Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Rehabilitation. Show all posts
Showing posts with label Rehabilitation. Show all posts

Friday, February 26, 2021

Supported Decision Making With People at the Margins of Autonomy

A. Peterson, J. Karlawish & E. Largent (2020) 
The American Journal of Bioethics
DOI: 10.1080/15265161.2020.1863507

Abstract

This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step model that specifies the necessary conditions of supported decision making: identifying domains for support; identifying kinds of supports; and reaching a mutually acceptable and formal agreement. Finally, we identify a series of challenges for supported decision making, provide preliminary responses, and highlight avenues for future bioethics research.

Here is an excerpt:

Are Beneficiaries Authorized to Enter into a Supported Decision-Making Agreement?

The need for supported decision making implies that a beneficiary has diminished decision-making capacity. But there is a presumption that she is still capable to enter into a supported decision-making agreement. What justifies this presumption?

One way to address this challenge is to distinguish the capacity to enter into a supported decision-making agreement from the capacity to make the kinds of decisions enumerated in the agreement. For example, it is recognized in U.S. law that people who lack capacity to make medical decisions at the end of life may still have capacity to assign a surrogate decision maker (Kim and Appelbaum 2006). This practice is justified because the threshold of capacity required to appoint a surrogate is lower than that to consent to more complex decisions. Similarly, the kinds of decisions enumerated in supported decision-making agreements will often be complex and could result in unfortunate consequences if poor decisions are made. But the decision to enter into a supported decision-making agreement is relatively less complex. Moreover, these agreements are often formalizations of ongoing, trusting relationships with friends and family intended to enhance a beneficiary’s wellbeing. Thus, the threshold of capacity to enter into a supported decision-making agreement is justifiably low. People with marginal capacity would reasonably satisfy this threshold.

This response, however, raises questions about the minimum level of decision-making capacity required to enter into a supported decision-making agreement. The project of supported decision making would benefit from future scholarship that describes the specific decisional abilities that show a person with dynamic impairments can (or cannot) enter into a valid supported decision-making agreement.

Thursday, December 24, 2015

Mental health courts significantly reduce repeat offenses, jail time

Medical News Today
Originally published December 4, 2015

New research from North Carolina State University finds that mental health courts are effective at reducing repeat offending, and limiting related jail time, for people with mental health problems - especially those who also have substance use problems.

"Previous research has provided mixed data on how effective mental health courts are at reducing recidivism, or repeat offending, for people with mental health problems," says Sarah Desmarais, an associate professor of psychology at NC State and senior author of a paper on the research. "We wanted to evaluate why or how mental health courts may be effective, and whether there are specific characteristics that tell us which people are most likely to benefit from those courts. The goal here is to find ways to help people and drive down costs for state and local governments without impinging on public safety."

The entire article is here.

Tuesday, August 11, 2015

Free Will Skepticism and Criminal Behavior: A Public Health-Quarantine Model

Gregg D. Caruso
[Draft 6/11/2015]
[Cite final version: Southwest Philosophy Review 2016, 32 (1)]

One of the most frequently voiced criticisms of free will skepticism is that it is unable to
adequately deal with criminal behavior and that the responses it would permit as justified are
insufficient for acceptable social policy. This concern is fueled by two factors. The first is that
one of the most prominent justifications for punishing criminals, retributivism, is incompatible
with free will skepticism. The second concern is that alternative justifications that are not ruled
out by the skeptical view per se face significant independent moral objections (Pereboom 2014,
153). Yet despite these concerns, I maintain that free will skepticism leaves intact other ways to
respond to criminal behavior—in particular preventive detention, rehabilitation, and alteration of
relevant social conditions—and that these methods are both morally justifiable and sufficient for
good social policy. The position I defend is similar to Derk Pereboom’s (2001, 2013, 2014),
taking as its starting point his quarantine analogy, but it sets out to develop the quarantine model
within a broader justificatory framework drawn from public health ethics. The resulting model—
which I call the public health-quarantine model—provides a framework for justifying quarantine
and criminal sanctions that is more humane than retributivism and preferable to other nonretributive
alternatives. It also provides a broader approach to criminal behavior than Pereboom’s
quarantine analogy does on its own.

The entire paper is here.

Wednesday, April 10, 2013

Viewpoint: We Need to Rethink Rehab

By David Sheff
Time
Originally published April 3, 2013

Here are some excerpts:

I’ve already written about my experience with Nic, but for my new book, Clean, I wanted to understand why so many suffer and die. So I undertook an investigation of the treatment system that so often fails. I learned that no one actually knows how often treatment works, but an oft-quoted number of those who abstain from using for a year after rehab is 30%. Even that figure is probably high. “The therapeutic community claims a 30% success rate, but they only count people who complete the program,” according to Joseph A. Califano Jr., the founder of the National Center on Addiction and Substance Abuse and former U.S. Secretary of Health, Education, and Welfare. “Seventy to eighty percent drop out in three to six months.” Over the course of my research, I did hear one statistic that I trusted. Father John Hardin, chair of board of trustees at St Anthony’s, a social services foundation with an addiction recovery program in San Francisco, told me, “Success for us is that a person hasn’t died.”

The treatment system fails because it’s rooted in an entrenched but inaccurate view that addicts are morally bereft and weak. If they weren’t, the belief goes, they’d stop using when drugs begin to negatively impact their lives. Most treatment centers in America are based on an archaic philosophy that’s rooted in the Twelve-Step model of recovery. Twelve-Step programs have saved countless lives, but they don’t work for a majority of people who try them. It’s not a fault in the program itself. Its founder, Bill Wilson, wrote, “These are but suggestions.” But many rehabs require them. This is particularly problematic for teenagers and young adults, the very people most susceptible to addiction. Twelve-Step programs require people to accept their powerlessness and turn their lives over to God or another higher power. Many adolescents question religion and in general teenagers aren’t going to turn their lives over to anyone.

In many of these Twelve-Step-based programs, patients are berated and yelled at if they don’t “surrender” and practice the steps. They’re warned — in some cases, threatened — that if they don’t they’ll relapse and die. It can become a self-fulfilling prophecy.

The entire story is here.