Autonomy In Health Care Research Articles

Balancing paternalism and autonomy in healthcare: Insights from Ayurveda

The doctor–patient relationship has undergone a transition throughout the ages. Before the last two decades, the relationship was predominantly between a patient seeking help and a doctor whose decisions were silently complied with by the patient. In this paternalistic model of the doctor–patient relationship, the doctor utilizes his skills to choose the necessary interventions and treatments most likely to restore the patient’s health or ameliorate his pain. Any information given to the patient is selected to encourage them to consent to the doctor’s decisions. This description of the asymmetrical or imbalanced interaction between doctor and patient has been challenged during the past 20 years. Critics have proposed a more active, autonomous and thus patient-centered role for the patient who advocates greater patient control, reduced physician dominance, and more mutual participation. This patient-centered approach has been described as one where “the physician tries to enter the patient’s world, to see the illness through the patient’s eyes” and has become the predominant model in clinical practice today.

An “ethics of strangers”? On knowing the patient in clinical ethics

The shape and function of ethical imperatives may vary if the context is an interaction between strangers, or those who are well acquainted. This idea, taken up from Stephen Toulmin’s distinction between an “ethics of strangers” and an “ethics of intimacy”, can be applied to encounters in healthcare. There are situations where healthcare personnel (HCP) know their patients (corresponding to an “ethics of intimacy”) and situations where HCP do not know their patients (corresponding to “an ethics of strangers”). Does it make a difference for normative imperatives that follow from central concepts and principles in medical ethics whether HCP know their patients or not? In our view, this question has not yet been answered satisfactorily. Once we have clarified what is meant by “knowing the patient”, we will show that the distinction is particularly relevant with regard to some thorny questions of autonomy in healthcare (e.g., regarding advance directives or paternalism in the name of autonomy), whereas the differences with regard to imperatives following from the principles of justice and beneficence seem to be smaller. We provide a detailed argument for why knowing the patient is ethically valuable in encounters in healthcare. Consequently, healthcare systems should provide fertile ground for HCP to get to know their patients, and structures that foster therapeutic continuity. For this to succeed, a number of questions still need to be clarified, which is an important task for medical ethics.

Health care and contraceptive decision-making autonomy and use of female sterilisation among married women in Malawi.

Female sterilisation is the most common contraceptive method used globally. The use of female sterilisation is disproportionately low in sub-Sahara Africa (SSA) at just 1%. Nonetheless, the prevalence of sterilisation among married women in Malawi is quite high at about 11%. While a few recent studies in SSA have examined the relationship between women's decision-making autonomy and use of long-acting contraceptives, very few have investigated whether different dimensions of decision-making autonomy predict the use of female sterilisation differently. The objective of this study was therefore to examine the relationship between health care and contraceptive decision-making autonomy and the use of female sterilisation in Malawi. The study relied on secondary data from the 2015-16 Malawi Demographic and Health Survey. The sample comprised 9,164 married women in Malawi that were using a modern contraceptive. Multinomial logistic regression analysis was used to examine the association between health care and contraceptive decision-making autonomy and the use of female sterilisation, controlling for key socio-demographic characteristics. The study revealed that the percentage of married women that made health care and contraceptive decisions independently was quite low. The main finding of this study was that contraceptive decision-making autonomy increased the relative likelihood of using female sterilisation while health care autonomy was associated with a lower likelihood of being sterilized. The socio- demographic characteristics that significantly predicted the use of female sterilisation included age, place of residence, household wealth and the number of children a woman had. This study demonstrates that health care and contraceptive decision making have different effects on the use of female sterilisation among married women in Malawi. Specifically, women with autonomy in health care decision making had a relatively lower likelihood of using female sterilisation while those with contraceptive decision-making autonomy had a higher likelihood of using female sterilisation. This suggests that intervention aimed at increasing the uptake of female sterilisation in Malawi need to focus on empowering women in the contraceptive decision-making domain.

Deviating from the Norm? The Pregnant Body in Scandinavian Health Law

Abstract This article explores how the political ideal of data interacts with the legal entitlement of autonomy in the care of pregnant people guided by feminist theory and critical approaches to data. Using Scandinavian legislation and administrative practice, it analyses how the presence or absence of data, namely scientific evidence, interacts with pregnant people’s legal autonomy in healthcare. Data –particularly scientific evidence - is shown as something that is not neutral but open to interpretation and misappropriation. First, administrative complaints illustrate that not only a lack of scientific studies on pregnant people but also patriarchal attitudes have implications for care. Second, Scandinavian legislation authorizes the involuntary detention of pregnant drug users despite an absence of evidence supporting such drastic actions. Third, complaints bodies are found to frame injury to pregnant bodies as a natural consequence of birth, despite clear evidence as to the duties of healthcare professionals in preventing harm. A relational approach that sees the pregnant body and fetus as integrated though quintessentially unequal is needed. Evidence is not the only answer; an approach that recognizes the dignity of pregnant people must be central. This requires eliminating coercion, recognizing the pregnant patient as the decision maker in healthcare choices and prizing the birthing patient’s voice as a valuable data source.

Impact of laws prohibiting domestic violence on wasting in early childhood.

Intimate partner violence (IPV) affects an estimated 641 million women and girls globally with far-reaching consequences for the health of women and children. Yet, laws that prohibit domestic violence (DV) are not universal. Countries actively debate the effectiveness of DV laws in improving conditions given the inconclusive evidence on deterrent effects within households particularly in low- and middle-income countries that have limited infrastructure, and fewer resources to implement and enforce policy changes. This is the first study to rigorously examine the impact of DV laws on women's health decision-making and the intergenerational impact on children's wasting, a key predictor of mortality. We used the Demographic and Health Surveys (DHS) data collected between 2000-2020 across 23 African countries. Exploiting the staggered adoption of laws, we used a difference-in-differences study design to estimate the impact of DV laws in the treated countries compared to countries without such laws. We find that DV laws increased women's decision-making autonomy in healthcare by 16.7% as well as other measures of women's autonomy that matter for health such as financial autonomy by 6.3% and social mobility by 11.0%. The improvements in women's autonomy translated into reductions in the probability of wasting among children aged 0-23 months by 5.4% points, a 30.9% reduction from the mean. DV laws also reduced wasting among older children aged 24-59 months by 3.6% points, a 38.7% reduction from the mean. The laws were effective in all 6 countries analyzed individually that criminalized DV. A civil prohibition in the seventh country was not found to be effective. The effect was positive and significant for all wealth and geographical categories. Our findings demonstrate the value of enacting criminal laws that prohibit domestic violence as one important tool to reducing the profound health impacts of IPV, a critical health and human rights issue.

Virtue Ethics in a Value-driven World: How to Ethically Support the Healthcare Autonomy of Adolescent Patients.

Virtue Ethics in a Value-driven World: How to Ethically Support the Healthcare Autonomy of Adolescent Patients.

Women's views and experiences of pregnancy yoga. A qualitative evidence synthesis

BackgroundPregnancy yoga is a holistic practice to support the physiological and psychological changes women experience in pregnancy, with the potential to be offered by mainstream maternity services. Evidence suggests benefits of pregnancy yoga are reduced anxiety and stress, enhanced mood and sleep, with reported improvements in physical and overall wellbeing. Women report that yoga in pregnancy assists in their birth preparation and self-efficacy in labour, with improved labour and birth experience. To date, a Qualitative Evidence Synthesis (QES) of qualitative studies of women's experiences of pregnancy yoga has not been undertaken and accordingly, the literature lacks a high-level synthesis of women's first-hand accounts. MethodsThis qualitative systematic review aims to synthesise and present new evidence about women's views and experiences of pregnancy yoga. Qualitative studies reporting women's views and experiences of practising pregnancy yoga as a sole intervention, were eligible for inclusion. Systematic searches of eight academic databases, AMED, ASSIA, CINAHL, EMBASE, MEDLINE, MIDIRS, PsycInfo and Web of Science, accompanied by extensive searches of Grey Literature, and evidence libraries, took place in May 2022. The methodological quality of included studies was formally evaluated, independently, by two reviewers using an adapted quality assessment tool. Data extraction followed and thematic synthesis, using the Thomas and Harden 2008 framework, was the validated method for the development of six analytical themes. ResultsSeven studies, providing the experiences of 92 pregnant women, were included in the review. The methodological quality of the studies was mixed, with three of the seven scoring highly and two scoring medium for weight of evidence. The three key synthesised themes were: Equilibrium; Personal Autonomy in Healthcare; and Connection. There were six analytical subthemes: intuitive knowing, embedding the practice of yoga practice, practical toolkit, holistic care, baby bonding and peer social support. ConclusionSynthesis of pregnant women's voices identified what women want - easy access to the holistic benefits of pregnancy yoga; what they recommend - pregnancy yoga provided as mainstream maternity support and what should be provided – pregnancy yoga for all women, not only those who can afford to pay; Paying attention to what women identify as important, brings us closer to a woman-centred maternity service.

Factors affecting pregnancy registration in India: does the pregnancy intention matter?

BackgroundPregnancy registration is one of the most critical components of women’s reproductive health because it is the gateway to entering the continuum of care services such as antenatal care, institutional delivery, and postnatal care. There is a lack of studies exploring the relationship between pregnancy intention and pregnancy registration, especially in the Indian context.MethodThis study used the National Family Health Survey-5 (2019-21) data to explore the relationship between birth intention and failure of pregnancy registration. The bivariate and multivariate (binary logistic regression) analysis was carried out.ResultsAdjusting the effects of socio-demographic and economic characteristics, compared with women with an intended pregnancy, the odds of failure of pregnancy registration were significantly high among women with a mistimed pregnancy (OR = 1.60, 95% CI = 1.47–1.73) and unwanted pregnancy (OR = 1.38, 95% CI = 1.26–1.52). The study found pregnancy intention as a significant predictor of pregnancy registration.ConclusionsResults suggest strengthening the interaction of grassroots-level health workers with women, especially those with possibly lower healthcare autonomy and unintended pregnancy. Higher and earlier pregnancy registration will enhance maternal healthcare utilization and reduce adverse health consequences to mothers and children, thus ensuring better maternal and child health.

Reproductive Autonomy of Women in India: A Socio-legal Analysis

Indian reality pertaining to pregnancy and reproductive justice is different as the traditional values, myths and patriarchal role assumed by the society paves way for undermining the decision-making capacity of the women within a family setup. They are considered subordinate to their male counterparts and are having less power in relationships due to many factors like economic, political, and socio-cultural status and at times, not in a position to protect themselves from gender-based violence. They are considered incapable to decide on their own even in a matter pertaining to their own reproductive choices. The concept of autonomy in healthcare in general has a full-fledged acceptance by the judiciary as it affects the bodily integrity of a person. Likewise, the same idea must be reiterated in the pregnancy decision making, as women are the sole person who undergoes the physical and mental transformation during the process. Women should therefore, have the right to choose when and under what circumstances they should bear a child. So, the interest of the woman is a determinant and she should be mentally prepared to conceive, continue the same and give birth to a child. There are various social and ethical factors that pose a hindrance to pregnancy decision making of women in India. Family and social pressure forms the key factor that knocks upon the decision-making capacity of women.

Women’s ability to negotiate safer sex with partners by contraceptive status among a nationally representative sample of married women in Nigeria

BackgroundExisting studies established that safer sex negotiation influences contraceptive use, and women who are able to negotiate safer sex were expected to be contraceptive users. However, it is not certain that all contraceptive users have the ability to negotiate safer sex. Likewise, there is no evidence that all non-users are not able to negotiate safer sex with partners. The study assesses the prevalence of women’s ability to negotiate safer sex and examines the determinants of women’s ability to negotiate safer sex among contraceptive users and non-users.MethodsThe comparative cross-sectional research design was adopted. Data were extracted from the 2018 Nigeria Demographic and Health Survey. The study analyzed a sample of 2,765 contraceptive users and 20,304 non-users. The outcome variable was women’s ability to negotiate safer sex with partners. The explanatory variables examined are eight socio-demographic characteristics (age, child marriage, education, parity, media exposure, religion, work status, and experience of female genital mutilation), six relational characteristics (healthcare autonomy, financial autonomy, household wealth quintile, partners’ education, ownership of assets, and type of marriage). Attitude to wife-beating, male controlling behavior, place of residence, and geo-political zone of residence were included as control variables. Multivariable regression models were estimated.ResultsFindings showed that 6.2% of women who were not able to negotiate safer sex were contraceptive users, while 15.9% of women who were able to negotiate safer sex were contraceptive users. Among non-users, the significant determinants were child marriage, education, parity, mass media exposure, religion, work status, healthcare autonomy, financial autonomy, household wealth, partner education, type of marriage, geo-political zone, attitude to wife-beating, and male controlling behavior. Regarding contraceptive users, the significant determinants were parity, religion, the experience of female genital mutilation, financial autonomy, partner education, type of marriage, and the geo-political zone of residence.ConclusionThe ability to negotiate safer sex differs among contraceptive users and non-users. Also, the determinants of the ability to negotiate safer sex differ among contraceptive users and non-users. While existing strategies may continue to focus on women not using contraceptives, new strategies promoting reproductive autonomy are required among contraceptive users.

Challenges of Deep Learning in Medical Image Analysis—Improving Explainability and Trust

Deep learning has revolutionized the detection of diseases and is helping the healthcare sector break barriers in terms of accuracy and robustness to achieve efficient and robust computer-aided diagnostic systems. The application of deep learning techniques empowers automated AI-based utilities requiring minimal human supervision to perform any task related to medical diagnosis of fractures, tumors, and internal hemorrhage; preoperative planning; intra-operative guidance, etc. However, deep learning faces some major threats to the flourishing healthcare domain. This paper traverses the major challenges that the deep learning community of researchers and engineers faces, particularly in medical image diagnosis, like the unavailability of balanced annotated medical image data, adversarial attacks faced by deep neural networks and architectures due to noisy medical image data, a lack of trustability among users and patients, and ethical and privacy issues related to medical data. This study explores the possibilities of AI autonomy in healthcare by overcoming the concerns about trust that society has in autonomous intelligent systems.

123. Healthcare Autonomy Among Adolescents and Young Adults in the United States: A Scoping Review

123. Healthcare Autonomy Among Adolescents and Young Adults in the United States: A Scoping Review

Exploring patients' perspectives of gestational diabetes mellitus screening and counselling in Ontario: A grounded theory study.

Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. Approaches to screening for GDM continue to evolve, introducing potential variability of care. This study explored the impact of these variations on GDM counselling and screening from the perspectives of pregnant individuals. Following a Corbin and Strauss approach to qualitative, grounded theory we recruited 28 individuals from three cities in Ontario, Canada who had a singleton pregnancy under the care of either a midwife, family physicianor obstetrician. Convenience and purposive sampling techniques were used. Semi-structured telephone interviews were conducted and transcribed verbatim between March and December 2020. Transcripts were analysed inductively resulting in codes, categoriesand themes. Three themes were derived from the data about GDM screening and counselling: 'informing oneself', 'deciding'and 'screening'. All participants, regardless of geographical region, or antenatal care provider, moved through these three steps during the GDM counselling and screening process. Differences in counselling approaches between pregnancy care providers were noted throughout the 'informing' and 'deciding' stages of care. Factors influencing these differences included communication, healthcare autonomyand patient motivation to engage with health services. No differences were noted within care provider groups across the three geographic regions. Participant experiences of GDM screening were influenced by logistical challenges and personal preferences towards testing. Informing oneself about GDM may be a crucial step for facilitating decision-making and screening uptake, with an emphasis on information provision to facilitate patient autonomy and motivation. Participants of our study included patients and service users. Participants were actively involved in the study design due to the qualitative, patient-centred nature of the research methods employed. Analysis of results was structured according to the emergent themes of the data which were grounded in patient perspectives and experiences.

Mechanisms of power, victimization and autonomy in the health care system

The aim of this paper is to describe power relations, doctor-patient relationships among themany ongoing changes in health care from sociological point of view. This paper is based oninterviews with 17 people who work in various fields of health care. To conduct the interviews aswell as to write the paper, a number of concepts and theoretical approaches were resorted to:Dominique Memmi’s ’delegated biopower’, Eve Bureau and Judith Hermann-Mesfen’s notion of’contemporary patient’, François Dubet’s concept of institutional programme as well as results ofHungarian health sociology. The main focuses of interest of the paper are role models in healthcare, the characteristics and consequences of new doctor-patient relations, their manifestationsin Hungary as well as potentials of defencelessness and autonomy in Hungarian health care.

A blueprint for a new model of sexual and reproductive health care in subspecialty medicine.

A blueprint for a new model of sexual and reproductive health care in subspecialty medicine.

Corruption, public trust and medical autonomy in the public health sector of Montenegro: Taking stock of the COVID-19 influence.

In this paper, we analyze the influence of corruption perception, experiences of corruptive behavior, and healthcare autonomy on the public trust in Montenegrin healthcare, by surveying the general population before and after the global COVID-19 pandemic. By providing a quasi-replication of a previous empirical study of corruption and trust in the Croatian public healthcare sector, we introduce the COVID-19 pandemic as a new research context. Before the pandemic, we found a consistent and significant negative influence of the corruptive practices and the generally perceived level of corruption (corruption salience) on the trust in public healthcare. The emergence of COVID-19 had mixed effects: while there is a slightly higher effect of corruption salience to the preference of public healthcare, corruptive experiences still matter but are tolerated much higher than before the pandemic. Public assessment of the autonomy of the health system increases preference for public healthcare, both before and after the pandemic, although the emergence of COVID-19 somewhat lowers this effect. The obtained results point to the most significant challenges of the ‘post-COVID-19’ social context to public health policymaking and management of public healthcare institutions. These include focusing the public healthcare reforms on corruption, reducing waiting times for different diagnostics and medical procedures in the public healthcare system, and regulating the ‘dual practice’ (simultaneous work in public and private healthcare institutions).

The limits of explainability & human oversight in the EU Commission’s proposal for the Regulation on AI- a critical approach focusing on medical diagnostic systems

ABSTRACT The EU Commission’s proposal for the Regulation on Artificial Intelligence, whilst providing important specifications on the importance of transparency of high-risk systems, falls short in providing a nuanced picture of how technical safeguards in Articles 13 and 14 in the proposal should be translated to AI systems operating on the ground. This paper focusing on medical diagnostic systems offers a perspective on how transparency safeguards should be applied in practice, considering the role of post hoc explainability and Uncertainty Estimates in medical imaging. Medical diagnostic systems offer probabilistic judgements regarding disease classification tasks, having an impact on the interactive experience between the doctor and the patient. Accordingly, we need additional guidance regarding Articles 13 and 14 in the proposal, considering the role of shared decision-making, and patient autonomy in healthcare and to ensure that technical safeguards secure medical diagnostic systems that are a safe, reliable, and trustworthy.

Microcredit Membership and Self-Reported Healthcare Autonomy among Bangladeshi Women

Participation in microcredit programs has so far received widespread research and policy attention in the context of health and empowerment among Bangladeshi women. However, not much is known regarding the relationship between participation in microcredit programs and healthcare autonomy (HA) among women. In the present study, we analyzed two nationally representative surveys (Bangladesh Demographic and Health Survey 2004 and 2014), to assess the relationships between MC membership and HA among adult women (n = 29163), while adjusting for various sociodemographic correlates. Self-reported healthcare decision-making autonomy was assessed by asking whether or not the participant had final say on her healthcare. The findings revealed that between 2004 (20.9%, 95%CI = 19.8, 22.0) and 2014 (14.1%, 95%CI = 13.3, 15.0), the proportion of women reporting HA decreased significantly, despite considerable improvements across several socioeconomic indices, including higher education enrollment and labor market participation. Between 2004 and 2014, the percentage of microcredit borrowers decreased for Grameen (18.9% vs. 10.7%) and BRAC (7.9% vs. 7.4%), while it increased for BRDB (0.9% vs. 7.0%). A multivariate regression analysis revealed that Grameen Bank membership was positively associated with reporting HA in both male- (OR = 1.16, 95%CI = 1.09, 1.23) and female-headed households (OR = 1.44, 95%CI = 1.13, 1.85). A positive association between microcredit membership and HA was also observed for BRAC (OR = 1.33, 95%CI = 1.20, 1.47) and BRDB (OR = 1.18, 95%CI = 1.09, 1.29), but in the male-headed households only. Further analysis indicated that membership with Grameen bank was the most important predictor of HA, followed by BRAC, BRDB, and ASA, with the degree of importance varying substantially between male- and female-headed households. In conclusion, these findings suggest the potential of microcredit programs to promote healthcare autonomy among Bangladeshi women and provide insights for further research, as to why certain programs are more effective than others.

Autonomy and paternalism in shared decision-making in a Saudi Arabian tertiary hospital: A cross-sectional study.

Medical paternalism has long been a common medical practice. However, patient autonomy in healthcare has been recently adopted by doctors and patients alike. This study explored whether doctors and patients in a tertiary care hospital in Saudi Arabia preferred autonomy or paternalism in shared decision-making. A total of 118 participants (51 patients requiring total knee replacement, owing to stages 3-4 of osteoarthritis, and 67 doctors) from the Eastern province, Saudi Arabia. responded to a 17-question category-based questionnaire involving four scales of autonomy. Descriptive statistics and chi-square test results revealed that in this hospital, patients preferred a paternalistic approach toward their medical care along with a full disclosure of the risks related to surgical procedures. We recommend health education regarding the specific autonomy subscales (doctor knows best, patient should decide, right to non-participation, and obligatory risk information), and the implementation of protocols that protect patients' rights and enhance personal autonomy.

Sociodemographic correlates of cervix, breast and oral cancer screening among Indian women.

IntroductionCervix, breast and oral cancers account for about one-third of all cancers in India which as a group is a major contributor to all non-communicable disease-related morbidity and mortality among women. Existing evidence suggests that early diagnosis plays a pivotal role in the prevention and intervention of these cancers, and many community-based early screening and awareness programs have been in place in developed countries. Currently, there is not enough research evidence regarding the sociodemographic correlates of cervix, breast and oral cancer screening among Indian women. In the present study, we aimed to assess the self-reported percentage and sociodemographic factors associated with the use of these three types of cancer screening services among Indian women aged 15–49 years.MethodsData were collected from National Family Health Survey conducted during 2015–16. Sample population was 699,686 women aged 15–49 years. Associations between self-reported cervical, breast and oral cancer screening status and the associated sociodemographic factors were analyzed using multivariable logistic regression methods.ResultsThe percentage of screening for cervical (21%), breast (8.95%), and oral cancers (13.45%) varied significantly across the population sub-groups. Higher age, urban residence, higher education, having employment, health insurance, use of electronic media, higher household wealth quintile, having healthcare autonomy, showed a positive effect on taking screening services. Further analyses revealed that the strength of the associations varied considerably between urban and rural residents, denoting the need for region-specific intervention strategies. Sex of household head, age, watching TV, using radio, and having health insurance were the most significant contributors to the outcome effects.ConclusionsThe present study provides important insights regarding the current scenario of seeking cancer screening services among women in India. These findings could inform policy analysis and make an avenue for further in-depth analysis for future studies. Our findings conclude that cancer prevention policies should focus on leveraging the positive effects of better socioeconomic status, employment, health insurance ownership, exposure to electronic media, and better healthcare autonomy to improve the cancer screening service uptake among Indian women.