Supported Decision Making With People at the Margins of Autonomy

Peterson, Andrew; Karlawish, Jason; Largent, Emily A.

doi:10.1080/15265161.2020.1863507

Cited by 50 publications

(35 citation statements)

References 51 publications

(43 reference statements)

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“…Other justifications for deception and nudging may be found in the idea of supported decision‐making, particularly for people who are marginally autonomous or have dynamic impairments 33 . In this decision‐making model, the person with impaired capacity freely chooses to be supported by a trusted party who assists them to exercise their self‐determination.…”

Section: Two Sets Of Ethical Concernsmentioning

confidence: 99%

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

Anderson¹,

Teti²,

Hercules³

et al. 2022

Hastings Center Report

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Decisions made in health care architecture have profound effects on patients, families, and staff. Drawing on research in medicine, neuroscience, and psychology, design is being used increasingly often to alter specific behaviors, mediate interpersonal interactions, and affect patient outcomes. As a result, the built environment in health care should in some instances be considered akin to a medical intervention, subject to ethical scrutiny and involving protections for those affected. Here we present two case studies. The first includes work aimed at manipulating the behavior of persons with neurocognitive impairments, often in long‐term care facilities. This is done to ensure safety and minimize conflicts with staff, but it raises questions about freedom, consent, and disclosure. The second concerns design science in service of improved outcomes, which involves research on improving patient outcomes or the performance of health care teams. There is evidence that in some ICU designs, certain rooms correlate to better outcomes, giving rise to questions about equity and fairness. In other cases, a facility’s architecture seems to be putting a finger on the scale of equipoise, raising questions about the intentionality of clinical judgment, freedom of choice, and disclosure. As a result of this innovation occurring outside the boundaries of traditional care delivery and oversight, important ethical questions emerge concerning both the individual patient and patient populations. We discuss, analyze, and make recommendations about each and suggest future directions for these and related issues.

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Section: Two Sets Of Ethical Concernsmentioning

confidence: 99%

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

Anderson¹,

Teti²,

Hercules³

et al. 2022

Hastings Center Report

View full text Add to dashboard Cite

show abstract

“…Again, this conclusion is part of the existing consensus, but our view expands the scope of decisions that patients should be considered capacitated to make. Our view may have similar upshot for the emerging literature on supported decision making (Peterson, Karlawish, and Largent 2020).…”

Section: Conclusion: Broader Consequences Of Our Viewmentioning

confidence: 53%

Three Kinds of Decision-Making Capacity for Refusing Medical Interventions

Navin

Brummett

Wasserman

2021

The American Journal of Bioethics

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According to a standard account of patient decision-making capacity (DMC), patients can provide ethically valid consent or refusal only if they are able to understand and appreciate their medical condition and can comparatively evaluate all offered treatment options. We argue instead that some patient refusals can be capacitated, and therefore ethically authoritative, without meeting the strict criteria of this standard account-what we call comparative DMC. We describe how patients may possess burdens-based DMC for refusal if they have an overriding objection to at least one burden associated with each treatment option or goals-based DMC for refusal if they have an overriding goal that is inconsistent with treatment. The overridingness of a patient's objections to burdens, or of their commitment to a goal, can justify the moral authority of their refusal, even when a patient lacks some of the cognitive capacities that standard accounts of DMC involve.

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“…[266][267][268] A third approach to fostering functional interaction is the use of supported decision making. 269,270 Supported decision making involves an adult with cognitive impairments (i.e., the "beneficiary") entering freely into an agreement with a closely trusted person or persons (i.e., the "supporter(s)") who assist the beneficiary in exercising and amplifying her self-determination.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Neuroethics across the Disorders of Consciousness Care Continuum

Young

Peterson

2022

Semin Neurol

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This review provides an ethical analysis of disorders of consciousness (DoC) along the care continuum, from preinjury to injury, acute care to subacute care and early rehabilitation, and finally transitioning to chronic rehabilitation and societal reintegration. We provide an actionable, chronological assessment of ethical issues related to DoC care. This expands upon established ethics literature, which focuses almost exclusively on the clinical encounter for DoC. Our goal is to broaden the aperture of ethical analysis to address how social and environmental conditions predispose some persons to brain injury, and how such conditions might also pose barriers to meaningful societal reintegration after recovery.

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Supported Decision Making With People at the Margins of Autonomy

Cited by 50 publications

References 51 publications

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

Three Kinds of Decision-Making Capacity for Refusing Medical Interventions

Neuroethics across the Disorders of Consciousness Care Continuum

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