Clinical Ethics Issues in Geriatric Psychiatry

Walaszek, Art

doi:10.1016/j.psc.2009.02.004

Cited by 24 publications

(29 citation statements)

References 90 publications

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“…Evidence of assessing the person’s mental capacity was scarce even though all had taken a Mini-Mental-Status-Examination [50]; not a completely reliable test and therefore recommended to be used in conjunction with other tests [66] Only in one case (Mrs J) was there an assessment based on guidelines suggested by Grisso and Appelbaum [20], Lai and Karlawish [67], Mitty [68] and Walaszek [69]. When assessing mental competence, Engedal and Kirkevold [70] claim that health workers in Norway rely more on experience than on using standardized tests.…”

Section: Discussionmentioning

confidence: 99%

How do persons with dementia participate in decision making related to health and daily care? A multi-case study

Smebye

Kirkevold

Engedal

2012

BMC Health Serv Res

162

233

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BackgroundMany countries have passed laws giving patients the right to participate in decisions about health care. People with dementia cannot be assumed to be incapable of making decisions on their diagnosis alone as they may have retained cognitive abilities.The purpose of this study was to gain a better understanding of how persons with dementia participated in making decisions about health care and how their family carers and professional caregivers influenced decision making.MethodsThis Norwegian study had a qualitative multi-case design. The triad in each of the ten cases consisted of the person with dementia, the family carer and the professional caregiver, in all 30 participants. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2, moderate dementia; (3) able to communicate verbally. The family carers and professional caregivers were then asked to participate.A semi-structured interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day centre. How the professional caregivers facilitated decision making was the focus of the observations that varied in length from 30 to 90 minutes. The data were analyzed using framework analysis combined with a hermeneutical interpretive approach.ResultsProfessional caregivers based their assessment of mental competence on experience and not on standardized tests. Persons with dementia demonstrated variability in how they participated in decision making. Pseudo-autonomous decision making and delegating decision making were new categories that emerged. Autonomous decision making did occur but shared decision making was the most typical pattern. Reduced mental capacity, lack of available choices or not being given the opportunity to participate led to non-involvement. Not all decisions were based on logic; personal values and relationships were also considered.ConclusionsPersons with moderate dementia demonstrated variability in how they participated in decision making. Optimal involvement was facilitated by positioning them as capable of influencing decisions, assessing decision-specific competence, clarifying values and understanding the significance of relationships and context.

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Section: Discussionmentioning

confidence: 99%

How do persons with dementia participate in decision making related to health and daily care? A multi-case study

Smebye

Kirkevold

Engedal

2012

BMC Health Serv Res

162

233

View full text Add to dashboard Cite

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“…Risk of making a diagnosis too early or too late because of reasons related to differences in age-or gender-related disease frequencies 3,25 . Risk of making inappropriate diagnoses related to varying definitions of mild cognitive impairment 2,3,12,17,[26][27][28][29][30] . Underestimation of the relatives' experiences and assessments of the person with dementia 2,30,31 Adequate point of making a diagnosis: .…”

Section: Fundingmentioning

confidence: 99%

“…Underestimation of the relatives' experiences and assessments of the person with dementia 2,30,31 Adequate point of making a diagnosis: . Risk of disavowing signs of illness and disregarding advanced planning 3,12,31,32 . Respecting psychological burdens in breaking bad news 17,30,31,33 .…”

Section: Fundingmentioning

confidence: 99%

“…Insufficient consideration of existing preferences of the patient 2,3,14,17,31,34,35,[40][41][42][43][44][45][46][47][48][49][50] . Problems concerning understanding and handling of patient autonomy 2,3,12,40,51,52 2 Assessing patient decision-making competence Ambiguity in understanding competence 2,3,6,12,14,17,[52][53][54][55][56][57] Problematic aspects in patient decision-making competence: . Inadequate assessment 2,3,4,14,29,57,58 .…”

Section: Fundingmentioning

confidence: 99%

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The full spectrum of ethical issues in dementia care: systematic qualitative review

et al. 2013

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The systematically derived spectrum of ethical issues in clinical dementia care presented in this paper can be used as training material for healthcare professionals, students and the public for raising awareness and understanding of the complexity of ethical issues in dementia care. It can also be used to identify ethical issues that should be addressed in dementia-specific training programmes, national strategy plans and clinical practice guidelines. Further research should evaluate whether this new genre of systematic reviews can be applied to the identification of ethical issues in other cognitive and somatic diseases. Also, the practical challenges in addressing ethical issues in training material, guidelines and policies need to be evaluated.

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“…Internationally, the awareness of the ethical dimension of health care is increasing, and over the past years, moral dilemmas in health care have become more prominent in international publications. [1][2][3][4][5][6][7] In response to this, various clinical ethics support activities have been developed, such as clinical ethics consultation teams or ethics consultants. 8,9 In Dutch health care, moral case deliberation (MCD) is a widely used form of clinical ethics support.…”

Section: Introductionmentioning

confidence: 99%

Aims and harvest of moral case deliberation

et al. 2013

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Deliberative ways of dealing with ethical issues in health care are expanding. Moral case deliberation is an example, providing group-wise, structured reflection on dilemmas from practice. Although moral case deliberation is well described in literature, aims and results of moral case deliberation sessions are unknown. This research shows (a) why managers introduce moral case deliberation and (b) what moral case deliberation participants experience as moral case deliberation results. A responsive evaluation was conducted, explicating moral case deliberation experiences by analysing aims (N = 78) and harvest (N = 255). A naturalistic data collection included interviews with managers and evaluation questionnaires of moral case deliberation participants (nurses). From the analysis, moral case deliberation appeals for cooperation, team bonding, critical attitude towards routines and nurses' empowerment. Differences are that managers aim to foster identity of the nursing profession, whereas nurses emphasize learning processes and understanding perspectives. We conclude that moral case deliberation influences team cooperation that cannot be controlled with traditional management tools, but requires time and dialogue. Exchanging aims and harvest between manager and team could result in co-creating (moral) practice in which improvements for daily cooperation result from bringing together perspectives of managers and team members.

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Clinical Ethics Issues in Geriatric Psychiatry

Cited by 24 publications

References 90 publications

How do persons with dementia participate in decision making related to health and daily care? A multi-case study

How do persons with dementia participate in decision making related to health and daily care? A multi-case study

The full spectrum of ethical issues in dementia care: systematic qualitative review

Aims and harvest of moral case deliberation

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