Standards for Health Care Decision-Making: Legal and Practical Considerations

This Article explores the guardian’s role in making, or assisting the ward to make, health care decisions, and provides an overview of existing standards and tools that offer guidance in this area. Part II outlines briefly the legal decisions and statutory developments assuring patient autonomy in medical treatment, and shows how these legal texts apply to and structure the guardian’s role as health care decision-maker. Part III examines the range of legal and practical approaches to such matters as decision-making standards, determining the ward’s likely treatment preferences, and resolving conflicts between guardians and health care agents appointed by the ward. Part IV offers a general road map for legal and ethical decision-making in the health care arena. Finally, Part V offers scenarios based on real-life stories to illustrate how these standards and tools can guide guardians towards appropriate decisions in particular cases

Standards for Health Care Decision-Making: Legal and Practical Considerations

This Article explores the guardian’s role in making, or assisting the ward to make, health care decisions, and provides an overview of existing standards and tools that offer guidance in this area. Part II outlines briefly the legal decisions and statutory developments assuring patient autonomy in medical treatment, and shows how these legal texts apply to and structure the guardian’s role as health care decision-maker. Part III examines the range of legal and practical approaches to such matters as decision-making standards, determining the ward’s likely treatment preferences, and resolving conflicts between guardians and health care agents appointed by the ward. Part IV offers a general road map for legal and ethical decision-making in the health care arena. Finally, Part V offers scenarios based on real-life stories to illustrate how these standards and tools can guide guardians towards appropriate decisions in particular cases

Assuring Detached But Passionate Investigation and Decision : The Role of Guardians Ad Litem in Saikewicz-type Cases

The author focuses this Article upon the aspect of the Saikewicz decision which determines that the kind of proxy consent question involved in that case required for its decision the process of detached but passionate investigation and decision that forms the ideal on which the judicial branch of government was created. This aspect of the decision has drawn much criticism from the medical community on the ground that it embroils what doctors believe to be a medical question in the adversarial processes of the court system. The author criticizes the decision from an entirely opposite perspective, arguing that the court\u27s opinion fails in not laying down guidelines that would assure a truly adversary process in Saikewicz-type cases. He agrees with the Saikewicz court that our democratic institutional structure and societal commitment to individual liberty require that persons not competent to consent for themselves to acts of euthanasia be protected by a process of detached but passionate investigation. However, he points out that this ideal of the court system was not realized in Saikewicz itself and is not likely to be realized in other cases without reform of some of the procedures currently being employed by the courts in proxy consent cases. Drawing on previous articles that he has written in related areas, he then proposes a set of guidelines that he believes not only will remove existing procedural deficiencies, but also may reform some aspects of the existing system that have drawn criticism from the medical community

Boys Will Be Boys, Girls Will Be...

Lets talk about sex. Well not really, just the double standard that comes with the topic. It’s no secret that men and women are taught to think about sex differently. While there are many (myself included) who fail to accept these culturally imposed ideas and attitudes about sex, it would be incredibly naïve to not acknowledge the existence of the double standard that exists. [excerpt

The public use of reason: A philosophical understanding of knowledge sharing

Copyright @ 2005 Common Ground PublishingFree access to knowledge and knowledge-sharing are among the most relevant claims of the so called "knowledge society", whose beginnings can be find out in the Age of Enlightenment (18th Century). As a matter of fact, in the thinking of Immanuel Kant these claims are explicitly assumed in a philosophical perspective. Thus, the need of sharing knowledge, and in general the need of freedom in the communication of thinking, is not merely held as self evident or just empirically given: on the contrary, Kant asks about its transcendental meaning, and attempts to deduce this meaning a priori from the essence of human being itself. However, this task is not systematically developed, but rather exposed en passant in different passages of his work, where, facing phenomena such as the amazing expansion of book trade, the increasing diffusion of journals and newspapers, the growing role of public opinion and the fierce fighting for freedom of press, Kant tries to demonstrate their critical significance - and therefore also the threat they may represent ñ for the use of reason and thus for the manifestation of human nature as such. In this perspective, he elaborates the concept of the "public use of reason", which will represent the (more or less unspoken) canon for the present understanding of the modern society as a knowledge-based society. The paper analyses Kant' s thought on these topics, with particular reference to the concept of "enlightenment" and of the sense of access to knowledge in a philosophical perspective. Then it considers the misleading transformation of these critical concepts in present day society as characterised by mass culture

Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières

BACKGROUND: Chagas disease (American trypanosomiasis) is a zoonotic or anthropozoonotic disease caused by the parasite Trypanosoma cruzi. Predominantly affecting populations in poor areas of Latin America, medical care for this neglected disease is often lacking. Médecins Sans Frontières/Doctors Without Borders (MSF) has provided diagnostic and treatment services for Chagas disease since 1999. This report describes 10 years of field experience in four MSF programs in Honduras, Guatemala, and Bolivia, focusing on feasibility protocols, safety of drug therapy, and treatment effectiveness. METHODOLOGY: From 1999 to 2008, MSF provided free diagnosis, etiological treatment, and follow-up care for patients <18 years of age seropositive for T. cruzi in Yoro, Honduras (1999-2002); Olopa, Guatemala (2003-2006); Entre Ríos, Bolivia (2002-2006); and Sucre, Bolivia (2005-2008). Essential program components guaranteeing feasibility of implementation were information, education, and communication (IEC) at the community and family level; vector control; health staff training; screening and diagnosis; treatment and compliance, including family-based strategies for early detection of adverse events; and logistics. Chagas disease diagnosis was confirmed by testing blood samples using two different diagnostic tests. T. cruzi-positive patients were treated with benznidazole as first-line treatment, with appropriate counseling, consent, and active participation from parents or guardians for daily administration of the drug, early detection of adverse events, and treatment withdrawal, when necessary. Weekly follow-up was conducted, with adverse events recorded to assess drug safety. Evaluations of serological conversion were carried out to measure treatment effectiveness. Vector control, entomological surveillance, and health education activities were carried out in all projects with close interaction with national and regional programs. RESULTS: Total numbers of children and adolescents tested for T. cruzi in Yoro, Olopa, Entre Ríos, and Sucre were 24,471, 8,927, 7,613, and 19,400, respectively. Of these, 232 (0.9%), 124 (1.4%), 1,475 (19.4%), and 1,145 (5.9%) patients, respectively, were diagnosed as seropositive. Patients were treated with benznidazole, and early findings of seroconversion varied widely between the Central and South American programs: 87.1% and 58.1% at 18 months post-treatment in Yoro and Olopa, respectively; 5.4% by up to 60 months in Entre Ríos; and 0% at an average of 18 months in Sucre. Benznidazole-related adverse events were observed in 50.2% and 50.8% of all patients treated in Yoro and Olopa, respectively, and 25.6% and 37.9% of patients in Entre Ríos and Sucre, respectively. Most adverse events were mild and manageable. No deaths occurred in the treatment population. CONCLUSIONS: These results demonstrate the feasibility of implementing Chagas disease diagnosis and treatment programs in resource-limited settings, including remote rural areas, while addressing the limitations associated with drug-related adverse events. The variability in apparent treatment effectiveness may reflect differences in patient and parasite populations, and illustrates the limitations of current treatments and measures of efficacy. New treatments with improved safety profiles, pediatric formulations of existing and new drugs, and a faster, reliable test of cure are all urgently needed

Sharing Social Research Data in Ireland: A Practical Tool

Your data is valuable and has an importance outside your own original project. Allowing other researchers to reuse your data maximises the impact of your work, and benefits both the scholarly community and society in general. Sharing your data allows other researchers to use your material in ways you may not have thought of, or may not have been able to do within your research project. It allows other researchers to replicate your findings, to verify your results, test your instruments and compare with other studies. It also allows them to use your work to expand knowledge in important areas. It provides value for money by reducing duplication and advancing knowledge and also has a significant value in education, as it allows both graduate and under-graduate students to develop their skills in qualitative and quantitative research by using high-quality data in their studies, without having to conduct their own surveys.Archiving your data also guarantees its long-term preservation and accessibility. As many research teams are assembled only for individual projects, long-term preservation and access to research data collections can only be guaranteed if they are deposited in an archive which will manage them, ensure access and provide user-support. In addition, the archives will ensure that the datasets do not become obsolescent or corrupted.Finally, increasingly funders require that you make your research data available as a condition of their funding your research, so that other researchers can test your findings, and use your data to extend research in your area. Equally, publishers are also specifying access to research data as a condition for publication

Comment: Judicial Selection and Decisional Independence

To protect the decisional independence of judges without disturbing the proper balance of control on the exercise of judicial power, substantive reforms to the selection processes should include adjustments in judicial term length, responsible campaign finance reform and efforts to assure public understanding of the role of the judiciary in the government structure of the US

A review of Link Ethiopia's sponsorship programme: learning from small stories

This report highlights the small stories of nine participants who are part of Link Ethiopia’s sponsorship programme. Link Ethiopia has celebrated 20 years of work in Ethiopia, and it is dedicated to changing lives through education and increasing cultural awareness among young people in Ethiopia and the UK. There are currently over 200 students who are part of the programme that aims to provide resources to children and young people with the aim of reducing potential barriers to learning. The nine children and guardians featured in this report speak highly of the programme and value its contribution in supporting individual educational and career aspirations. The report discusses the children and young people’s perceptions of being part of the programme and the role of Link Ethiopia in supporting their educational ambitions, before outlining potential areas for improvement