Evaluation of the Capacity to Appoint a Healthcare Proxy

Moye, Jennifer; Sabatino, Charles P.; Brendel, Rebecca W.

doi:10.1016/j.jagp.2012.09.001

Cited by 29 publications

(13 citation statements)

References 30 publications

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“…Note that in addition to explaining the importance of making and communicating a consistent choice, the above quote from Grisso and Appelbaum also alludes to another concept, capacity to appoint a proxy. The latter is a concept that has been gaining increased attention both in the context of research consent (Kim et al, 2011) and healthcare (Moye, Sabatino, & Weintraub Brendel, 2013) but has yet to be widely incorporated into clinical practice or the law. In brief, the idea is that even a patient who lacks capacity to validly consent/dissent to treatment may retain sufficient capacity to appoint a person they trust to help them with the decision.…”

Section: Four Component Model Of Decisional Capacitymentioning

confidence: 99%

Assessment of Healthcare Decision-making Capacity

Palmer

Harmell

2016

Arch Clin Neuropsychol

119

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It is often necessary for neuropsychologists, clinical psychologists, and other healthcare professionals to assess an individual's capacity to consent to treatment related to healthcare. This task can be challenging and requires a delicate balance of both respect for individuals' autonomy, as well as the protection of individuals with diminished capacity to make an autonomous decision. The purpose of the present review is to provide an overview of the conceptual model of decisional capacity as well as a brief summary of some of the currently available instruments designed to help evaluate medical decision making. In addition, current empirical literature on the relationship between neuropsychological abilities and decision-making capacity is discussed and a brief set of recommendations is provided to further aid clinicians or consultants when they are required to complete the ethically important but difficult task of making determinations about healthcare decision-making capacity.

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Section: Four Component Model Of Decisional Capacitymentioning

confidence: 99%

Assessment of Healthcare Decision-making Capacity

Palmer

Harmell

2016

Arch Clin Neuropsychol

119

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“…Nevertheless, we found very few papers specifically addressing AD‐Ps, 11–14 or dealing with the ethical and legal issues related to advance care planning by proxies 15 . Moreover, a search in Pubmed and Scopus reveals that the paper of Volicer et al has only been cited 10 times in the scientific literature 11,12,16–22 . The ethico‐legal literature identified by us, including comprehensive standard works on surrogate decision‐making 3 or advance care planning (ACP), 23 does not analyze or discuss the specific issues of AD‐Ps.…”

Section: Introductionmentioning

confidence: 99%

Advance care planning by proxy in German nursing homes: Descriptive analysis and policy implications

Schmitten

Jox

Pentzek

et al. 2021

J American Geriatrics Society

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Background: Legally recognized advance directives (ADs) have to be signed by the person to whom the decisions apply. In practice, however, there are also ADs written and signed by legal proxies (surrogates) on behalf of patients who lack decision-making capacity. Given their practical relevance and substantial ethical and legal implications, ADs by proxy (AD-Ps) have received surprisingly little scientific attention so far.Objectives: To study the form, content, validity, and applicability of AD-Ps among German nursing home residents and develop policy implications. Methods: Secondary analysis of two independent cross-sectional studies in three German cities, comprising 21 nursing homes and 1528 residents. The identified AD-Ps were analyzed in parallel by three independent raters. Interrater agreement was measured using free-marginal multi-rater kappa statistics.Results: Altogether, 46 AD-Ps were identified and pooled for analysis. On average (range), AD-Ps were 1 (1-7) year(s) old, 0.5 (0.25-4) pages long, signed by 1 (0-5) person, with evidence of legal proxy involvement in 35%, and signed by a physician in 20% of cases. Almost all the AD-Ps reviewed aimed to limit life-sustaining treatment (LST), but had widely varying content and ethical justifications, including references to earlier statements (30%) or actual behavior (11%). The most frequent explicit directives were: do-not-hospitalize (67%), do-not-tube-feed (37%), do-notattempt-resuscitation (20%), and the general exclusion of any LST (28%). Inter-rater agreement was mostly moderate (kappa ≥0.6) or strong (kappa ≥0.8).Conclusions: Although AD-Ps are an empirical reality in German nursing homes, formal standards for such directives are lacking and their ethical justification based on substituted judgment or best interest standard often remains unclear. A qualified advance care planning process and corresponding documentation are required in order to safeguard the appropriate use of this important instrument and ensure adherence to ethico-legal standards.See related editorial by Cohen et al.

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“…The Rules provide patients and their personal representatives' right of access to health information, and permit sharing identifiable health information relevant to a patient's care with involved family members or friends. 12 However, confusion regarding interpretation of these Rules, 13 complexity in the application of these Rules for specific sub-populations such as adolescents and persons with questionable capacity, 14,15 and provider prioritization of safeguarding electronic health information over its disclosure, 16 have collectively resulted in practices that inhibit family caregivers' access to health information as desired by patients. 17 Health system privacy rules were cited in one study as impeding health information access by nearly half (48.6 %) of family caregivers with technology experience.…”

Section: Introductionmentioning

confidence: 99%

Family Caregivers and Consumer Health Information Technology

2015

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Health information technology has been embraced as a strategy to facilitate patients' access to their health information and engagement in care. However, not all patients are able to access, or are capable of using, a computer or mobile device. Although family caregivers assist individuals with some of the most challenging and costly health needs, their role in health information technology is largely undefined and poorly understood. This perspective discusses challenges and opportunities of engaging family caregivers through the use of consumer-oriented health information technology. We compile existing evidence to make the case that involving family caregivers in health information technology as desired by patients is technically feasible and consistent with the principles of patient-centered and family-centered care. We discuss how more explicit and purposeful engagement of family caregivers in health information technology could advance clinical quality and patient safety by increasing the transparency, accuracy, and comprehensiveness of patient health information across settings of care. Finally, we describe how clarifying and executing patients' desires to involve family members or friends through health information technology would provide family caregivers greater legitimacy, convenience, and timeliness in health system interactions, and facilitate stronger partnerships between patients, family caregivers, and health care professionals.KEY WORDS: health information technology; electronic health records; family caregivers.

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Evaluation of the Capacity to Appoint a Healthcare Proxy

Cited by 29 publications

References 30 publications

Assessment of Healthcare Decision-making Capacity

Assessment of Healthcare Decision-making Capacity

Advance care planning by proxy in German nursing homes: Descriptive analysis and policy implications

Family Caregivers and Consumer Health Information Technology

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