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manual gearbox for saleA Guide for Physicians and Other Health Professionals The protection of a patient's right to decide, as well as the protection of incompetent patients from the potential harm of their decisions, rests largely on clinicians' abilities to judge patients' capacities to decide what treatment they will receive. However, confusing laws and the complicated ethical issues surrounding the concept of competence to consent have made the process of competence assessment intimidating for many clinicians. Health professionals--physicians, medical students, residents, nurses, and mental health practitioners--have long needed a concise guidebook that translates the issues for practice. That is what this book accomplishes. This volume is the product of an eight-year study of patients' capacities to make treatment decisions--the most comprehensive research of its kind. The authors describe the place of competence in the doctrine of informed consent, analyze the elements of decision-making, and show how assessments of competence to consent to treatment can be conducted within varied general medical and psychiatric treatment settings. The book explains how assessments should be conducted and offers detailed, practice-tested interview guidelines to assist medical practitioners in this task. Numerous case studies illustrate real-life applications of the concepts and methods discussed. Grisso and Appelbaum also explore the often difficult process of making judgments about competence and describe what to do when patients' capacities are limited. Winner of the American Psychiatric Association's Guttmacher Award, 2000. Preview available via Google Books. New York: Oxford University Press.A Guide for Physicians and Other Health Professionals. The 13-digit and 10-digit formats both work. Please try again.Please try again.Please try again. Used: GoodSomething we hope you'll especially enjoy: FBA items qualify for FREE Shipping and Amazon Prime. Learn more about the program.http://training-access.com/upload/brother-mfc-6890cdw-service-manual.xml
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The protection of a patient's right to decide, as well as the protection of incompetent patients from the potential harm of their decisions, rests largely on clinicians' abilities to judge patients' capacities to decide what treatment they will receive. A timely, practical handbook relevant to every medical specialty, Assessing Competence to Consent to Treatment will benefit a wide array of medical practitioners--including physicians, medical students, residents, nurses, and other allied health professionals--who need to assess the mental competence of patients in their everyday practice. It will also interest ethicists and moral philosophers, as well as geriatricians and clinical psychologists working with cognitively impaired patients. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. Show details Hide details Choose items to buy together.If patients are deemed incompetent to make informed decisions, they lose the power to make medical choices and to control their own care. In daily practice, it is physicians who frequently determine whether patients lack decision-making capacity. Assessing Competence to Consent to Treatment is a concise, lucid, wise, and practical book on how to do so. The first chapters thoughtfully describe the pertinent ethical and legal issues and analyze the components of the capacity to make decisions. The authors emphasize that assessing decision-making capacity requires more than estimating a patient's ability to make a medical choice; the physician must also take into account the demands of the particular decision-making situation and any possible harm that may result from respecting the patient's choice. The book stresses that patients may understand disclosed information and yet fail to appreciate that this information applies to their own clinical situation.http://eraucheta.ru/uploads/brother-mfc-7220-parts-manual.xml For example, patients may not accept their diagnosis or may not believe that they will not benefit from the recommended treatment. In this book, case vignettes are effectively used to illustrate these points. The next several chapters provide comprehensive, practical information on how clinicians should assess a patient's decision-making capacity. The authors suggest specific questions to ask and provide useful practical advice on how to carry out the interview. Although the authors favor the MacArthur Competence Assessment Tool, which they developed and tested, they acknowledge that physicians may prefer to use other questions. They also make it clear that no threshold score on a standardized instrument can identify patients whose ability to make a decision is inadequate. The level of impairment that disqualifies patients as decision makers should vary according to the likely benefits and risks of treatment. A few limitations of the book need to be pointed out. The book gives relatively little attention to the ultimate question -- how to judge whether the patient's choice should be respected or whether decision-making power should be given to a surrogate. It would be useful to learn more about how to make judgments in difficult situations, such as cases in which patients refuse to cooperate with an interview or hold cultural beliefs about illness that are inconsistent with Western biomedicine. Likewise, they might give more specific advice on how to adjust the standards for assessing decision-making capacity according to the relative risks and benefits of treatment. Clearly there is a danger that such adjustment may be inconsistent or biased and therefore unfair. The authors stress that these difficult judgments about decision-making capacity should be made by the patient's attending physicians; routine psychiatric consultation or involvement of the courts is neither feasible nor desirable. These decisions require expertise, judgment, and wisdom.http://seasailing.us/node/4356 This book provides extremely useful guidance. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.His books include: Trauma and Memory: Clinical and Legal Controversies (OUP, 1997) and Almost a Revolution: Mental Health Law and the Limits of Change (OUP, 1994). Full content visible, double tap to read brief content. Videos Help others learn more about this product by uploading a video. Upload video To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzes reviews to verify trustworthiness. Please try again later. Kindle Customer 5.0 out of 5 stars I am using it with our hospital bioethics committee. Luke's Medical Center, Chicago, Illinois Search for more papers by this author Field of medicine: Psychiatry and medical ethics. Format: Hardcover book. Audience: All clinicians, especially those in critical care medicine, geriatrics, and mental health. Purpose: To provide clinicians with a practical, user-friendly guide to the assessment of competence of patients with regard to consent to treatment. Content: This book covers the concept of competence and its place in the doctrine of informed consent, the circumstances in which the issue Comments are moderated. By continuing to use our website, you are agreeing to our use of cookies. You can change your cookie settings at any time. Learn more about these useful resources on our COVID-19 page. Do be advised that shipments may be delayed due to extra safety precautions implemented at our centers and delays with local shipping carriers. The protection of a patient's right to decide, as well as the protection of incompetent patients from the potential harm of their decisions, rests largely on clinicians' abilities to judge patients' capacities to decide what treatment they will receive. It will also interest ethicists and moral philosophers, as well as geriatricians and clinical psychologists working with cognitively impaired patients. His books include: Trauma and Memory: Clinical and Legal Controversies (OUP, 1997) and Almost a Revolution: Mental Health Law and the Limits of Change (OUP, 1994). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Inquire now!For renewal instructions pleaseDisclaimer: Sedo maintains no relationship with third party advertisers. Reference to any specific service or trade mark is not controlled by Sedo nor does it constitute or imply its association, endorsement or recommendation. The protection of a patient's right to decide, as well as the protection of incompetent patients from the potential harm of the decisions they might make, rests largely on clinicians' abilities to judge patients' capacities to decide what treatment they will receive. Confusing laws and complex ethical questions surrounding competence to consent to treatment have made the process of competence assessment intimidating for many clinicians. Health professionals - physicians, medical students nad residents, nurses, and mental health practitioners - have long needed a consice guidebook that translates the issue for practice. This is what this book accomplishes. The aurthors describe the place of competence in the doctrine of informed consent and show how assessments of competence to consent to treatment can be structured by using a specific set of general medical and psychiatric treatment settings, explain how the assessment should be conducted, and offer a structured interview method to assist the task. They also explore the often difficult process of making the judgement about competence and desire what to do when patients' capacities are limited. More titles by Thomas Grisso Paul S. Appelbaum, M.D., is the A.F. Zeleznik Distinguished Professor of Psychiatry, Chairman of the Department of Psychiatry, and Director of the Law and Psychiatry Program at the University of Massachusetts Medical Center, Worcester. His previous books include Almost a Revolution: Mental Health Law and the Limits of Change (OUP, 1994) and Informed Consent: Legal Theory and Clinical Practice (OUP, 1987). More titles by Paul S. Appelbaum Be the first add your own review for this title. It could have been deleted, moved, or it never existed at all. You are welcome to search for what you are looking for with the form below. Dismiss Click the link for more info on Sharepoint. N Engl J Med. 2007;357(18):1834-1840. Included in this right is the freedom to make decisions about one's physician, medical treatment plan, and other health care matters. A democratic society does, however, provide moral, ethical, and social guidelines within which these decisions must fall--medical and health care choices are no different. The goal of this framework is to optimize personal freedom and autonomy, while ensuring that individual choices are within the guidelines for safe, acceptable behavior and practice. The imposition of limits is a complicated matter, though, particularly when it comes to health care, where a patient must demonstrate decision-making capacity, often measured by his or her physician. These requests demonstrate the physicians' awareness of the importance of accurately judging patient capacity. Still, nonpsychiatrist physicians overwhelmingly determine patient fitness to make treatment decisions on their own. In practice, this means holding patients who are facing more serious procedures and therapies to higher standards of competence. Still, it is reasonable to ask that physicians take the positive endorsement and the criticisms of this “sliding scale” into account before applying it into clinical practice. First, by what standards is the physician basing his or her judgment of the patient's understanding. Furthermore, reliance on the standardized tools assumes that the physician has taken the time to explain the patient's condition adequately and answer his or her questions--something that perhaps should not be assumed. In short, I believe that the overarching question is: how reliable are these assessments? In order to achieve greater uniformity, a physician must know how to execute the exams properly. But do physicians receive specialized training for the specific assessment they will give. If the test itself is standardized, what are the procedures for administering it.Appelbaum gives this little attention in the article, speaking about it specifically only when discussing situations in which an outside evaluator is called upon. He writes: Before patients can be properly evaluated for competency, they must be given information related to their condition. Further, physicians must do more than just tell patients about a proposed procedure or therapy and its risks and benefits. They must communicate in ways that patients understand, even if it means requesting a language translator or using terms that are understandable to those who are not trained in medicine. Physicians must also ask questions that compel the patient to demonstrate a deeper understanding of the treatment proposals, not merely prompt the patient to parrot information back. I think that it is entirely possible that, for some patients the decision about an elective procedure may be more difficult to make than the decision about whether to undergo treatment for a life-threatening condition. When a patient is uninsured or underinsured, he or she is likely to have more than just the risks and benefits to consider. The patient might also weigh which procedure is least expensive, which will be best covered by his or her insurance, or which has the quickest recovery time so that he or she can return to work. Because interventions for life-saving illnesses are more likely to be subsidized by insurance, patients may be willing to undergo those procedures more readily than they would less serious or preventive procedures that, while important, are not covered by insurance. The combination of necessity and health insurance can thus significantly simplify or complicate the patient's decision-making process. Physicians must carefully judge whether a patient's decision--especially if it is suboptimal in the doctor's opinion--is one of incompetence and negligence or of pragmatism and personal choice. This article assumes that the physician has communicated effectively with the patient about the latter's diagnosis, treatment options, and the risks and benefits of those options--including the option of no treatment at all. Assuming that the informed consent process was managed effectively, as this article does, leaves a big piece of the competency assessment puzzle missing. Readers will have to make use of Appelbaum's many bibliographic references to complete the picture. Informed Consent: Legal Theory and Clinical Practice. 2nd ed. New York, NY: Oxford University Press; 2001. Accessed July 21, 2008. She will begin a master's program in social work at the University of Chicago School of Social Service Administration in the fall of 2008. All Rights Reserved. Close this message to accept cookies or find out how to manage your cookie settings. Total loading time: 0.352. Render date: 2021-07-14T01:14:37.791Z. Has data issue: true. English Francais Advances in Psychiatric Treatment Article contents Extract References Competence and consent to treatment in children and adolescents. Published online by Cambridge University Press: For example, competent minors can consent, but their refusal can be overruled by the consent of a person with parental authority or by the court. This paper is an attempt to make sense of the topic for clinicians. It includes a discussion of the law and the small body of relevant research evidence. There are clinical case examples, checklists and guidelines for good practice. However, it is not a substitute for legal advice, which should be sought wherever doubt remains. InformationFor example, competent minors can consent, but their refusal can be overruled by the consent of a person with parental authority or by the court. However, it is not a substitute for legal advice, which should be sought wherever doubt remains. The 14-year-olds showed a level of competence similar to that of the two adult groups. There were deficits in the 9-year-olds' understanding and reasoning, but their conclusions were very similar to those of the other groups. Surgery was being undertaken for relief of chronic pain, disability or deformity, and on average the patients had already had five operations. It seems likely that past exposure to treatment decisions made the orthopaedic group more confident, suggesting that young people can be prepared for making treatment decisions. This suggests that these health professionals were in danger of expecting too much of their young patients. Asked what they might do if they disagreed with their parents over the decision on surgery, relatively few said they would try to get their own way (22 of boys, 11 of girls). This suggests that conflict of this sort was relatively unlikely. Reviewing what research can contribute to our understanding of competence, Rutter (1999) concludes: That is because there is no universally acceptable level of competence that applies to an individual child. Rather, the question is of a child's competence in a particular context, for a particular type of decision, given particular circumstances.” The Gillick decision (see below) defines competence as the ability to understand information about the proposed treatment. This includes the treatment's purpose, nature, likely effects and risks, chances of success and the availability of any alternatives. The patient may weigh the information differently from the doctor, and unwise choices are permitted. Also, understanding does not imply that a decision is made on a rational basis.If the treatment is simple, effective and relatively risk-free, a high-level criterion will be selected and a patient who refuses is more likely to be deemed incompetent. Alternatively, where the treatment is dangerous and the benefits speculative, a lower criterion is selected, to protect the patient's autonomy. Pearce (1994) argues: Understanding can only be inferred and not observed directly, it is influenced by the quality of information given, and the ability to understand is not the same as actual understanding. Roth et al (1977) say, This, as Devereux et al (1993) put it, is revealed in In her judgment Lady Justice Butler-Sloss drew attention to: Again careful scrutiny of the evidence is necessary because fear of an operation may be a rational reason for refusal to undergo it. Fear may also, however, paralyse the will and thus destroy the capacity to make a decision.” (p. 224). Their recommendations are outlined in Box 1. In complex cases it is best practice for an independent clinician to advise on competence. It is vital to document carefully all the factors contributing to a judgement of competence. Finally, it is important not to set a higher standard for competence than would be expected for adults. He has become unhappy and hostile since it emerged that his mother was having an affair. Biological symptoms of depression responded to antidepressants.She understands that all living things need energy and water to survive, but claims she does not want to become incapacitated or die. Although he is behaving irrationally, there is no suggestion that his capacity to understand is impaired. By contrast, it is doubtful whether the girl appreciates the physical dangers of not eating. Although she may be able to comprehend and retain the relevant information, she is unable to believe it (in the sense of seeing how it applies to her) or weigh it in the balance. (If this girl needs to be treated against her wishes, the Mental Health Act 1983 will go further than the Children Act to protect her rights - see Refusal below.) An adult having parental responsibility (including a local authority having a care order) can give consent on behalf of a young person (before the 18th birthday). However, this power is subject to a number of qualifications.As is well known, this case examined the circumstances in which it would be lawful to give contraceptive advice to a young person under the age of 16 years without the parents' permission. In his judgment Lord Scarman said: West Norfolk and Wisbech Area Health Authority, 1986 ). In his ruling in the Gillick case, Lord Fraser set out five preconditions that would justify a doctor prescribing contraceptives to a young woman under the age of 16 years without her parents' consent. These are summarised as follows:The onus is on the latter to obtain a prohibited steps order under section 8. Alderson (1993) cites: respect for the child; to answer questions and help the child know what to expect; to reduce anxiety; to help the child make sense of the experience; to warn about risks; to prevent misunderstanding or resentment; to promote confidence and courage; and to increase compliance. Rylance et al (1995) looked at consent in an immunisation campaign for school children. They distributed a questionnaire concerning consent to 851 school pupils (11- to 15-years-old) within 21 days of the campaign; 513 (60) were completed and returned. While 435 (85) children felt they had sufficient understanding to make a decision regarding immunisation, only four (1) considered the information leaflet to be directed at young people, and only 34 (7) reported that they had been asked to give consent. Most did not believe that attending the immunisation session implied consent (333, 65), or that health professionals should assume that they consented (300, 58). She told no one at the time and is still reluctant to tell her parents. It is then a matter of judgement whether it is safer to encourage her to talk to her parents, respecting her decision if she chooses not to tell them, or to break her confidence. The onus is on the latter to obtain a prohibited steps order (Children Act, s8 (1)). Unmarried fathers do not have parental responsibility unless they have taken legal steps to acquire it. It is good practice to keep an absent parent informed, but a matter of judgement how far to pursue this under circumstances like this where there is conflict. The Children Act explicitly gives competent under-16-year-olds the right to refuse assessment and treatment in the very limited circumstances of care proceedings (which can be overridden by the court). There are five provisions in the Act whereby a child of sufficient understanding to make an informed decision may refuse medical or psychiatric examination or other assessment: s38 (6), s43 (8), s44 (7) and paragraphs 4 (4) (a) and 5 (5) (a) of Schedule 3; and one provision where the child can refuse medical or psychiatric treatment: paragraph 5 (5) (a) of Schedule 3. But the central premise of the Children Act is that “the child's welfare shall be the court's paramount consideration” (s1 (1)). Unlike the competent adult, the competent child's views may be overruled in pursuit of his or her welfare. They concern R, a 15-year-old woman refusing antipsychotic medication, and W, a 16-year-old woman with anorexia nervosa refusing transfer to another treatment centre. In the case of R, Lord Donaldson argued that in the Gillick ruling: These rulings have effectively made it impossible for a competent minor to refuse treatment and have led to controversy. In his judgment in Re W, Lord Justice Balcombe admitted: In cases involving sterilisation or abortion the court's guidance should always be sought. If neither the young person nor any other person can give valid consent, the authority of the court should be sought, unless emergency treatment is required. When he or she is in care, the local authority has parental responsibility and can give consent (parents also retain responsibility and it is good practice to consult them). Young people who are wards can only receive treatment with the leave of the court ( Re G-U (A Minor) (Wardship) ), and the court can use its inherent jurisdiction to overrule a competent child ( Re W). A competent young person could instruct a solicitor to seek a specific steps order, but this would require an unusual degree of initiative and understanding of the law. This contrasts with the strict safeguards governing restriction of liberty in the Children Act: a young person's liberty cannot be restricted for more than 72 hours in any consecutive 28 days without the authority of the court (Regulation 10(1)) and must have access to legal representation in any proceedings (S25 (6)). With its requirement for a second opinion, time-limited application and opportunity for independent review, the Mental Health Act goes further than the Children Act to protect the rights of young people treated against their wishes. However, there is still a stigma attached to being detained under the Mental Health Act. Where there is a choice between using the Mental Health Act or the Children Act, account may be taken of the family's preferences.The court needs to intervene if parents withhold treatment, the young person is either not competent or refuses to consent, discussion and modification of a treatment plan have been exhausted, or the young person is more likely than not to suffer significant harm without treatment. Where the parents' refusal is part of a wider process of neglect or abuse, a care order may be appropriate. This gives the local authority parental responsibility and the treatment can proceed with its consent.Article 8 of the Act deals with the right to “private and family life” and could form the basis for a challenge to the court's existing approach to young people and refusal to treatment. In these circumstances it may be utterly inappropriate to use parental authority to override the young person's objections (in the last resort application to the court may be needed). Pearce (1994) suggests that Even when overruling a young person's refusal it will often be possible to give limited choices. Her mother has a long history of depression and agoraphobia and the family is socially very isolated. Despite close liaison with the paediatric team and school over several years, the local child and adolescent mental health service has not managed to engage the family. He and his mother were repeatedly threatened and physically assaulted by his substance-misusing father. His mother is now in a relationship with a non-violent partner, but continues to be troubled by post-traumatic stress disorder and bouts of depression. The family has been referred to a child psychiatric in-patient unit and, while the mother is very motivated to get help, the boy is adamant that he will not go into hospital and physically attacked staff on his first visit to the unit. If the situation does not improve the girl might have to be removed from home. For admission to succeed considerable time and patience will be needed to engage this boy. An important step in that direction may be making him aware that he has a choice. Unfortunately, this is an area where legal advice can vary, so clinicians need to be sure of the support of their trust's solicitors and defence organisations.Buckingham: Open University Press. Google Scholar. CrossRef Google Scholar London: BMA. Google Scholar. London: BMA. Google Scholar London: Department of Health. Google Scholar London: The Stationery Office. London: The Stationery Office. CrossRef Google Scholar PubMed London: GMC. Google Scholar. London: Butterworth. 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