Treating adolescents. Legal and ethical considerations

Treating adolescents in the health care system raises significant legal and ethical issues related to consent for treatment, confidentiality of communications and records, and payment for care. The law provides many opportunities for adolescents to consent to their own care and offers significant protections of confidentiality. Publicly funded programs provide access to free care for some adolescents, but financial considerations continue to limit access for many poor and low-income adolescents. In addition to legal concerns, serious ethical dilemmas arise, particularly with respect to treatment of special populations of adolescents. Resolution of the legal and ethical questions requires cooperation of professionals from many disciplines.     

Treatment considerations for the elderly person with cancer

In an aging population, the number of patients with cancer continues to rise. Little research has focused on the treatment of cancer in the elderly. Therefore, the treatment for various cancers differs across the healthcare system. A uniform approach in assessing the elderly person with cancer is lacking. This article describes two case studies in the elderly population, focusing on two common cancers: acute myelogenous leukemia and breast cancer. Common side effects of treatment and determinants of treatment options are discussed. It is important that the elderly receive appropriate screening, early detection, treatment, and management of comorbidities.     

Prolonged ventilator dependence: economic and ethical considerations.

Patients who receive ventilator treatment tend to be older and sicker than ever before, factors that contribute to the complexity of ventilator weaning. The provision of prolonged ventilator support entails a commitment of expensive hospital resources, yet survival is often poor. Consideration must be given to limiting ventilator treatment in instances when benefit is highly unlikely or when the burdens of treatment outweigh benefits. Decisions to withhold or withdraw mechanical ventilation must be made with full knowledge and understanding of relevant ethical principles. If ventilator support is to be terminated, this should be accomplished according to institutional protocols that take into account these ethical considerations, as well as the medical and legal facts that apply.     

Living with loss: dementia and the family caregiver.

Two focus group interviews with 15 relatives, investigated family caregivers' perceptions of having a relative in a dementia care unit. Data analysis revealed the significant theme of living with loss. The results demonstrate that the burden of care giving creates growing stress and tension that continues even when the family member is placed into a residential care setting. The findings suggest that health professionals must be prepared to assist family members with the anticipatory grieving of losses that accrue with the changing relationship with the relative and health care staff. Furthermore, there is a need to look for a means of helping and supporting family caregivers so that they can develop a sense of satisfaction and accomplishment in their care giving role.     

Self-care aids for the parkinsonian patient and his family.

Methods and aids for helping the individual with Parkinson's disease overcome some of the problems encountered in daily living. Only by a continuous, on-going program, much patience, and knowledge of how and what can be done can the patient be helped to maintain his interests and independence within the range of his abilities.     

Adolescent autonomy and family functioning are associated with headache-related disability

OBJECTIVES: The aims of this study were to examine the relationships between a range of family factors, including autonomy and general family functioning, on headache outcomes (ie, pain and functional impairment) in adolescents with recurrent headaches. METHODS: Forty nine adolescents, ages 11 to 16 years, (mean age=13.5 y, 63% female) receiving treatment through pediatric neurology for recurrent headaches were enrolled. Adolescents and their parents completed measures of pubertal status, pain, functional impairment, parental solicitousness, behavioral autonomy, depressive symptoms, and family functioning. RESULTS: Lower levels of adolescent autonomy (r=0.53, P<0.01) and less healthy family functioning (r=0.32, P<0.01) were significantly related to higher levels of functional impairment. In multivariate regression analyses controlling for pain intensity, pubertal status, and depressive symptoms, parent and family variables added significant variance in the prediction of functional impairment (r change=0.21, P<0.05). Both adolescent autonomy (beta=0.38, P<0.05) and general family functioning (beta=0.34, P<0.05) were significant individual predictors of adolescent functional impairment. DISCUSSION: This study extends research on family factors and adolescent headache-related pain and disability. Future research is needed to discover whether family based interventions helping adolescents to acquire appropriate and supportive levels of autonomy may be useful in reducing headache-related disability.     

Transcultural care principles, human rights, and ethical considerations.

During the past three decades, the author has developed and used some general principles to guide transcultural instruction, practice and research. These principles were developed from my transcultural care theory, research studies and direct clinical experiences, consultation and general writings on the subject [Leininger 1967, 1970, 1973, 1976, 1978, 1979, 1980, 1981, 1984a, 1984b, 1988, 1989, 1990]. The principles include some assumptive premises with regard to universal and diverse considerations of human beings with the importance to know and respect the cultural rights of people in order to provide meaningful, satisfying and appropriate culture care to people. Through the years, a number of nursing students, faculty, and clinicians have used these principles, rights and ethical considerations to guide them in their thinking and to protect client's human and ethical rights. Since many nurses frequently request copies of these statements for teaching, consultation and clinical work, they are published below with this intent in mind.