Informed Consent in the Twenty‐First Century: What It Is,What It Isn't,and Future Challenges in Informed Consent and Shared Decision Making

Consent evolved from judge‐made law in Great Britain in 1767. The term informed consent entered the judicial lexicon in 1957. The first court case to articulate a reasonable person standard adopted by the high courts in Canada and Australia was heard in the U.S. in 1972. Today, informed consent continues to develop in four areas: (i) the court‐based doctrines of consent and informed consent in clinical care in judge‐made law; (ii) federal regulations related to research on human study participants; (iii) shared decision making adopted by care organizations and medical societies in the US, Canada, and Europe; and (iv) areas including decision analysis, discourse analysis, ethics, linguistic analysis, patient–physician communication, risk and evidence communication, and social theory. In this paper, we will focus on consent and informed consent in the first part of the twenty‐first century. We will examine a range of information and decision making frameworks from the oldest court‐established frameworks of consent and informed consent to recent conceptions of information and decision making in evidence‐based decision making and shared decision making in the patient–physician relationship. This paper is divided into three parts: I. What informed consent is, II. What informed consent isn't, and III. Future challenges in informed consent and shared decision making.     

The Place of Values In Psychotherapy

Psychotherapy is a value-laden process because the very notions of therapeutic', 'cure', and 'health' involve patients and therapists in making value choices. Two hierarchies of health values as they apply to therapy are reviewed. The first guides the therapist in setting limits on pathological behavior and constitutes the so-called 6 D's of pathology: destructiveness, dysphoria, disorganization, deviancy, dependency, and disillusionment. The second illuminates the therapist's role-modeling or ideal-setting function and takes the form of a developmental sequence of positive health values, as derived from Kohlberg's work on moral judgment. These health values, from the lowest to the highest forms, are fit-survival, pleasure-seeking, social-belonging, structural duty, adaptive flexibility, and universal commitment. this hierarchy has important implications for understanding the nature of therapeutic changeand the appropriate matching of therapist and patients     

Forced Migration and the Expatriation of the Rohingya: A Demographic Assessment of Their Historical Exclusions and Statelessness

This paper attempts to outline the forced migration and consequent flee and displacement of the Rohingya Muslims in Northwestern Arakan State of Myanmar after several violent clashes and insurgencies between the Rohingya Muslims, the Buddhists and government security forces. More than 400,000 Rohingya Muslims have fled from Myanmar in August 2017 violence which has been described as “a textbook example of ethnic cleansing” by United Nations High Commissioner for Human Rights (UNHCHR). Being only visible as “refugee problem” of this mass expatriation, the continuous forced migration and displacement of the Rohingya have been rendered invisible. In this context, this paper attempts a demographic assessment of Rohingya people through historical process of their exclusions and the magnitude of the forced migration to the neighboring countries as illegal, economic burden, stateless migrants. This paper analyses the historical origin of the underlying situation, identity politics, ethnic crisis, and statelessness for better understanding the demographic decline of the Rohingya in this geographic region. Finally, it highlights the international community's responses to this undergoing humanitarian crisis of the Rohingya.     

2015 Rosalie Wolf Memorial Award Lecture: Past,present, and future of elder abuse

ABSTRACT

This article aims to advance the global issue of elder abuse through exploring how the current body of elder abuse literature can collectively pave the way for present and future directions for research, practice, and policy.     

State of the science on prevention of elder abuse and lessons learned from child abuse and domestic violence prevention: Toward a conceptual framework for research

ABSTRACT

The goal of this review is to discuss the state of the science in elder abuse prevention. Findings from evidence-based programs to reduce elder abuse are discussed, drawing from findings and insights from evidence-based programs for child maltreatment and domestic/intimate partner violence. A conceptual measurement model for the study of elder abuse is presented and linked to possible measures of risk factors and outcomes. Advances in neuroscience in child maltreatment and novel measurement strategies for outcome assessment are presented.     

TimeOut@UCLA: An Intergenerational Respite Care and Workforce Development Program

TimeOut@UCLA is an intergenerational program that recruits undergraduate college students to provide companionship to older adults with early Alzheimer’s or other forms of dementia in a community setting, providing respite for their caregivers. In the program, 86 students and 89 seniors participated from September 2015 to December 2016. This program appears to reinforce positive attitudes about working with older adults among undergraduate students and gives caregivers an innovative option for respite time.     

Abstracts of the Scientific Programs of the American College Health Association Fifty-Seventh Annual Meeting May 22-25, 1979, Washington,D.C.

Abstract

This article focuses on a therapeutic approach to help women deal with the feelings of grief and guilt they may feel as a result of a voluntary termination of a pregnancy. Available medical and psychological literature indicates that, from a public health perspective, significant psychological problems related to an abortion are “minuscule.” Several women the author saw during the 1992/93 academic year who considered themselves to be extremely religious and prolife had undergone elective abortion. They experienced tremendous guilt and grief 4 to 6 months after the procedure. The author recommends that college health center medical and counseling providers who must deal with this issue help the woman validate her loss by revisiting the site of her abortion to reflect upon the experience and to hold a Gestalt dialogue with the fetus to end the relationship. The provider or someone else should accompany the woman to the site because of the increasing potentiality for violence on the part of prolife protesters.     

Financing Rural New England University Health Services: A Pilot Study

Abstract

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

The Political,Social, and Public Health Problems of Binge Drinking in College

Abstract

Despite extensive efforts to decrease alcohol abuse among college students, prevention approaches have had limited success. This study attempted to clarify reasons for this limited success and to identify directions for future interventions by directly interviewing college students on this topic. Five issues were discussed in the focus group interviews: (1) reasons for drinking alcohol, (2) reasons for not drinking alcohol, (3) circumstances surrounding overconsumption of alcohol, (4) topics and methods for prevention, and (5) gender differences in drinking patterns.

The focus group interviews were found to be a valid tool for elucidating sensitive aspects of these issues and the relative importance of these issues to each other. The students revealed how susceptible they are to societal pressures to drink alcohol and how the limitations of their intrapersonal skills affect their alcohol consumption, most notably regarding sexuality issues. The authors contend that improving intrapersonal skills should be a major focus of programs to prevent alcohol abuse.