Disparities In Decision-making Research Articles

Hospital Policy Variation in Addressing Decisions to Withhold and Withdraw Life-Sustaining Treatment

BackgroundSociodemographic disparities in clinician decisions to withhold and withdraw life sustaining treatment exist. Little is known about the content of hospital policies that guide clinicians involved in these decisions. Research QuestionWhat is the prevalence of United States hospitals with policies that address withholding and withdrawing life sustaining treatment; how do these policies approach ethically controversial scenarios; and how do these policies address sociodemographic disparities in decisions to withhold and withdraw life sustaining treatment? Study Design and MethodsThis national cross-sectional survey assessed the content of hospital policies addressing decisions to withhold or withdraw life sustaining treatment. We distributed the survey electronically to American Society of Bioethics and Humanities members between July and August 2023 and descriptively analyzed responses. ResultsAmong 93 respondents from hospitals or hospital systems representing all 50 US States, Puerto Rico, and Washington, DC, 92% had policies addressing decisions to withhold or withdraw life sustaining treatment. Hospitals varied in their stated guidance, permitting life sustaining treatment to be withheld or withdrawn in cases of patient or surrogate request (82%), physiologic futility (81%), and “potentially inappropriate” treatment (64%). Of the 8% of hospitals with policies that addressed patient sociodemographic disparities in decisions to withhold or withdraw life sustaining treatment, these policies provided opposing recommendations to either exclude sociodemographic factors in decision-making or actively acknowledge and incorporate these factors in decision-making. Only 3% of hospitals had policies that recommended collecting and maintaining information about patients for whom life sustaining treatment was withheld or withdrawn that could be used to identify disparities in decision-making. InterpretationWhile most surveyed United States hospital policies addressed withholding or withdrawing LST, these policies varied widely in criteria and processes. Surveyed policies also rarely addressed sociodemographic disparities in these decisions.

Efficient Production Factors Taking into Account The Risks In Shallot: Case Study in Nawungan Village, Imogiri District, Bantul Regency, DIY

The risks of shallot farming refer to the failure of production and price due to fluctuating prices. These farming risks cause farmers to be reluctant to take risks. Differences in risk aversion between individuals can lead to disparities in decision-making. This research seeks to analyze (1) the behavior of farmers towards the risks, and (2) the efficient use production factors by considering production risks. The study was undertaken through interviews with farmers and other relevant stakeholders and field observations. The total sample of 100 farmers was taken at simple random. The majority of farmers behaved reluctantly toward the risks. The use of production factors for land area, labor and organic fertilizers in the shallot production function is not yet efficient. While the use of seeds, Urea fertilizer, TSP fertilizer, NPK fertilizer, POSKA fertilizer, Curacron EC pesticide, Score pesticide, Sellestol pesticide and Dithane M-45 pesticide is inefficient. It is time for farmers to be advised to use organic fertilizers and organic pesticides as a substitute for inorganic fertilizers and chemical pesticides.

Racial/ethnic and gender disparities in child protection decision-making: What role do stereotypes play?

BackgroundA wide range of studies have revealed racial/ethnic and gender disparities in child protection decision-making. ObjectiveThis study investigated whether disparities are mediated by stereotypes that professionals may hold, by applying the Stereotype Content Model (SCM) which suggests that stereotypes are formed by perceptions of sociability, morality, and competence. Participants and setting258 professionals (133 current staff and 125 trainees) from Colorado participated in the study. MethodsThe study applied a 2 × 3 randomized experimental vignette design. Participants read a case in which the gender of the parent responsible for maltreatment (mother or father) and race/ethnicity of the family (white, Black, or Latinx) varied. ResultsA SEM model (CFI = .94, RMSEA = .05) with free parameters for trainees and current staff was estimated. No significant association between stereotypes and race/ethnicity and gender appeared. However, evidence for disparities emerged. In the trainee group, scores to decide for a supervision order were higher for white fathers, Black mothers, Latinx mothers, and Latinx fathers (β = 0.18 to 0.25) compared to white mothers. Current staff provided larger risk scores for Black mothers and both Latinx parents (β = 0.20 to 0.22) compared to the white mother, resulting in increased inclinations to decide for a supervision order (β = 0.26). Lastly, negative perceptions of morality increased supervision order scores (β = −0.55 to −0.36). ConclusionsEvidence for disparities in decision-making appeared, but the study could not confirm that these disparities were mediated by stereotypes. Furthermore, perceptions of morality seemed to impact decision-making processes.

The effects of migrant background and parent gender on child protection decision-making: An intersectional analysis

BackgroundDisparities in decision-making are a recognized concern within child protection systems and imply that marginalized groups are being treated unequally compared to majoritized groups. Previous studies reported that both ethnicity and the gender of the parent that maltreated the child seem associated with an increased likelihood that child protection agencies provide services after an investigation or that children are placed out of their homes. ObjectiveWe investigated whether migration background and the gender of the parent who maltreated the child seem associated with the decision whether a case was opened for continuing services. In addition, we inspected whether the intersections between migration background and parent gender were correlated with disparities in decision-making. Participants and settingOur multinational sample consisted of 1189 cases that were involved with child protection agencies in England, the Netherlands, and Germany. MethodsWe systematically coded and analyzed child protection case files. We conducted logistic regression analysis to investigate for disparities in decision-making. ResultsThe intersectional analysis showed that maltreatment committed by mothers (OR = 2.25, p = .001) and migrant fathers (OR = 2.21, p = .030) was associated with an increased likelihood to provide ongoing services. However, country specific analyses showed that these effects were most pertinent in the English sample. ConclusionsThese findings suggest a need to address migration background and gender disparities in child protection practice. Future research could investigate whether other contextual factors (e.g. characteristics of the professional and agency) seem associated with disparities in decision-making.

Disparity Analysis of Judge’s Decisions of The Crime of Premeditated Murder

Abstract: This study aims to find out the Disparity analysis of judges' decisions on the crime of premeditated murder in Decision Number 7/Pid.Sus-Anak/PN.Kbj and Decision Number 1/Pid.Sus-Anak/2016/PN.Gto. The method used in this research was normative legal research. The approach used a legal approach or a statute approach and a case approach. The judge in making a decision, of course, first sees whether the act committed by the child is intentional or unintentional so that it can be seen by a judge when enforcing Restitave Justice where one way to move the legal process through the courts is to become a legal settlement outside the court by involving the victim's family as the most important element in the settlement of a crime. However, if you look at the crimes against children that have been committed, diversion efforts are not enforced because the child has committed a very severe crime. The community needs to understand that inequality or disparity is not a bad thing but it is natural for clear legal reasons except arbitrarily, this is normal and is not prohibited by the legal system in Indonesia. The community needs to be informed in advance about the background of the emergence of disparities in decision-making.Keywords: Disparity Analysis, Murder;

Linking transportation and population health to reduce racial and ethnic disparities in transportation injury: Implications for practice and policy

ABSTRACTIn both developing and advanced economies, it is commonly believed that lower income and minority populations are disproportionately at risk of being injured or killed in a motor vehicle crash, especially as pedestrians. However, this risk is rarely quantified with information about exposure. We argue that a combined transportation–population health framework is one way to quantify, and therefore prioritize, equity considerations in transportation safety decision-making. We illustrate this approach with an analysis that compares age-adjusted fatal and nonfatal injury rates per 100 million person-trips by race/ethnicity and sex for motor vehicle occupants, bicyclists, and pedestrians. We found that, per trip, whites are equally safe as pedestrians and motor vehicle occupants, whereas other racial and ethnic groups for whom we have data are less safe when they walk. In addition, black/African-American female motor vehicle occupants and pedestrians have higher inpatient injury risk than female travelers of other races and ethnicities (for whom we had sufficient data). Such differences in transportation injury risk by race and ethnicity warrant deeper analysis to understand the underlying reasons, such as whether certain groups of travelers are exposed to qualitatively different hazards when they travel. We discuss frameworks for including information about injury disparities in decision-making.