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Decision-making Capacity (decision-making + capacity)

Distribution by Scientific Domains
Medical Sciences28%
Humanities and Social Sciences28%

Selected Abstracts

Knowledge Warfare in the 21ST Century: An Extension in Performance

NAVAL ENGINEERS JOURNAL, Issue 2 2003
Dr. Yvonne R. Masakowski
ABSTRACT As we move into the 21st century, we are faced with a critical need to address the ways in which knowledge is generated and used to optimize system and human performance. Today, we are inundated with a plethora of information, emails, and ever-changing software. There is a dynamic relationship among humans, computers, expert systems and intelligent agent software that shapes the way we live, conduct business and participate in war. It is imperative that we master the critical components of knowledge management that will enhance their decision-making capacities and empower the warfighter. In the 21st century, knowledge management tools, intelligent agent architectures, robotics, and automated systems will facilitate expert performance necessary to fortify net-centric warfare. One of the principal metrics of performance will be our ability to reduce uncertainty and provide the most accurate information to the decision-maker at the right time. The importance of these goals becomes clear when considered within the context of images of the World Trade Center (WTC) crumbling to the ground. Now, we understand the cost of poor information in terms of life and freedom. This paper will provide an introduction to the importance of knowledge management and implications for future ship design. [source]

U.S. Federal Regulations for Emergency Research: A Practical Guide and Commentary

ACADEMIC EMERGENCY MEDICINE, Issue 1 2008
Andrew McRae MD
Abstract Emergency medicine research requires the enrollment of subjects with varying decision-making capacities, including capable adults, adults incapacitated by illness or injury, and children. These different categories of subjects are protected by multiple federal regulations. These include the federal Common Rule, the Department of Health and Human Services (DHHS) regulations for pediatric research, and the Food and Drug Administration's (FDA) Final Rule for the Exception from the Requirements of Informed Consent in Emergency Situations. Investigators should be familiar with the relevant federal research regulations to optimally protect vulnerable research subjects, and to facilitate the institutional review board (IRB) review process. IRB members face particular challenges in reviewing emergency research. No regulations exist for research enrolling incapacitated subjects using proxy consent. The wording of the Final Rule may not optimally protect vulnerable subjects. It is also difficult to apply conflicting regulations to a single study that enrolls subjects with differing decision-making capacities. This article is intended as a guide for emergency researchers and IRB members who review emergency research. It reviews the elements of Federal Regulations that apply to consent, subject selection, privacy protection, and the analysis of risks and benefits in all emergency research. It explores the challenges for IRB review listed above, and offers potential solutions to these problems. [source]

Fighting over the Forests: Environmental Conflict and Decision-making Capacity in Forest Planning Processes

GEOGRAPHICAL RESEARCH, Issue 3 2003
Jean Hillier
Abstract This paper tells a story of environmental conflict and the attempted political resolution of issues of planning for native forests in Western Australia. It refers to the Western Australian Regional Forest Agreement and Draft Forest Management Plan processes to demonstrate how a range of actors utilise vari-ous discourses and network relations in attempts to influence governmental decision-making capacity. Adapting elements of a model of capacity-building for environmental decision-making, the paper indicates how traditional exclusionary decision networks serve to inhibit decision capacity, whilst more inclusive processes may be more likely to cope with challenges of reconciling multiple values and decision-making for managing the forests in the interests of society as a whole. [source]

How Would Terminally Ill Patients Have Others Make Decisions for Them in the Event of Decisional Incapacity?

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007
A Longitudinal Study
OBJECTIVES: To determine the role terminally ill patients would opt to have their loved ones and physicians play in healthcare decisions should they lose decision-making capacity and how this changes over time. DESIGN: Serial interviews. SETTING: The study institutions were The Johns Hopkins Medical Institutions in Baltimore, Maryland, and St. Vincent's Hospital, in New York. PARTICIPANTS: One hundred forty-seven patients with cancer, amyotrophic lateral sclerosis, or heart failure, at baseline and 3 and 6 months. RESULTS: Patients' baseline decision control preferences varied widely, but most opted for shared decision-making, leaning slightly toward independence from their loved ones. This did not change significantly at 3 or 6 months. Fifty-seven percent opted for the same degree of decision control at 3 months as at baseline. In a generalized estimating equation model adjusted for time, more-independent decision-making was associated with college education (P=.046) and being female (P=.01), whereas more-reliant decision-making was associated with age (P<.001). Patients leaned toward more reliance upon physicians to make best-interest determinations at diagnosis but opted for physicians to decide based upon their own independent wishes (substituted judgment) over time, especially if college educated. CONCLUSION: Terminally ill patients vary in how much they wish their own preferences to control decisions made on their behalf, but most would opt for shared decision-making with loved ones and physicians. Control preferences are stable over time with respect to loved ones, but as they live longer with their illnesses, patients prefer somewhat less reliance upon physicians. [source]

Strengthening Presidential Decision-Making Capacity

PRESIDENTIAL STUDIES QUARTERLY, Issue 1 2000
KAREN M. HULT
Like the U.S. political system as a whole, the presidency has grown far more open to members of the public and, especially, to organised interests. Over roughly the same period, the presidency has become less permeable to much of the expertise and experience available within the executive branch. Together, these two features have contributed to weaknesses in the decision-making capacity of the institution, with implications for policy effectiveness and perceived legitimacy. This article sketches the bases for the claim of attenuated decision capacity and its implications. After arguing that changes in rules and structuring may help strengthen presidential decision-making capabilities, the article goes on to propose several such alterations. [source]

Declining medical decision-making capacity in mild AD: a two-year longitudinal study,

BEHAVIORAL SCIENCES & THE LAW, Issue 4 2006
Justin S. Huthwaite Psy.D.
This is a report of a two-year longitudinal study comparing healthy older adult subjects (n,=,15) and mild Alzheimer's disease (AD) patients (n,=,20) using an objective performance measure of medical decision-making capacity (MDC). Capacity to consent to medical treatment was measured using the Capacity to Consent to Treatment Instrument (CCTI). The CCTI is a psychometric measure that tests MDC using a series of four core capacity standards: S1 (evidencing/communicating choice), S3 (appreciating consequences), S4 (providing rational reasons), and S5 (understanding treatment situation), and one experimental standard [S2] (making the reasonable treatment choice). For each standard, mild AD patients were assigned one of three capacity outcomes (capable, marginally capable, or incapable) based on cut-off scores derived from control group performance. At baseline, mild AD patients performed equivalently with controls on simple standards of evidencing a choice (S1) and making the reasonable choice ([S2]), but significantly below controls on complex standards of appreciation, reasoning, and understanding (S3, S4, and S5) (p,<,0.02). Control performance was stable over time on all capacity standards. At one-year follow-up, the mild AD group did not show significant decline from baseline on any capacity standard. However, at two-year follow-up the mild AD group showed significant declines from baseline on the three complex standards (S3, S4, and S5) (p,<,0.02), and a trend on one of the simple standards (S1). Over the two-year period, the proportion of marginally capable and incapable outcomes in the AD group increased substantially for four of the five standards (S1, S3, S4, and S5). Performance on [S2] remained stable over time in the AD group. We conclude that mild AD patients have impaired MDC at baseline, and demonstrate significant additional decline on complex consent abilities of appreciation, reasoning, and understanding over a two-year period. AD patients also show emerging impairment on the simple consent ability of evidencing choice at two-year follow-up. Capacity outcome data reflect similar declines over time for these four consent standards. The findings suggest the value of early assessment and regular monitoring at two-year intervals of MDC in patients with mild AD. Copyright © 2006 John Wiley & Sons, Ltd. [source]