Your psychologist should explain why the current treatment is no longer appropriate, suggest alternative service providers, address feelings of rejection and resolve any practical issues. In contrast, abandonment occurs when a psychologist inappropriately ends treatment.
Full Answer
When is it time to stop trying new treatments for cancer?
If this happens, your doctor might say your cancer has advanced or progressed. There may or may not be other treatment options. But when many different treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments.
Why is it important that treatment be appropriate?
It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture. Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs.
Is there a single treatment that is appropriate for everyone?
No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients.
Can psychologists legally discontinue treatment?
Psychologists can ethically discontinue treatment when clients aren’t benefiting from therapy, may be harmed by treatment, no longer need therapy or threaten the therapist, themselves or others.
Why is refusal of treatment an ethical dilemma?
In general, ethical tension exists when a physician's obligation to promote a patient's best interests competes with the physician's obligation to respect the patient's autonomy. “When you don't take your medication, you're more likely to get sick.”
Under what conditions should treatment be discontinued?
Ethical and legal framework Ethics Standard 10.10 (Terminating Therapy) specifically addresses terminations as follows: (a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.
What are the most relevant end-of-life issues in health care ethics as they relate to this case?
The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide.
What are 3 legal and ethical issues that occur with end-of-life patient?
These issues include patients' decision-making capacity and right to refuse treatment; withholding and withdrawing life-sustaining treatment, including nutrition and hydration; "no code" decisions; medical futility; and assisted suicide.
Why do clients cancel therapy sessions?
Administrative: long lag times, poor reminder system. Relevance: a lack of clarity of how their treatment is providing benefits. Comfort: feeling disrespected, talked-down to or detached from their therapist. Personal: forgetfulness, embarrassment, skepticism of the treatment efficacy.
Why do therapists terminate?
Therapists typically terminate when the patient can no longer pay for services, when the therapist determines that the patient's problem is beyond the therapist's scope of competence or scope of license, when the therapist determines that the patient is not benefiting from the treatment, when the course of treatment ...
What are the ethical issues involved with end-of-life care with technology?
Common end-of-life ethical problemsBroken communication. ... Compromised patient autonomy. ... Poor symptom management. ... Shared decision-making.
What are the concerns and ethical decisions regarding life sustaining treatment?
The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide.
What are some ethical concerns that are specific to the healthcare setting?
5 Ethical Issues in HealthcareDo-Not-Resuscitate Orders. ... Doctor and Patient Confidentiality. ... Malpractice and Negligence. ... Access to Care. ... Physician-Assisted Suicide.
What is the issue with end-of-life care?
These challenges include physical pain, depression, a variety of intense emotions, the loss of dignity, hopelessness, and the seemingly mundane tasks that need to be addressed at the end of life. An understanding of the dying patient's experience should help clinicians improve their care of the terminally ill.
What are the top 5 ethical issues in healthcare?
Five Top Ethical Issues in HealthcareBalancing Care Quality and Efficiency. ... Improving Access to Care. ... Building and Sustaining the Healthcare Workforce of the Future. ... Addressing End-of Life Issues. ... Allocating Limited Medications and Donor Organs.
Is end-of-life care a human right?
The Human Rights Act (1998) takes 16 of its rights directly from the European Convention on Human Rights and can aid ethical decision making, affect change, ensuring compassion and dignity are at the heart of end of life care. Using a human rights framework could effectively guarantee high- quality personalised care.
How effective are asthma drugs?
The drugs available to treat asthma are particularly effective for patients with asthma of mild or moderate severity. They also help those with more severe asthma but many of these patients continue to have disabling symptoms and severe exacerbations. When treatment is given appropriately the proportion of patients with asthma who continue to have symptoms that limit their lifestyle is fairly small but because asthma is common the total number is considerable. Some estimate of the numbers can be gauged from two measures of morbidity: the use of regular oral steroids, a clear indication of severe asthma since patients have to contend with the adverse effects of steroids in addition to those of asthma; and the need for a short course of oral steroids. Our community-based studies suggest that some 50 000 patients in the UK currently take oral steroids on a regular basis for asthma (
Can asthma be cured?
Asthma is common and cannot be cured, and there is no convincing evidence that it can be prevented except in an occupational setting. It can be treated, however, and good care and optimum drug treatment can convert asthma from a major handicap to a minor inconvenience. Management of asthma has improved enormously over the past 20 to 30 years due to advances in both drug development and in the way that drugs and care are delivered. While recognising the importance of all aspects of management I will focus here on pharmacological approaches to treatment.
Do inhalers cost more than tablets?
Cost is an important consideration for chronic conditions such as asthma and inhalers unfortunately cost more than tablets. Studies of the health economics of treating asthma and the cost implications of introducing new treatments have shown that some treatments such as inhaled steroids can be cost effective, at least in patients with moderately severe asthma in whom the additional cost of treatment is offset by a reduction in hospital costs.
Is leukotriene antagonist a new drug?
The fact that the leukotriene antagonists are the only new category of drug to reach the market in the past 20 years is disappointing considering the great investment of time and effort that many scientists and pharmaceutical companies have devoted to asthma pharmacology. Perhaps we need to stand back and ask why progress is slow. It undoubtedly reflects our limited understanding of the mechanisms underlying asthma and in particular of the factors that initiate the inflammatory process. Inflammation once established involves a large number of cells, mediators, cytokines, transcription factors, and adhesion molecules and hitting one part of this pathway or some secondary phenomenon to the primary inflammatory pathway is unlikely to have much impact. We need to be able to separate the crucial and pivotal events in the development of inflammation from those that are secondary and relatively inconsequential. Whether there are crucial steps in the inflammatory cascade which, if blocked, would prevent airway inflammation is as yet unclear. Various approaches have or could be tried to develop new drugs for asthma (see panel ).
What happens if cancer stops working?
Or maybe one type of cancer treatment has stopped working and the cancer has kept growing. If this happens, your doctor might say your cancer has advanced or progressed. There may or may not be other treatment options. But when many different treatments have been tried and are no longer controlling the cancer, it could be time to weigh ...
How to trust your doctor about cancer?
Trusting your cancer care team. Talking with your doctor and cancer care team, and trusting them to be honest, open, and supportive, is very important. You will have more confidence in treatment decisions if you trust the doctors making recommendations. This means communication is a key part of your care, from diagnosis throughout treatment ...
Is there hope for a life without cancer?
Staying hopeful. Your hope for a life without cancer might not be as bright, but there is still hope for good times with family and friends – times that are filled with happiness and meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the most important things in your life.
Can cancer shrink?
If you have cancer that keeps growing or comes back after one kind of treatment, it’s possible that another treatment might still help shrink the cancer, or at least keep it in check enough to help you live longer and feel better. Clinical trials also might offer chances to try newer treatments that could be helpful.
Can you get a second opinion on cancer?
When faced with deciding whether to continue cancer treatment, some patients or their loved ones may want to get a second opinion. Even when you place full trust in your doctor and cancer care team, you might wonder if another doctor could offer something else or more information. It's normal to think about talking to someone else, and your doctor should support you if you decide to get another opinion. Remember that your cancer care team wants you to be sure about the decisions you make. You can read more in Seeking a Second Opinion.
Does cancer stop working?
If Cancer Treatments Stop Working. Cancer treatments can help stop cancer from growing or spreading. But sometimes treatment does not work well or stops working. Maybe treatment ended a while ago and was successful at first, but cancer has come back. Or maybe one type of cancer treatment has stopped working and the cancer has kept growing.
Can palliative care be used for cancer?
Be sure to ask about and get treatment for any symptoms you might have, such as nausea or pain. Palliative care can be used whether you are getting cancer treatment or not. And it can be used at any stage of your illness. Palliative care is used to help ease symptoms and side effects.
Why are patients not required to take on the sick role?
The first is that patients are no longer required to take on the ‘sick role’: merely passive recipients of altruistic care in our own best interests, expected to comply with the project of getting well again. Instead, we are citizens, with legally recognized human rights that are not lost when we use health services and with lives beyond our interactions with health professionals. This does not necessarily lead to increased obligations on health professionals. Respect for human rights to family and private life, including autonomy, means noting that we should be free to make independent choices and bear the responsibility of living with the consequences of those choices. This prevents ‘patient’ becoming a legal quasi-status.
What is informed consent?
Informed consent, despite its popularity in the bioethics literature, is a flawed concept that is closely linked to the passive role of patient. It assumes that the decisions people make when using healthcare are focused on whether or not to accept treatment offered to them. However, real people place those decisions in their broader lives and seek information from many sources. In the new paradigm of patient as citizen it is for them to choose when and how to seek information. As the Tracey decision explores, they are entitled to know that decisions are being made about them so that they can decide how they wish to be involved. This right is independent of the issue of consent; not least because it relates to decisions not to offer treatment, where consent never even comes into play. Building on autonomy as an Article 8 right loosens the shackles of the forms of action problem—the debate between trespass and negligence actions (with a hint of contract)—that constrained the Sidaway decision and opens up a more productive paradigm for analysis. We should now be talking not about informed consent, but the ‘duty to consult’. 151
What case did the Supreme Court rule on informed consent?
The Supreme Court has now ruled on the issue of informed consent in the case of Montgomery (AP) v Lanarkshire Health Board. 68 On the earlier appeal to the Inner House of the Court of Sessions, the issue had been ‘frankly summarised’ by the pursuer as ‘being whether the decision in Pearce had effectively changed the law as had previously been understood following the decision in Sidaway .’ 69 While he ‘did not go so far as to submit that in Pearce the Court of Appeal had approved and applied Lord Scarman’s dissenting approach, he accepted that the test which it was sought … to identify from the terms of the judgment of the Court Appeal in Pearce was “very close” to that dissenting view.’ 70 This construction was firmly rejected by the Inner House, which found that reading Pearce as a whole made it clear that it confirmed the majority view from Sidaway that ‘the test for liability for failure to warn of risks was essentially the Bolam test.’ 71 Turning to consider Chester v Afshar, the court was ‘unable to see… any recognition that… in Pearce the Court of Appeal had departed, or advanced, from Sidaway or that what was said by the majority of their Lordships in Sidaway required to be revised or revisited.’ 72
What is the dominant feature of the decision in the Inner Court of Sessions?
The dominant feature of the decision in the Inner Court of Sessions (the first level of appeal) is the fact that the judges do not perceive the pursuer to be an ill-informed, passive supplicant but an intelligent (if anxious) woman using maternity services and supported by experts of her own (in the form of her medically qualified family). 104 They describe a relationship between woman and doctor which takes the form of a conversation about the planned delivery
What is significant about Chester v. UCLH?
It is significant that Chester was a case in which it was conceded by the defendant that there had been a breach of the duty of disclosure, so there was no need to define that duty precisely. 62 While some judges were content to accept the view that the law had moved in the direction of autonomy rights, others were not. For the most part, the more confident comments to the effect that the law had developed a doctrine of informed consent have come in cases, as indeed in Chester itself, where there was no need to decide this in order to dispose of the case. 63 In Birch v UCLH NHSFT Cranston J noted that even the defendants advanced Lord Woolf’s formulation as ‘a current statement of the law’ and suggested that while ‘perhaps any discussions of those legal nuances may be regarded as unduly pedantic. I can only plead that for this judge the matter is not as straightforward as it could be.’ 64 In that case, too, the finding for the claimant was made in circumstances where the expert witness for the defendant had given evidence that the patient should have been informed of the information in question. 65 It is difficult for defendants to deny liability in cases where they accept that their practice fell below the standard they required of themselves, 66 even if those self-imposed standards might be higher than those of their peers. It is an interesting feature of medical negligence litigation that in many of the cases where judges have concluded that negligence is made out, despite the existence of expert evidence in favour of the defendants, there was also evidence that the defendants had believed they had in fact acted in the way that claimants suggested that they should. They lost after the judge rejected their evidence that they had done so. 67
What is the responsibility of a doctor to inform the patient of that significant risk?
If there is significant risk which would affect the judgement of the reasonable patient, then in the normal course it is the responsibility of a doctor to inform the patient of that significant risk, if the information is needed so that the patient can determine for him or herself as to what course he or she should adopt. 56
What was the subject of medical law?
When Ian Kennedy first defined the subject that he called ‘Medical Law’, he saw the subject as centred on patients and driven by respect for their autonomy and dignity. The importance of consent, truth-telling, confidentiality, and justice (which he identified as common issues permeating the subject) were the means for delivering that respect. 28 When I argued for a wider definition of the subject, to be called ‘Health Care Law’, I moved on slightly from this focus on the patient to include wider public health issues but I still found that the scope of the subject was to be defined by international obligations in respect of people’s rights to health and to social and medical assistance—connecting the subject with the interests of patients. 29 I suggested that it was important to appreciate the complexity of health services and the roles of non-medical professions, and to acknowledge the impact of inter-professional rivalries on legal doctrine. 30 I was sceptical how far the idea of patients’ rights captured the approach of English law, 31 but I did not seriously doubt the centrality of the patient to the subject. Later, when I argued that a new paradigm was needed, it was not to displace the patient as the focus but rather the professional (in place of a wider appreciation of institutional responsibilities) and the law (placing it in a context of other normative systems, especially those of the health professions and the institution of the National Health Service). 32 I tried to show in my first inaugural lecture as a professor how the judges responded to the existence of these normative systems by integrating them into their analyses. 33 In all of this, it seemed that understanding the implications of being a ‘patient’, who is the recipient of health services, remained of central importance in making sense of the law. However, this is no longer so obvious.
Multiple Relationships
Confidentiality
- Employers, spouses, school administrators, insurance companies and others often ask psychologists to provide information about their clients. APA’s Ethics Codesays that psychologists may only share the minimum information necessary. 1. Your psychologist should be clear about whether and why he or she is disclosing information. Sometimes, for instance, a law requires psychologists to disclose something, such as possible abu…
Informed Consent
- Your psychologist should give you the information you need to give informed consent right from the start. Topics to discuss include: 1. Limits of confidentiality 2. Nature and extent of your psychologist’s record-keeping 3. Expertise, experience and training 4. What servicesyour psychologist can’t or won’t provide 5. Estimated lengthof therapy 6. Alternative approachesto treatment or service 7. Feesand billing practices 8. Your right to terminateyo…
Trainees
- Sometimes a therapist in training may provide your treatment. The therapist should let you know he or she is a trainee and give you the supervising psychologist's name. 1. Keep in mind that bills may be under the supervisor’s name, not the trainee’s. You don’t want to report a billing problem when none exists!
Roles
- When psychologists work with organizations or groups, there may be confusion about who the actual client is. 1. In court, for instance, it may not be clear whether a psychologist is serving as an expert witness or an advocate for one side. Confusion is also possible when psychologists provide services to one person at the request of another, such as parents requesting therapy for children or police departments requesting evaluations of officers. 2. Psyc…
Expertise
- Psychologists should only practice in areas where they are competent. 1. If you’re in a custody battle, for instance, a psychologist who’s unfamiliar with working with courts could harm your case no matter how well-intentioned he or she is. 2. If you ask your psychologist to write a letter to the judge about your child’s relationship with you and your spouse, the psychologist could get in trouble by failing to note something like the fact that she never met th…
Billing
- Your psychologist has an ethical obligation to bill patients and insurers accurately. Your psychologist should explain financial policies at the beginning of treatment. 1. Sloppy bookkeeping lands some psychologists in hot water. Others get in trouble because they try to manipulate the systemto get clients more benefits than they’re entitled to. 2. Don’t ask your psychologist to bill for a service that’s covered rather than what was actually provid…
End of Therapy
- You should know the difference between treatment termination and abandonment. 1. Psychologists can ethically discontinue treatmentwhen clients aren’t benefiting from therapy, may be harmed by treatment, no longer need therapy or threaten the therapist, themselves or others. 2. Your psychologist should explain why the current treatment is no longer ...