Limited Decision-making Capacity Research Articles

Utilization Patterns of Maternal and Child Health (MCH) Care Services: A Cross-Sectional Study in Rawalpindi, Pakistan

Background: Despite the implementation of various maternal health programs and schemes at both regional and national levels in Pakistan, maternal mortalities and morbidity remain significantly high. This suggests that maternal health services are being underutilized. Aim: This current study focuses on assessing the utilization patterns of maternal health services and the factors associated with their utilization in Rawalpindi, Pakistan. Methods: The cross-sectional study was conducted over one year (2021-2022) among mothers aged 15 to 49 years in the field practice area of DHQ Rawalpindi. The minimum required sample size was determined as 645. Participants were selected using a simple random sampling technique from a randomized list of villages. Data was collected through home visits, utilizing a pretested, standardized questionnaire. In the analysis, the significance of associations between variables was established at P<0.05. Results: Among the 645 potential participants, 632 provided consent for inclusion in the study. Only 58.3% of participants received any Antenatal Care (ANC), and a mere 11.7% received full ANC services. More than half of the participants (52.7%) had experienced pregnancy-related complications. Variables such as younger age and limited decision-making capacity were significantly associated with the lack of full ANC services (P<0.05). Conclusion: This study highlights that a woman’s age, literacy status, parity, socioeconomic status, and occupation are major determinants influencing the utilization of maternal health care services. These determinants should be taken into account when planning future interventions aimed at promoting attitudinal changes and, consequently, enhancing the utilization of maternal health care services.

Does Land Ownership Really Improve the Decision-Making Capacity of the Rural Women? Reflections from Bangladesh

ABSTRACT Women’s limited decision-making capacity is recognized as one of the major challenges to women’s empowerment. Decision-making is a complex process that often relies on ownership and access to resources. This study aims to assess the opinions of rural Bangladeshi women about the impact of land ownership on their decision-making capacity. The Binary Logistic Regression (BLR) analysis demonstrates that women’s access to land, income, distance from the rural market, and distance from Non-Governmental Organizations (NGOs) have a significant influence on their decision-making capacity. The study underlines the need for gender transformation in formal and informal structures to enhance rural women’s decision-making capacity.

Dysfunkcjonalność ochrony praw pacjenta małoletniego. Część 1: Reprezentowanie interesów i prawo do informacji

The article considers the functionality of protecting the rights of the child as a patient from abuse of parental authority and assesses the possibility of independent activity of adequately mentally mature children. In Polish medical law, the age ceiling for limited decision-making capacity in of consent to medical acts is set too high. The legislation only regulates the issue of decisional age from the side of the validity of the consent for the provision of medical service and the due medical information. Even the best parent is, after all, only a third party to the personal interests of his/her child and is not entitled to the right to exercise his/her rights as a patient. The consequences of neglecting care in matters that do not require immediate medical attention can be harmful when they result in future bodily dysfunctions, such as worsening visual impairment or dramatic dental defects. Medical law, however, does not differentiate between the rights of a minor. A highly defined decision age ceiling is dysfunctional in many respects because it does not distinguish between a newborn and a 15-year-old, whereas already school adolescents show at least a limited understanding of their own health matters health. Although the law provides for applying for the authorization of a guardianship court, this method is completely ineffective unless it is carried out by an adult. The child should be equipped with the legal means to act independently, freely, and free of to act without the involvement of protective services, at least in relatively simple and obvious matters. After a deeper analysis of the norms, it appears that the legal sanctions for medical assistance in ordinary health matters, given to a child under conditions of abuse of parental authority, can be overruled by an argument of a conflict of goods and interests.

Health communication for behavior change: evolution of a marketing framework

PurposeThis study aims to present a novel framework of “communication-led behavioral intention” in an effort to aid in the process of planning and coordinating social marketing campaigns on difficult subjects that go against social conventions, including the proper postnatal nutrition practices.Design/methodology/approachThe study followed a quasi-experimental research design. Health communications (public service announcements) were shown to the women aged 18–65 years and responses were collected using a quantitative questionnaire. Structural equation modeling with exploratory and confirmatory factor analyses was used to investigate the linkage between the factors that influence breastfeeding outcomes.FindingsA strong positive impact of contextual communication was confirmed empirically on the behavioral intention to follow and recommend exclusive breastfeeding. Three communication-specific factors – “content quality,” “message clarity” and “belief in message” – were found to play a pivotal role in inducing the “behavioral intention.” These relationships were found to be mediated by “empathy” which is an emotional state experienced out of the respondent’s ability to sense the thoughts and feelings of the characters in the communication.Originality/valueThis study is one of the few attempts on measuring breastfeeding outcomes using theoretical constructs. The framework suggested in the study has a lot of potential in assisting practitioners and researchers to develop effective interventions on complex topics that challenge social norms. Further, this paper offers important insights on the women with limited decision-making capacity on breastfeeding and child care.

사회복지사의 성년후견제도 인식을 통해 본 전문후견사회복지사의 역할과 과제

This study attempted to explore the roles and tasks of professional guardianship social workers as human rights advocates through a survey on the perception of social workers on the adult guardianship system. The research method used a method similar to the snowball sampling with the SNS questionnaire. The survey was conducted by 454 social workers working in the field. Ninety-four percent of respondents were aware of the need for adult guardianship and public guardianship. They also showed their positive attitude towards the expected effect of the guardianship system but had little understanding (58.2%) of the types of adult guardianship system and the procedure for selecting a guardianship system. Regarding the roles of professional guardianship social workers, most social workers recognized the importance of providing adult guardianship and finding guardians, and 63.1% answered that they were willing to act as professional guardians. Based on the above research results, the roles and tasks of professional guardianship social workers as human rights advocates in the field of social welfare practice can be summarized as follows. First, it is required to establish the role of a professional guardianship social worker as an advocate for the people with mental disorders and with limited decision-making capacity Second, social workers who are experts in protecting the confidentiality of clients are also required to be treated and supported equally as other professional guardians, such as lawyers and legal officers. Third, there is a need to improve the contents of in-service education for social workers, such as corporate guardianship services and public guardianship support programs at the level of the Korean Social Workers Association.

The associations of palliative care experts regarding food refusal: A cross-sectional study with an open question evaluated by triangulation analysis.

Health professionals in oncologic and palliative care settings are often faced with the problem that patients stop eating and drinking. While the causes of food refusal are very different, the result is often malnutrition, which is linked to health comorbidities and a high mortality rate. However, the professionals lack the time and knowledge to clarify the cause for each patient. What associations do health professionals have when faced with food refusal? To investigate the associations that health professionals in oncological and palliative settings have about denied eating behavior. A cross-sectional study, starting with an open question focusing professionals' associations regarding food refusal. The results were inductively analyzed, whereby generic categories were developed. Subsequently, the categories were transformed into quantitative data to calculate the relationships between the categories. A total of 350 out of 2000 participants completed the survey, resulting in a response rate of 17.5%. Food refusal is primarily associated with physical and ethical aspects and with end-of-life. Half of the participants frequently find that patients refuse to eat. The attitudes show that the autonomy of the patient is the highest good and is to be respected. Even in the case of patients with limited decision-making capacity, the refusal to eat is acceptable. Clarifying the cause of food refusal requires a great deal of knowledge and is strongly influenced by the associations of health professionals. While the associations have very negative connotations, information and training is needed to make professionals aware of this and to change their associations. With this knowledge and in an interprofessional cooperation, mis-labelling of patient settings can be avoided and fears can be reduced.

Focusing on Partnership in the Context of Limited Decision-Making Capacity.

Focusing on Partnership in the Context of Limited Decision-Making Capacity.

Who gets to decide for the older patient with a limited decision-making capacity: a review of surrogacy laws in the European Union.

Family members of older incompetent patients are increasingly playing an essential role in the decision-making process relating to medical treatment. Furthermore, rights of patients and carers and the extent of their legal involvement vary widely across the European Union. Starting with an illustrative case within the Italian legal framework, this review focuses on statutory laws in the European Union to analyse the role and the rights of surrogates on behalf of older incompetent patients. The authors have identified two main essential areas of surrogate's law in Europe, in the absence of the advance directives: the role of family members automatically accepted as surrogates by law and a legal representative appointed by a court.

Progress towards health systems strengthening in Myanmar

# Objectives This is a commentary on the health care system of Myanmar during the ongoing transition to a new democratic government intent on engaging with the international community. In the years Myanmar was isolated, its health system remained undeveloped and underfunded with large disparities in health outcomes for poor, indigenous populations. # Study design Observational, descriptive. # Methods Observations, published reports, data, conferences, and interviews. # Results Decades of under-investment have resulted in critical shortages of human resources for health. Although improvements are slowly being made by government, poor, indigenous people have developed a system of community health workers and auxiliary midwives to meet the needs of their communities. The government plans to develop a national emergency ambulance system but there are systemic factors that delay progress towards modernization and equity in health care. # Conclusions Health care decision-makers remain constrained by the legacy of strict hierarchical structures, limited decision-making capacity and political uncertainty. Structural and cultural factors delay progress in health system strengthening and equity in poor, indigenous regions. In Myanmar change is a slow and complicated process with many obstacles to overcome.

Assumptions of Decision-Making Capacity: The Role Supporter Attitudes Play in the Realisation of Article 12 for People with Severe or Profound Intellectual Disability

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) was the first legally binding instrument explicitly focused on how human rights apply to people with disability. Amongst their obligations, consistent with the social model of disability, the Convention requires signatory nations to recognise that “…persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” and mandates signatory nations to develop “…appropriate measures to provide access by persons with disability to the support they may require in exercising their legal capacity”. The Convention promotes supported decision-making as one such measure. Although Australia ratified the UNCRPD in 2008, it retains an interpretative declaration in relation to Article 12 (2, 3, 4), allowing for the use of substituted decision-making in situations where a person is assessed as having no or limited decision-making capacity. Such an outcome is common for people with severe or profound intellectual disability because the assessments they are subjected to are focused on their cognition and generally fail to take into account the interdependent nature of human decision-making. This paper argues that Australia’s interpretative declaration is not in the spirit of the Convention nor the social model of disability on which it is based. It starts from the premise that the intention of Article 12 is to be inclusive of all signatory nations’ citizens, including those with severe or profound cognitive disability. From this premise, arises a practical need to understand how supported decision-making can be used with this group. Drawing from evidence from an empirical study with five people with severe or profound intellectual disability, this paper provides a rare glimpse on what supported decision-making can look like for people with severe or profound intellectual disability. Additionally, it describes the importance of supporters having positive assumptions of decision-making capacity as a factor affecting supported decision-making. This commentary aims to give a focus for practice and policy efforts for ensuring people with severe or profound cognitive disability receive appropriate support in decision-making, a clear obligation of signatory nations of the UNCRPD. A focus on changing supporter attitudes rather than placing the onus of change on people with disability is consistent with the social model of disability, a key driver of the UNCRPD.

"And If Your Friends Jumped Off a Bridge, Would You Do It Too?": How Developmental Neuroscience can Inform Legal Regimes Governing Adolescents

Legal models of adolescent autonomy and responsibility in various domains of law span a spectrum from categorical prohibitions of certain behaviors to recognitions of total adolescent autonomy. The piecemeal approach to the limited decision-making capacity of adolescents lacks an empirical foundation in the differences between adolescent and adult decision-making, leading to counterintuitive and inconsistent legal outcomes. The law limits adolescent autonomy with respect to some decisions that adolescents are perfectly competent to make, and in other areas, the law attributes adult responsibility and imposes adult punishments on adolescents for making decisions that implicate their unique volitional vulnerabilities. As developmental neuroscientists discover more about the biological underpinnings of juvenile decision-making, policymakers now have the opportunity to enhance consistency within and across the legal domains that regulate adolescent behavior. To serve this goal, our paper typologizes extant legal regimes that account for the limitations of adolescent decision making, reviews the neuroscientific evidence about how the brain’s developing structures and functions affect decision making, explores case studies of how certain youth behaviors that implicate the adolescent brain’s unique vulnerabilities intersect with the legal system, and proposes a matrix-based approach for the consistent legal evaluation of adolescent behavior.

Decision-making capacity and communication about care of older people during their last three months of life

BackgroundLimited decision-making capacity (DMC) of older people affects their abilities to communicate about their preferences regarding end-of-life care. In an advance directive (AD) people can write down preferences for (non)treatment or appoint a proxy as a representative in (non)treatment choices in case of limited DMC.The aim is to study limited DMC during the end of life and compare the background, (satisfaction with) care and communication characteristics of people with and without limited DMC. Furthermore, the aim is to describe patient proxies’ opinions about experiences with the use of (appointed proxy) ADs.MethodsUsing a questionnaire, data were collected from proxies of participants of a representative sample of the Longitudinal Aging Study Amsterdam (n=168) and a purposive sample of the Advance Directive cohort study (n=184). Differences between groups (with and without limited DMC, and/or with and without AD) were tested with chi-square tests, using a level of significance of p < 0.05.ResultsAt a month before death 27% of people had limited DMC; this increased to 67% of people having limited DMC in the last week of life. The care received was in accordance with the patient’s preferences for the majority of older people, although less often for people who had limited DMC for more than a week. The majority of the proxies were satisfied with the communication between physician and the patient and them, regardless of DMC of the patient. Of people with an AD, a small majority of relatives indicated that the AD had been of additional value. Finally, no differences were found in the role of the relative and the satisfaction with this role between people with and without a proxy AD.ConclusionsAlthough relatives have positive experiences with ADs, our study does not provide strong evidence that (proxy) ADs are very influential in the last phase of life. They can best be seen as a tool for advance care planning.

A new law on advance directives in Germany

This article presents the new German law on advance directives from 1 September 2009. The history of the parliamentary process of this law is described, the present regulations are explained,...

Use of substitute decision makers by the mentally ill rural elderly: an issue of concern for mental health nurses.

In 1986, the Abbe Center for Community Mental Health implemented a nurse-led elderly outreach program (EOP) designed to identify and treat elderly rural residents in need of mental health care. Because some EOP clients evidenced a lack of or limited decision-making capacity, a record review was conducted to answer the following questions: Do any of the clients have a legal substitute decision maker? What are the forms of substitute decision making? Is there a familial relationship between the elderly client and the substitute decision maker? Is there evidence that any of the named legal substitute decision makers have abused the elder? Almost half the clients who had a substitute decision maker used a power of attorney. Adult children were the most frequent family members named as substitute decision makers. Four records indicated that an adult child had been given a power of attorney and that the child had potentially abused the parent. Implications for mental health nurses dealing with this vulnerable population are set forth.