Using best interests meetings for people in a prolonged disorder of consciousness to improve clinical and ethical management
Current management of people with prolonged disorders of consciousness is failing patients, families and society. The causes include a general lack of concern, knowledge and expertise; a legal and professional framework which impedes timely and appropriate decision-making and/or enactment of the dec...
| Main Author: | |
|---|---|
| Format: | Electronic Article |
| Language: | English |
| Check availability: | HBZ Gateway |
| Journals Online & Print: | Drawer...
|
| Fernleihe: | Fernleihe für die Fachinformationsdienste |
| Published: |
BMJ Publ.
2018
|
| In: |
Journal of medical ethics
Year: 2018, Volume: 44, Issue: 5, Pages: 336-342 |
| Online Access: |
Volltext (JSTOR) Volltext (lizenzpflichtig) Volltext (lizenzpflichtig) |
MARC
| LEADER | 00000caa a22000002 4500 | ||
|---|---|---|---|
| 001 | 1816157821 | ||
| 003 | DE-627 | ||
| 005 | 20230428063458.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 220908s2018 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1136/medethics-2017-104244 |2 doi | |
| 035 | |a (DE-627)1816157821 | ||
| 035 | |a (DE-599)KXP1816157821 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rda | ||
| 041 | |a eng | ||
| 084 | |a 1 |2 ssgn | ||
| 100 | 1 | |a Wade, T. |e VerfasserIn |4 aut | |
| 245 | 1 | 0 | |a Using best interests meetings for people in a prolonged disorder of consciousness to improve clinical and ethical management |
| 264 | 1 | |c 2018 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 520 | |a Current management of people with prolonged disorders of consciousness is failing patients, families and society. The causes include a general lack of concern, knowledge and expertise; a legal and professional framework which impedes timely and appropriate decision-making and/or enactment of the decision; and the exclusive focus on the patient, with no legitimate means to consider the broader consequences of healthcare decisions. This article argues that a clinical pathway based on the principles of (a) the English Mental Capacity Act 2005 and (b) using time-limited treatment trials could greatly improve patient management and reduce stress on families. There needs to be early and continuing use of formal best interests meetings, starting between 7 and 21 days after onset of unconsciousness (from any cause, including progressive disorders). The treatment options need to evolve as the clinical state and prognosis becomes more certain. A formal discussion of treatment withdrawal should occur when the upper bound of predicted recovery falls below a level the patient would have considered acceptable, and it should always be discussed when the condition is considered permanent. Any decision to stop treatment should be contingent on a formal second opinion from an independent expert who should review the clinical situation and expected prognosis, but not the best interests decision. The article also asks how, if at all, the adverse effects on the family and the resource implications of long-term care of people left in a prolonged state of unconsciousness should be incorporated in the process. | ||
| 773 | 0 | 8 | |i Enthalten in |t Journal of medical ethics |d London : BMJ Publ., 1975 |g 44(2018), 5, Seite 336-342 |h Online-Ressource |w (DE-627)323607802 |w (DE-600)2026397-1 |w (DE-576)260773972 |x 1473-4257 |7 nnns |
| 773 | 1 | 8 | |g volume:44 |g year:2018 |g number:5 |g pages:336-342 |
| 856 | |3 Volltext |u http://www.jstor.org/stable/26879734 |x JSTOR | ||
| 856 | 4 | 0 | |u https://doi.org/10.1136/medethics-2017-104244 |x Resolving-System |z lizenzpflichtig |3 Volltext |
| 856 | 4 | 0 | |u http://jme.bmj.com/content/44/5/336.abstract |x Verlag |z lizenzpflichtig |3 Volltext |
| 935 | |a mteo | ||
| 951 | |a AR | ||
| ELC | |a 1 | ||
| ITA | |a 1 |t 1 | ||
| LOK | |0 000 xxxxxcx a22 zn 4500 | ||
| LOK | |0 001 4185611765 | ||
| LOK | |0 003 DE-627 | ||
| LOK | |0 004 1816157821 | ||
| LOK | |0 005 20220908053721 | ||
| LOK | |0 008 220908||||||||||||||||ger||||||| | ||
| LOK | |0 035 |a (DE-Tue135)IxTheo#2022-08-03#E353728CEF951DB0BAC1C0AAD8C9D021A378D5E3 | ||
| LOK | |0 040 |a DE-Tue135 |c DE-627 |d DE-Tue135 | ||
| LOK | |0 092 |o n | ||
| LOK | |0 852 |a DE-Tue135 | ||
| LOK | |0 852 1 |9 00 | ||
| LOK | |0 866 |x JSTOR#http://www.jstor.org/stable/26879734 | ||
| LOK | |0 935 |a ixzs |a ixrk |a zota | ||
| OAS | |a 1 |b inherited from superior work | ||
| ORI | |a SA-MARC-ixtheoa001.raw | ||