is a different debate between the practice and the academia. In this paper, through collecting, collating the current theory of literature and compare opinions of the current practice, to find the relation between "Arbitrarily Medical Behavior" and "Informed Consent" applied to the criminal law. First, the article discusses the meaning of the doctrine of informed consent including whether or not physicians inform, patients consent of medical field, and try to submit legislative proposal to clarify vague standard. Because the doctrine of informed consent is designed to protect patient autonomy, patient autonomy is belong to patients, and only they can exercise their rights. According to this description, the right of informed consent which does not only belong to the patients themselves has been a mere formality in medical law, so we must review it. And then discuss physicians do not fulfilling the doctrine of informed consent affect whether they found criminal responsibility. Last ,we must distinguish the situation is an emergency or non-emergency, and the kind and the degree of legally protected interest, and then we can judge a conduct of violating the doctrine of informed consent is illegal. Therefore, physicians’ medical practices which is violation of the patient's consent do not always illegal, we have to make a judgment according to the circumstances.
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Adewale, Babatunde. "Assessing participants' understanding and voluntariness of informed consent in a clinical trial in Nigeria." Thesis, 2012. http://hdl.handle.net/10413/9218.
Full textAbstract:
Introduction: Citizens of developing countries are often in vulnerable situations because of illiteracy, unfamiliarity with medical interventions, effects of war resulting in famine, and extreme poverty. The health-related conditions that arise out of these situations however make research in these populations vital and increasing funding for research on diseases that affect the world 's poor is making such research possible. The resulting tension between the need for research and the possibility of exploitation of participants' vulnerability, mandates the development of reliable ways of ensuring that participants' consent is voluntary, adequately informed and well understood. The Nuremberg Code emphasises the requirement of voluntariness in informed consent by insisting that participants should be able to exercise freedom of choice without the intervention of any element of force, fraud , deceit, duress, or other forms of constraint
or coercion. Aim: This study assessed research participants' understanding and voluntariness of informed consent in a clinical trial. Methods: The study design was a cross-sectional analysis of the informed consent process. It consisted of qualitative and quantitative components. It was a cross-sectional survey of 75 research participants in a malaria clinical trial using questionnaires in the from of forced-choice check lists and patient self-report to assess voluntariness and understanding of informed consent. Data were analysed using SPSS V 17. Results: All the respondents involved in the clinical trial gave consent before they were recruited. The reasons for consenting to participate in the clinical trial ranged from the
opportunity to get treatment (28%), opportunity for diagnosis of ailments (32%), to prevent illness (36%) and to receive information about medical care (4%). The major benefits participants attributed to taking part in the research were the opportunity to obtain treatment (59%), diagnostic tests (35%) and education (6%). Among the research participants, 10.7% believed that they should be paid for participation and about 8% felt that payment could influence their decision to participate because it could act as a motivation. They could however not proffer an amount that they would consider significant enough to influence their decision. There was no significant association between factors that influenced participation and age (p=0.533), sex (p=0.342), education (p=0.078), religion (p=0.144) and marital status (p=0.239). Almost all (98.7%)
participants claimed that they had understood the information given to them during the consent procedure and they all gave consent without consulting anybody apart from the medical personnel.The majority of respondents - 74 (98.7%) - stated that they were not allowed to go home with the informed consent document, while 1(1 .3%) of the respondents said there was no need to go home with the informed consent document. In the assessment of understanding using the forced-choice checklist, however, only 37% understood issues concerning randomization of participants and only 28.8% understood issues about compensation for research related injury. Discussion and Conclusion: In this study, the voluntariness of participants was influenced by factors related to the benefits accrued through participation. The need for
participants to make free and informed choices based on adequate information given by the investigator cannot but be emphasized as a right and not a privilege. In light of the limited understanding about randomization and injury compensation identified in this study, there is a need for additional protection of vulnerable populations. This could be in the form of allowing adequate time to enable the improvement of participants' understanding of the consent form, using innovative ways of explaining complex concepts such as randomization, and providing the necessary support to facilitate participants' right to self-decision, except when they are incapable of consenting.Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.
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Brindley-Richards, Lenna Getrinna. "South African stakeholders' perceptions of informed consent in HIV vaccine trials." Thesis, 2008. http://hdl.handle.net/10413/962.
Full textAbstract:
In the history of public health vaccines have proven to be among the most effective disease prevention tools. It is clear that in the fight against HIV that new and powerful preventive technology such as a vaccine is badly needed. Ethically, however the processes of developing a vaccine against HIV have been distinctly different from that of any previous pharmaceutical products. HIV vaccine trials can be ethically complex for a number of reasons. In 2004 the HIV I AIDS Vaccine Ethics Group undertook a research initiative that aimed to collect data from various South African stake holders of HIV vaccine trials to ascertain what they perceived as the ethical challenges related to HIV vaccine trials. A quantitative content analysis on the data from 31 semistructured interviews revealed that the ethical issue listed spontaneously by most of the respondents was that of informed consent. Further probing and discussion on informed consent identified a number of sub issues which the respondents thought would pose important challenges to HIV vaccine trials in the South African context. This study undertook to do a more in-depth qualitative analysis of the data to ascertain whether the challenges and concerns the stakeholders have are consistent with or different to those already identified in the literature and ethical guidelines on informed consent in medical research. What variables may be impacting on the position stakeholders take was also of interest. Results indicated that many concerns relating to the substantive and procedural elements of informed consent were consistent with those debated in the literature. These issues related to first person consent, the voluntariness of participants' consent, practicing cultural sensitivity, dealing with language issues, promoting and assessing understanding of material disclosed, issues around the vulnerability of .. participants, children and adolescents' capacity to consent and the role of the media. More specific to the South African context, stakeholders were concerned about the legal framework under which the trials take place, the general lack of education and training about HIV vaccine trials, a lack of communication and coordination between stakeholder groups, and the historical influences of apartheid on black South African participants' capacity to consent. The main variables that appeared to impact on the position stakeholders took related to the role the stakeholders play within the trials, the philosophical position underpinning their ethical viewpoints, stakeholders' understanding of vulnerability and capacity to consent, and how they view the universality or relativity of ethical issues.Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.
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Jacob, Marie-Andreé. "Consent, conversation, and the regulation of postmortem organ donation in a multicultural Canada." 2000. http://wwwlib.umi.com/cr/yorku/fullcit?pMQ59546.
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Thesis (L.L.M.)--York University, 2000. Graduate Programme in Law.Typescript. Includes bibliographical references. Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ59546.
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Coetzee, Lodewicus Charl. "Medical therapeutic privilege." Thesis, 2002. http://hdl.handle.net/10500/567.
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The therapeutic privilege is a defence in terms of which a doctor may withhold information from
a patient if disclosure of such information could harm the patient. This study explores the defence
of therapeutic privilege and provides a critical evaluation. A comparative investigation is
undertaken, while arguments springing from a variety of disciplines are also incorporated.
A number of submissions are made for limiting the ambit of the defence. The main submission
is that the therapeutic privilege should comply with all the requirements of the defence of
necessity. In addition, it should contain some of the safeguards afforded to the patient by the
requirements of the defence of negotiorum gestio so that therapeutic privilege is out of the
question if medical treatment is administered against the patient's will, or the doctor has reason
to believe (or knows) that the patient will refuse to undergo an intended intervention once
properly informed.Jurisprudence
L.L.M. (Jurisprudence)