Session: Centering the Perspectives Of Marginalized Patient Groups
Contextualizing expressions of dissent: highlighting the importance of trauma-informed restraints policy development
Thursday, September 19, 2024
3:00 PM – 4:00 PM CT
Location: Grand Ballroom A (First Floor)
Abstract: When patients lack decisional capacity regarding a treatment decision, a decision must be made on their behalf. Many patients who lack decisional capacity are nonetheless able to express preferences, such as dissent to medical treatment. Ethically fraught cases involving dissent are often brought to ethics committees for advice. The influence that contextual and demographic features have on the weight that is given to patients’ expressions of dissent in these ethically complex cases has not been adequately explored. Doing so is of particular importance (i) due to the relationship between expressions of dissent and the use of restraints and (ii) for identifying potentially unrecognized implicit biases influencing the weight that is given to the patient’s voice and restraints usage patterns.
We identified the primary ethical and contextual issues for patients expressing dissent who were seen by the Adult or Pediatric Ethics Committees at a tertiary care hospital from 2016 to 2023. In this presentation, we describe contextual and demographic factors associated with ethics recommendations that place more (and less) weight on the dissenting patient’s voice and consider how dissenting patients’ sex, race, age and psychiatric history: (i) correlates with the weight that is given to expressions of dissent and restraint use patterns and (ii) informs, and underpins the importance of developing, robust trauma-informed policies to guide the use of restraints
Learning Objectives:
After participating in this conference, attendees should be able to:
Reflect upon the weight given to patient voices in clinical ethics consults for which the primary ethical issue is the dissent of a patient lacking decisional capacity
Describe contextual and demographic factors associated with ethics recommendations that place more (and less) weight on the dissenting patient’s voice
Consider how patients’ sex, race, age and psychiatric history: (i) correlates with weight given to expressed dissent; (ii) informs, and underpins the importance of developing, trauma-informed policies guiding restraints usage
