Refusal of treatment and decision-making capacity

Bingham, Sarah-Louise

doi:10.1177/0969733011431925

Cited by 32 publications

(12 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rubin et al (2018) proposed a 7-question algorithm to provide clinicians with an ethical framework for managing treatment refusal in patients lacking capacity. 30 Case reports of medical treatment-refusal have been described in the literature, highlighting issues which may arise including impaired decision-making capacity, stigma and competing ethical principles 9,23,[31][32][33][34][35][36][37] although older adults, particularly those with mental illness, are underrepresented. Similarly, none of the aforementioned studies consider the specific ethical and human rights challenges pertinent to older adults, nor do they consider the combined interplay of medical and mental illness, and practical issues facing clinicians in the setting of treatment-refusal.…”

Section: Introductionmentioning

confidence: 99%

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

O'Cionnaith¹,

Wand²,

Peisah³

2021

CIA

View full text Add to dashboard Cite

The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice. Case Presentation: Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted. Conclusion:There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.

show abstract

Section: Introductionmentioning

confidence: 99%

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

O'Cionnaith¹,

Wand²,

Peisah³

2021

CIA

View full text Add to dashboard Cite

show abstract

“…As discussed in the literature review, patients have different reasons for refusing artificial platelets (Berend & Levi 2009, Bingham 2012, Rajtar 2013. When a patient refuses artificial blood platelets, the hospital will provide him or her with a suitable natural blood platelet type only if the patient brings donors on the same day to replace the given blood.…”

Section: Discussionmentioning

confidence: 99%

“…They suggest a working procedure to help those patients. Bingham (2012) explored the refusal of healthcare for legal and ethical reasons, done by patients who are adults. It was concluded that comprehension of these ethical and legal reasons is extremely important and will help nurses make decisions that protect the interests of vulnerable patients.…”

Section: Artificial Blood Plateletsmentioning

confidence: 99%

Blood platelet bank inventory management: an approximate dynamic programming approach

Albdulwahab¹

2021

Preprint

View full text Add to dashboard Cite

Blood platelets are precious and highly perishable; their supply and demand suffer from significant variation. Consequently, the inventory management of platelets is an actual, contemporary prob- lem of considerable human interest. Although many researchers have solved a plethora of inventory models, their solutions have faced various challenges. This dissertation models some of these chal- lenges, alongside expenses and stock levels. This dissertation is based on four key objectives: (1) to develop a blood platelet inventory model that can represent an actual blood bank inventory, while overcoming the problem's curse of dimensionality; (2) to look for the best issuing policy based on the proposed model that can serve different incoming blood platelet demands; (3) to analyze the effect of having a new, artificial blood platelet alongside the existing natural eight blood types; and (4) to enhance the proposed model for a dual-supplied regional blood platelet bank that serves a network of hospitals. Blood platelet inventory management model is a multi-period, multi-product model that considers the eight natural blood types with uncertain demand, and deterministic lead times, alongside the artificial platelet and patients right to refuse it. The study is supported by both a review of literature and a testing data provided by the Canadian Blood Service. The findings show that modeling blood platelet inventory management, including the eight blood types and their ages, represents the actual-life model without any need for downsizing. It also leads to significantly reductions in shortages and outdates while increasing reward gained and maintaining minimal inventory levels. Compared to a single supply model, the dual supply model give less shortage and outdate rates. The regional blood bank inventory model considers the fact that patients have the right to refuse transfusion using artificial blood platelets. Finally, if the percentage of artificial supply in the inventory is more than 30% and the rate of patient acceptance is more than 30%, then both outdate and shortage percentages are below 1%.

show abstract

“…They embraced the legislation, using it as a tool to champion their patients' rights, promote their individual needs and strive to enhance quality of life whilst simultaneously safeguarding them against harm. This approach was closely aligned with the MCA principles of balancing rights and protection (Bingham, 2012) and is applicable to all patient/client groups. Practitioners using this approach valued working together to draw upon expertise and to involve others who knew the person well.…”

Section: Discussionmentioning

confidence: 99%

Operationalising the Deprivation of Liberty Safeguards (DoLS) in support of brain injury survivors – views from practice

Scott

Weatherhead

Manthorpe

2021

JAP

View full text Add to dashboard Cite

Purpose Deprivation of Liberty Safeguards (DoLS), as part of the Mental Capacity Act 2005 (DoLS, 2007), was established to provide a legal framework for decision-making in respect of adults who lack capacity to make decisions in relation to their care and residence in England and Wales. The purpose of this study was to explore the DoLS decision-making process from the perspectives of health and social care practitioners when working with individuals with an acquired brain injury (ABI). Design/methodology/approach A total of 12 health and social care practitioners were interviewed in 2019–2020 about their experiences of using and making or supporting decisions in the DoLS framework with ABI survivors. Data were analysed, and a tentative explanation of variations in DoLS decision-making was developed. Findings Three distinct approaches emerged capturing different decision-making styles (risk-averse, risk-balancing and risk-simplifying) which appeared to influence the outcome of DoLS assessments. A range of mediating factors seemed to account for the variability in these styles. The wider contextual challenges that impact upon practitioners’ overall experiences and use of DoLS processes in their ABI practice were noted. Research limitations/implications The findings highlight a need for changes in practice and policy in relation to how DoLS or similar processes are used in decision-making practice with ABI survivors and may be relevant to the implementation of the Liberty Protection Safeguards that are replacing the DoLS system. Originality/value To the best of the authors’ knowledge, this is the first study to explore accounts of DoLS decision-making practices in ABI service.

show abstract

Refusal of treatment and decision-making capacity

Cited by 32 publications

References 9 publications

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

Blood platelet bank inventory management: an approximate dynamic programming approach

Operationalising the Deprivation of Liberty Safeguards (DoLS) in support of brain injury survivors – views from practice

Contact Info

Product

Resources

About