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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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At least 613 records · Page 34Linked to original sources
PubMed1993

Effects of the Patient Self-Determination Act on patient knowledge and behavior.

BACKGROUND: In effect since 1991, the Patient Self-Determination Act (PSDA) requires that institutions receiving government insurance payments document that they have informed patients of their right to decide on life-preserving measures. Implementing the PSDA should make discussion of advance directives a routine part of acute care hospital admissions. Yet the proportion of those actually completing advance directives such as living wills remains relatively small. METHODS: A telephone survey questionnaire was administered to patients who were hospitalized before and after the implementation of the PSDA. Survey questions probed patient knowledge about living wills and behavior toward obtaining living wills. RESULTS: Patient knowledge about advance medical directives correlated positively with race (white), income (> or = $10K), and level of education (high school or more). Moreover, a significantly greater number of patients hospitalized after implementation of the PSDA knew about living wills than the number of those hospitalized before the Act's implementation. However, actually obtaining a living will correlated positively with age (> 36 years) alone, and implementation of the PSDA was not related to the number of patients who obtained a living will. CONCLUSIONS: Although the study results show that the measures the hospital in the study used to meet PSDA requirements increased patient awareness of living wills, they failed to increase the number of patients who act on this awareness. This finding indicates that simply informing patients about their right of self-determination is insufficient to meet the intended goals of the legislation.

Adult↗
PubMedDate not supplied

Neonatologists and bioethics after Baby Doe.

The use of hospital ethics committees or infant care review committees has been recommended for difficult decision making. In a survey of military and civilian neonatologists, ethics committees had been established in 27 of their 28 hospitals and fewer than 50% had infant care review committees. Despite the frequently of potential cases for committee review, they were seldom consulted. Inquiry into the educational background of respondents revealed that at least 62% of neonatologists had received ethics education during their professional careers. Most made difficult decisions in conjunction with parents or used a multidisciplinary patient care conference. The use of these conferences antedated any federal regulations. Sixty-seven percent indicated that the Baby Doe regulations had affected neither their thinking about ethical issues nor their practice. In 13 different hypothetical cases in delivery room, intensive care nursery, and long-term care settings, the provision of comfort care, limited care, or withdrawal of support was noted by a sizable percentage of neonatologists; exceptions included meningomyelocele and trisomy 21. The need for ethics committee input in decision making for neonates is questionable.

Attitude of Health Personnel↗
PubMed1996

Applying advanced directives regulations in home care agencies.

As Dombi (1991) indicated, home healthcare agencies see people in their own settings and can be most influential in assisting clients and families to deal with important issues. Furthermore, in receiving care in their homes, clients and their families may be in a more amenable frame of mind to consider such issues. Agencies may find it helpful to identify special resource people who could be accessible to clients and families in enabling them to prepare appropriate documents. In a tape recording that reviews the state of life-sustaining therapy, Wolf (1993) highlighted the importance of seeing the regulations on advance directives as just the beginning of further work and discussion with clients and their families. Home healthcare agencies, in particular, need to do more than just comply with directives related to the Patient Self-Determination Act. Agencies can be in the forefront of identifying needs and concerns of clients and families related to critical life and death decisions and in exploring the ramifications of those decisions. The trend toward developing ethics committees in home healthcare agencies can be a vehicle for further exploration of such issues.

Advance Directives↗
PubMed1996

Lee v. State of Oregon.

HELD: Oregon's Death with Dignity Act, Measure 16, which legalizes physician-assisted suicide for certain terminally ill persons, violates the equal protection clause of the fourteenth amendment to the United States Constitution. Measure 16 fails to withstand even the lowest level of judicial scrutiny because the disparate treatment afforded the class of terminally ill persons does not further any legitimate state interest.

Adult↗
PubMed1996

In re Martin.

Explore the source record for details and available documents.

Bioethics↗
PubMed1997

A survey of New Zealand psychiatrists' clinical experience with the Mental Health (Compulsory Assessment and Treatment) Act of 1992.

AIMS: This study examines the clinical experience of New Zealand psychiatrists with the Mental Health (and Compulsory Assessment and Treatment) Act of 1992. METHODS: A survey was distributed to all psychiatric specialists residing in New Zealand who were registered with the Medical Council of New Zealand (n = 232). The survey examined the extent of practitioners' use of the Mental Health Act, perceived strengths and weaknesses of the Mental Health Act, and experiences with the family court system. RESULTS: Psychiatrists estimated that almost half (46.4%) of patients retained under the Mental Health Act were released within 3 weeks. Inpatient consultants reported dedicating 18.6% of their working time to Mental Health Act related activities. A majority of respondents indicated that: the Mental Health Act requires major revision (55.6%), the Mental Health Act results in the inappropriate release of some psychiatric patients into the community (70.9%), and that compulsory treatment orders are a useful tool for promoting community treatment of the mentally ill (69.2%). While a majority (81.5%) indicate that individual judges are consistent in their interpretation of the Mental Health Act across cases, only 26.5% of respondents agree that the law is interpreted uniformly by different judges. CONCLUSIONS: The Mental Health Act is perceived as time-consuming and cumbersome to administer. However, compulsory treatment orders do facilitate community treatment, an explicit goal of the Mental Health Act. Proposed areas for refinement of the Mental Health Act are discussed. Further examination of the interface between psychiatrists and the family court system would be useful.

Analysis of Variance↗
PubMed1997

Interpreting the effectiveness of involuntary outpatient commitment: a conceptual model.

Many experimental trials of community mental health interventions fail to develop testable conceptual models of the specific mechanisms and pathways by which relevant outcomes may occur, thus falling short of usefully interpreting what happens inside the experimental "black box." This paper describes a conceptual model of involuntary outpatient commitment (OPC) for persons with severe and persistent mental disorders. The model represents an attempt to "unpack" the effects of OPC by incorporating several interacting variables at various stages. According to this model, court-mandated outpatient treatment may improve long-term outcomes both directly and indirectly in several ways: by stimulating case management efforts, mobilizing supportive resources, improving individual compliance with treatment in the community, reducing clients' psychiatric symptoms and dangerous behavior, improving clients' social functioning, and finally by reducing the chance of illness relapse and rehospitalization. A randomized clinical trial of OPC is underway in North Carolina that will test the direct and indirect effects suggested by this model, using longitudinal data from the multiple perspectives of mental health clients, family members, and case managers.

Ambulatory Care↗
PubMed1997

Beyond the black letter of the law: an empirical study of an individual judge's decision process for civil commitment hearings.

To study the role of parens patriae and "police powers" considerations in an individual judge's civil commitment decisions, the judge's reports of the impact of various characteristics of the patient were analyzed. The validity of this methodology was tested by comparing it to an alternative technique based on objective statistical analysis of the dependence of the judge's decisions upon patient characteristics. A probate court judge filled out a questionnaire after each civil commitment hearing over which he presided during a seven-month study. For each of 26 decisions, the judge rated the patient on 26 features and indicated the impact of each feature on the decision. The judge's responses were analyzed to measure the role of various statutory and nonstatutory considerations (expressed as patient characteristics) in the judge's decisions. Results using self-reported impacts are compared with an objective, statistical characterization of the judge's decision-making policy. As in previous studies, the parens patriae model more closely described the individual judge's decision process than the "police powers" model. Contextual variables (e.g., the patient's family favoring commitment) also were influential. Results with the two methods were similar. The methodology developed here can be used not only in further research on judicial commitment decisions but also to educate judges and other decision-makers individually faced with potentially tragic choices as to their personal implicit decision-making strategies.

Civil Rights↗
PubMed1997

Involuntary hospitalization of delirium patients in Israel: a psychiatric case register study.

This paper compares the national Psychiatric Case Register (PCR) data of two groups of delirium patients who were admitted to psychiatric hospitals. One group consists of patients who underwent involuntary civil commitment following a hospitalization order by a district psychiatrist. The second group consists of delirium patients who were voluntarily admitted. During the period 1984-1993, 805 patients with a diagnosis of delirium were admitted to psychiatric hospitals: 710 (88%) were admitted on a voluntary basis, 88 (10.9% were admitted through civil commitment, 7 (0.8%) were admitted in other ways. The two major groups are further analysed regarding demographic, clinical and administrative variables. No statistically significant differences were found between the groups concerning the clinical and administrative variables studied (type of admission, suicide attempt prior to admission, length of hospitalization, type of discharge). Given the prevailing tendency to treat delirium patients in general hospitals, the small number of those involuntarily admitted and the lack of clinical and administrative differences between the groups, the appropriateness of civil commitment procedures regarding delirium patients is questioned.

Adolescent↗