Purpose: We examined race/ethnicity and cultural context within hypothetical end-of-life medical decision scenarios and its influence on patient-proxy agreement. Design and Methods: Family dyads consisting of an older adult and 1 family member, typically an adult child, responded to questions regarding the older adult's preferences for…

The ethical primacy of patient involvement in treatment decision-making requires that more attention be paid to assessment of a patient's competency to make treatment decisions. Makes recommendations to increase sensitivity to this issue with significantly impaired elderly nursing home patients and to improve existing decision-making procedures.…

Purpose: This study examined patients' and surrogates' attitudes about using advance directives to manage end-of-life medical care. It also explored process preferences, or how patients want decisions to be made. Design and Methods: Data come from the third wave of the Advance Directives, Values Assessment, and Communication Enhancement project, a…

Presented informed consent information on high and low risk medical procedures to elderly persons in long term care facility in standard, simplified, or storybook format. Comprehension was significantly better for simplified and storybook formats. Ratings of decision-making ability approximated comprehension test results. Comprehension test…

Surveyed nursing homes in New York in 1986 and 1988 concerning policies on decisions about life-sustaining treatment, patient decision-making capacity, prevalence of ethics committees to resolve disputes, and advance directives. Between 1986 and 1988, number of facilities with explicit policies and institutional vehicles to address issues…

Tested efficacy of educational interventions to increase use of advance directives among elderly. Examined three types of educational materials, various community-dwelling populations of elderly (n=293), and offers of free legal assistance. Interventions increased use slightly. Knowledge and use were associated with race and education. Deferring…

Assessed decision-making capability and preferences regarding advance directives of 39 nursing home residents and proxies. Most patients willingly stated preferences; over one-half opted to forego burdensome measures when death appeared imminent. Decisionally capable patients were more likely to forego life-sustaining measures than those of…

Purpose: The purpose of this study was to compare adults with and without dementia on capacities to consent to treatment as assessed by three instruments. Design and Methods: Eighty-eight older adults with mild to moderate dementia were compared with 88 matched controls on four indices of legal competency to consent to medical treatment as…

Interviewed 198 nursing home residents and 34 primary nurse caregivers regarding perceptions and preferences of resident participation in health care decisions. Approximately 40 percent of residents reported being told nothing about their medical conditions; another 40 percent reported being told everything. Concordance between residents' and…

To investigate empirical assumptions about substituted judgment, 3 treatment decision scenarios were presented to 43 competent elderly persons and 115 persons related to them. Related subjects who were explicitly asked to make substituted judgment came significantly closer to elderly person's preferences than those who were asked to make their…

Investigated functional competency to make informed decisions by elderly depressed and cognitively impaired psychiatric patients. Although depressed elderly patients did not appear to experience problems in informed consent process, cognitively impaired patients had difficulty understanding important aspects of consent information. Suggests that…

Shows how present emphasis on patient autonomy overlooks ways in which intimate relations enable autonomy to function meaningfully and how traditional categories of competent and incompetent discount intimacy as tool for accessing patients' subjective experiences. Urges intimate associations to mark moral boundaries for autonomy because they…

Examines feasibility and effectiveness of implementing a directive education program called "Let Me Decide" to veterans living in Ontario. Discusses two methods used to evaluate implementation of the program. Reports that 97% of the veterans found the education process beneficial whether or not they completed the directives. (Author/JDM)

Purpose: We reviewed the research literature on racial or ethnic diversity and end-of-life decision making in order to identify key findings and provide recommendations for future research. Design and Methods: We identified 33 empirical studies in which race or ethnicity was investigated as either a variable predicting treatment preferences or…

Informed consent is a legal doctrine designed to protect an individual from unwarranted medical intrusions upon his body. Because the processes of aging may affect the elderly subject's capacity to give competent, knowing, and voluntary consent, the securing of informed consent from the elderly will often require special procedural safeguards.…