On substituted arguments

Sulmasy, Daniel P.; Sulmasy, Lois Snyder

doi:10.1136/medethics-2014-102503

Cited by 6 publications

(8 citation statements)

References 4 publications

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“…In line with this, donors could be asked if they wanted or were willing to explicitly accept or nominate someone to make selected decisions 'in their interests' and 'on their behalf' after their own deaths. This could be a specific person, such as a relative or a medical school's Designated Individual, but it could instead be a group of people analogous to an ethics committee (Coggon et al, 2008;Farsides, 2012;Boyd, 2015;Sulmasy & Sulmasy, 2015;Gürses et al, 2018). These stewards would then try to make optimal decisions taking all relevant factors into consideration, including protecting the best interests of the deceased in light of all the information at their disposal.…”

Section: Possible Solutionsmentioning

confidence: 99%

Consent in body donation

Farsides¹,

Smith²

2020

Preprint

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This article explores potential threats to the validity of consent in body donation and potential responses to such threats. To minimize abstract generalizations, the article draws particularly on United Kingdom regulations but each of the issues it explores is applicable in many countries. Methods used were searches of relevant (e.g., medical ethical) literatures using pertinent search terms (e.g., consent) and discussions with multiple stakeholders (e.g., family members of body donors). The main threats identified were (1) failing to adequately acknowledge relatives’ roles in donation, particularly as donation often cannot be completed without relatives’ active participation; (2) failing to ensure that donors are informed enough to be able to give valid consent, especially given ‘specification’ and ‘temporality’ problems inherent in establishing consent for body donation; and (3) failing to genuinely prioritize donors’ motives and concerns during and after obtaining their consent. Possible ways of countering these threats include layering information given and made available to potential donors and having donors consent not to ‘donation and anything that might follow’ but instead to ‘relative-acknowledged donation, selective explicit consent, and delegated decision-making’. The latter involves donors specifying and relatives acknowledging donors’ key preferences and prohibitions, among which is nomination or acceptance of specified proxies who may make decisions on donors’ behalf after their death. By making such changes, the validity of consent for body donation could be substantially improved in ways that also increase respect for both donors and their autonomy and these changes may also increase the number of completed donations.

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Section: Possible Solutionsmentioning

confidence: 99%

Consent in body donation

Farsides¹,

Smith²

2020

Preprint

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“…Sulmasy and Sulmasy go further than Brudney, arguing that our view is essentially the same as their proposed alternative to the SJS, and inviting us to “acknowledge, formally, that [we] were mistaken in calling [their] model a best interests model, and simply to endorse the Substituted Interests Model” 5. In our paper, we nowhere refer to Sulmasy and Sulmasy's approach as a best interests model.…”

mentioning

confidence: 79%

“…As Sulmasy and Sulmasy wrote in their original (2010) paper (and repeat in their commentary), on their proposal “the surrogate is asked to apply the patient's authentic values and real interests, including the patient's known preferences” 5. We were, and remain, uncertain about the exact nature of the intended relationship between these three factors: authentic values, real interests and known preferences.…”

mentioning

confidence: 99%

Clarifying and defending the endorsed life approach to surrogate decision-making

Phillips

Wendler²

2015

J Med Ethics

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“…It is therefore of great significance that the person that acts as a deputy is someone who knows the person with dementia well. This can ensure the deputy safeguards the person’s norms and interests, as well as having a better understanding about what decision the person would probably have made him/herself (Sulmasy & Sulmasy, 2015).…”

Section: Discussionmentioning

confidence: 99%

Working in a gray area—Healthcare staff experiences of receiving consent when caring for persons with dementia

2022

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Background Every person has the right to autonomy, and to be involved in decisions about their care. When persons with dementia have difficulties in expressing what they want, their autonomy is challenged. Staff should strive to involve the person in care decisions, to obtain consent and to avoid the use of coercion and restraints. However, care without consent exists and coercion and restraints are being used. In order to improve care, further knowledge is warranted. Aims The purpose of this study was to explore staff’s experiences of obtaining consent when caring for persons with dementia. Methods In total 14 focus group interviews were conducted with staff with experience of dementia care who work in either home care or residential care in Sweden. An inductive qualitative content analysis was used to analyze the collected data. Results Three categories were generated describing staff experiences of consent in dementia care: the person as the decision-maker, the staff as the decision-makers, and the viability of the consent. Overall, staff found it difficult to know if they really had consent from the individual. Even if the person verbally gave consent, it was challenging to know if the person really understood what they had consented to. Common to all three categories was the significance of the relationship between the person with dementia and staff: getting to know the person, recognizing the person’s response in terms of their facial expressions and body language as well as being able to explain and justify specific actions to the person. Conclusion Staff need better conditions in dementia care, including training and time to reflect on how to obtain consent. A person-centered approach can be one way to develop care and ensure that persons with dementia are allowed autonomy and to share in making decisions.

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On substituted arguments

Cited by 6 publications

References 4 publications

Consent in body donation

Consent in body donation

Clarifying and defending the endorsed life approach to surrogate decision-making

Working in a gray area—Healthcare staff experiences of receiving consent when caring for persons with dementia

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