Physicians and Maternal-Fetal Conflicts: Duties, Rights and Responsibilities

The physician-patient relationship is substantially influenced by issues involving ethics, morality, law, and politics. Throughout this article, the nexus between law and medicine will be emphasized. Perhaps the most important of these associations is the relationship between principles, duties and rights. Justice Holmes aptly stated that since no rights were absolute, they were poor tools for analysis in any case because they were not truly fundamental considerations. Duties precede rights logically and chronologically. Holmes eventually came to view duties as derivative notions and thought that it was essential to understand the principles at work, not the moral sounding labels attached to the results. Consistent with this reasoning, this article will explore the nature of the ethical and legal foundations of the physician-patient relationship and its most important principle, the doctrine of informed consent. In addition, it will review the constitutional legitimacy of the relationship, the duties imposed upon it, which rights, if any, flow to the mother and the fetus, and how these principles interact with the physician\u27s role in so-called maternal-fetal conflicts. The ultimate question is whether the state can formulate a compelling interest in overruling the autonomy of the individual patient, in this case, a pregnant woman. The entire area of reproductive technology, prenatal care, and the approach to the fetus is affected by this issue, and this analysis should provide a clearer understanding of the physician\u27s medical and legal role in such controversies

Ariel - Volume 1 Number 3

Copyright 1969 Arie

Ariel - Volume 2 Number 2

Editors Delvyn C. Case, Jr. Paul M. Fernhoff News Editors Richard Bonanno Daniel B. Gould Ronald A. Hoffman Lay-Out Editor Carol Dolinskas Sports Editor James J. Nocon Contributing Editors MichaeI J. Blecker Lin Sey Edwards Jack Guralnik W. Cherry Light Features Editor Donald A. Bergman Stephen P. Flynn Business Manager Nick Grego Public Relations Robin A. Edward

Ariel - Volume 1 Number 2

Copyright 1969 Arie

Ariel - Volume 2 Number 5

Editors Delvyn C. Case, Jr. Paul M. Fernhoff News Editors Richard Bonanno Robin A. Edwards Features Editors Stephen P. Flynn Steven A. Ager Lay-Out Editor Carol Dolinskas Contributing Editors Michael J. Blecker W. Cherry Light Eugenia Miller Lin Sey Edwards Jack Guralnik Tom Williams James Noco

Developing a proxy version of the Adult Social Care Outcome Toolkit (ASCOT)

Background: Social care-related quality of life is a key outcome indicator used in the evaluation of social care interventions and policy. It is not, however, always possible to collect quality of life data by self-report even with adaptations for people with cognitive or communication impairments. A new proxy-report version of the Adult Social Care Outcomes Toolkit (ASCOT) measure of social care-related quality of life was developed to address the issues of wider inclusion of people with cognitive or communication difficulties who may otherwise be systematically excluded. The development of the proxy-report ASCOT questionnaire was informed by literature review and earlier work that identified the key issues and challenges associated with proxy-reported outcomes. Methods: To evaluate the acceptability and content validity of the ASCOT-Proxy, qualitative cognitive interviews were conducted with unpaid carers or care workers of people with cognitive or communication impairments. The proxy respondents were invited to ‘think aloud’ while completing the questionnaire. Follow-up probes were asked to elicit further detail of the respondent’s comprehension of the format, layout and content of each item and also how they weighed up the options to formulate a response. Results: A total of 25 unpaid carers and care workers participated in three iterative rounds of cognitive interviews. The findings indicate that the items were well-understood and the concepts were consistent with the item definitions for the standard self-completion version of ASCOT with minor modifications to the draft ASCOT-Proxy. The ASCOT-Proxy allows respondents to rate the proxy-proxy and proxy-patient perspectives, which improved the acceptability of proxy report. Conclusions: A new proxy-report version of ASCOT was developed with evidence of its qualitative content validity and acceptability. The ASCOT-Proxy is ready for empirical testing of its suitability for data collection as a self-completion and/or interview questionnaire, and also evaluation of its psychometric properties

Developing a proxy version of the Adult Social Care Outcome Toolkit (ASCOT)

Background: Social care-related quality of life is a key outcome indicator used in the evaluation of social care interventions and policy. It is not, however, always possible to collect quality of life data by self-report even with adaptations for people with cognitive or communication impairments. A new proxy-report version of the Adult Social Care Outcomes Toolkit (ASCOT) measure of social care-related quality of life was developed to address the issues of wider inclusion of people with cognitive or communication difficulties who may otherwise be systematically excluded. The development of the proxy-report ASCOT questionnaire was informed by literature review and earlier work that identified the key issues and challenges associated with proxy-reported outcomes. Methods: To evaluate the acceptability and content validity of the ASCOT-Proxy, qualitative cognitive interviews were conducted with unpaid carers or care workers of people with cognitive or communication impairments. The proxy respondents were invited to ‘think aloud’ while completing the questionnaire. Follow-up probes were asked to elicit further detail of the respondent’s comprehension of the format, layout and content of each item and also how they weighed up the options to formulate a response. Results: A total of 25 unpaid carers and care workers participated in three iterative rounds of cognitive interviews. The findings indicate that the items were well-understood and the concepts were consistent with the item definitions for the standard self-completion version of ASCOT with minor modifications to the draft ASCOT-Proxy. The ASCOT-Proxy allows respondents to rate the proxy-proxy and proxy-patient perspectives, which improved the acceptability of proxy report. Conclusions: A new proxy-report version of ASCOT was developed with evidence of its qualitative content validity and acceptability. The ASCOT-Proxy is ready for empirical testing of its suitability for data collection as a self-completion and/or interview questionnaire, and also evaluation of its psychometric properties

Exploring the views of being a proxy from the perspective of unpaid carers and paid carers: developing a proxy version of the Adult Social Care Outcomes Toolkit (ASCOT)

Background: Outcomes-based policy and administration of public services present a compelling argument for the value of outcomes data. However, there are a number of challenges inherent in collecting these data from people who are unable to complete a paper-based survey or interview due to cognitive or communication impairments. In this paper, we explore the views of being a proxy from the perspective of unpaid carers and paid carers who may be asked to act as a proxy on behalf of the person(s) they care for. We consider the key issues that need to be addressed when adapting an instrument designed to measure social care outcomes, the Adult Social Care Outcomes Tool (ASCOT), into a proxy-report tool. Methods: Participants took part in either a focus group (35 paid carers in eight focus groups), or a one-to-one interview (eight unpaid carers). All participants were recruited via carer organisations and care providers. Transcripts, field notes and audio data collected during focus groups and interviews were analysed using a thematic framework approach. Results: Participants agreed that any person acting as a proxy would need to be very familiar with the care recipient, as well as their needs and care provision. A number of provisions for proxy respondents were proposed to improve face validity and acceptability of completing a questionnaire by proxy, and to ensure that any potential bias is reduced in the design of the questionnaire. These included: providing two sets of response options for each proxy perspective (the proxy themselves and the proxy view of how they think the care recipient would respond); a comments box to help people explain why they have selected a given response option (especially where these indicate unmet need); and providing clear guidance for the proxy respondent on how they should complete the questionnaire. Conclusions: This study has shown some of the challenges involved in assessing outcomes by proxy and explored some potential ways these can be mitigated. The findings highlight the benefits of developing and testing proxy measures in a robust way to widen participation in social care research