Autonomy implies the right of a competent patient to make decisions about their own health care. To exercise autonomy a patient must receive an explanation of his/her condition. True autonomy presumes intellectual understanding, the ability to translate theoretical ideas into real-life concepts, and emotional connectedness to the situation. Children may not be able to understand or process information about treatment choices. Therefore, responsibility for decision-making is vested in the parents. In Norwegian law, this lasts until the child is 12 years old, though the child must be informed and involved commensurate with intellect and maturity. From the ages of 12 until 16, the youngster should increasingly be heard and involved, and from the age of 16 years a youngster is considered medico-legally competent. Parents who face serious illness in a child are in a life crisis. Yet in spite of this, decision-making competence is often assumed. Decisions with life-or-death or lifetime implications will profoundly influence the life of the family. The best interest of the sick child may not necessarily be compatible with the needs of the family as a unit. As medical caregivers we should be cautious about assuming that our insight into such family realities is adequate. We must sensitively, yet critically, consider decision-making competence, while at the same time supporting the parents’ efforts to cope and make the best decisions possible. However, we must never lose sight of the fact that our primary responsibility is towards the sick child.
Personal Autonomy

No abstract available.
Personal Autonomy ; Sex Education

The purpose of this study was to explore the subjective opinions related to the weight control by using Q-methodology. Forty four adults were selected for P-sample from July to August, 1998. The collected data were analyzed by PC Quanl program. The results were as follows : There were 5 types of the adult's opinions about the weight control. Type I(Concern about weight control) : This type believes that there is a problem with general social attitudes, but the weight control it self is necessary. Type II(Health conscious) : this type believes that good health is very important and weight control is way of maintaining and improving good health. Type III(Obsessive) : This type believes that weight control is absolutely necessary no matter what it takes including extreme dietary change. Type IV(Influence by social pressure) : This type believes that the external stimulation and help is needed to motivate weight control. Type V(Self control) : This type believes that self determination is necessary regardless of social pressure.
Adult* ; Humans ; Personal Autonomy

Judging the medical disputes which has been rapidly increasing recently, doctors' neglecting the obligatory explanation of medical practice has been the hot issues. Accordingly, medical practitioners are to have a growing concern about the Obligatory Explanation of Medical Practice. The key point of legal judgement on the Obligatory Explanation of Medical Practice is whether or not it would be enough in contents and appropriate in nature. As the patients have got more and more taken interest in the right to know and right of self determination in the practice of medicine, the importance of obligatory explanation of the diseases and the medical treatments, particularly invasive operations, which would be given to the patients could not be overemphasized in the present society. By the reflections of the present medical environment, trend of adjudicating the medical dispute in the court of justice shows that the doctors should give the detailed explanations of medical practice which would be given to the patients lest the right to know and right of self determination of the patients should not be violated. The Obligatory Explanation of Medical Practice is not only the way of protecting the right to know and right of self determination of the patients but also, in a way, the best means of mutual understanding and communication between patients and doctors which could guarantee the necessary environment for the good medical practices. In addition, satisfiable human relationship between patients and doctors which would be formed through the process of The Obligatory Explanation of Medical Practice could work as the excellent methods of the preparation for preventing and solving the medical disputes during or after the medical practices.
Dissent and Disputes ; Humans ; Personal Autonomy ; Social Justice

PURPOSE: This study aimed to develop a smartphone overdependence prevention program for college students based on the self-determination theory (SDT) and evaluate its effectiveness.METHODS: A non-equivalent control group repeated measures design was used for the study. Participants were 64 university freshmen (experimental group: 29, control group: 35). The developed program consists of eight sessions conducted twice a week. The program was designed to promote autonomy, competence, and relatedness the three elements of the basic psychological needs of self-determination theory. The participants were assessed before the program, immediately after, and 1 and 3 months after the program. Data were collected from April 23 to September 14, 2018 and analyzed by performing a Chi-square test, Fisher's exact test, independent t-test, and repeated measures ANOVA using SPSS/WIN 23.0.RESULTS: This study showed improvement in the basic psychological needs (F=3.90, p =.010) in the experimental group compared to the control group. Specifically, competence (F=2.93, p =.035), relatedness (F=2.89, p =.045), and self-regulatory ability (F=3.11, p =.028) improved significantly.CONCLUSION: Study findings indicate thatthe smartphone overdependence prevention program based on the Self-determination theory could be an effective intervention for improving basic psychological needs and self-regulation ability. Therefore, this program could be an efficient strategy for smartphone overdependence prevention in university students.
Humans ; Mental Competency ; Personal Autonomy ; Self-Control ; Smartphone

PURPOSE: With continuous positive airway pressure (CPAP) being the treatment of choice for Obstructive Sleep Apnea (OSA), adherence rates to CPAP are still low without a clear consensus of causes. The Self-Determination Theory (SDT) is a general theory of human motivation that emphasizes the extent to which behaviors are relatively autonomous based on the psychological needs that are critical to supporting the process of internalization and the development of optimal motivation. This study sought to determine whether the implementation of an SDT-based intervention is effective in improving: (1) perceived competence, (2) treatment self-regulation, (3) CPAP treatment adherence, and (4) Apnea–hypopnea index (AHI) of OSA patients. METHODS. Using a true experimental pretest-posttest design, 30 purposively selected participants were randomly allocated to experimental and control groups. The SDT-based intervention included group sessions, individual sessions, and follow up phone calls in three weeks. Written permission to conduct the study was obtained from the Institutional Review Board of the University of the East - Ramon Magsaysay Memorial Medical Center, Inc. (UERMMMCI) and the Lung Center of the Philippines. Participation was voluntary and all participants had the right to refuse or discontinue their participation at any time during the study. Data were analyzed using two way repeated-measures ANOVA, student's T-test, and chi-square. RESULTS AND CONCLUSION: The participants in the experimental group have increased adherence rates from Time 1 (60%) to Time 2 (92.9%) and Time 3 (85.7%). Although, when compared to the control group, no significant difference was noted across the different periods of measurement (p=0.70810, p=0870, p=0.2403). There were higher proportions of patients who eventually became adherent in the experimental group compared to the control group immediately after and 5 weeks after the intervention (p=0.0001). The experimental group had significantly better improvement in AHI compared to the control group immediately after (p=0.0152) and 5 weeks after the intervention (p=0.0022). Considering the importance of CPAP adherence in effectively treating OSA, measures to improve adherence such as SDT-based intervention could be usefully incorporated into OSA patients' treatment plans.
Continuous Positive Airway Pressure ; Personal Autonomy ; Sleep Apnea, Obstructive

PURPOSE: Internalization of students' motivation towards an intrinsic form is associated with increased interest, commitment, learning, and satisfaction with education. Self-Determination theory postulates that intrinsic motivation and autonomous forms of self-regulation are the desired type of motivation; as they have been associated with deep learning, better performance and well-being. It claims three basic psychological needs have to be satisfied in order to achieve intrinsic motivation. These are the needs for autonomy, competence and relatedness. This study aims to provide a review on how these basic psychological needs are encouraged in undergraduate students so they can be transferred to the clinical teaching environment. METHODS: Electronic searches were performed across four databases (Medline, Embase, PsycINFO, and ERIC), relevant journals, and retrieved bibliography of selected articles. In total, searches produced 4,869 references, from which 16 studies met the inclusion criteria. RESULTS: Main themes were coded in three categories: The support of autonomy, competence and relatedness. The research-based evidence appears to be of reasonable quality, and indicates that teachers should work to satisfy students' basic psychological needs to foster internalization of self-regulation. Our findings suggest that teachers should interact with students in a more 'human centred' teaching style, as these actions predict motivational internalization. Several themes emerged from different contexts and further investigation should expand them. CONCLUSION: This review identified actions that clinical teachers could implement in their daily work to support students' self-determination. Autonomy supportive teaching in health professions educations would benefit students and may actually result in more effective health care delivery.
Delivery of Health Care ; Education ; Health Occupations ; Humans ; Learning ; Mental Competency ; Motivation* ; Personal Autonomy ; Personal Satisfaction ; Self-Control

BACKGROUND: The decision on whether or not to transfuse should be based on agreement from the patient's own understanding and free will. In Korea, the transfusion guideline first developed in 2009 specified that informed consent should be obtained before transfusion. The standard consent form has also been distributed since 2010. The purpose of this study was to evaluate the degree of improvement in obtaining informed consent for blood transfusion. METHODS: Prior to the development of the transfusion guideline in 2008, an e-mail survey was conducted on 105 clinicians. In 2015, questionnaires were sent to 1,179 clinicians, 32 academic societies, and 6 institutions. RESULTS: Forty-three and 374 answers were received in 2008 and 2015, respectively (response rate, 41.0% and 30.7%). Compared with 2008, the use of explanatory materials increased from 20.9% to 70.5%, and consent acquisitions using a written form increased from 27.9% to 81.7%. The number of respondents who answered that informed consent for transfusions is absolutely necessary also increased from 51.2% to 71.3%. Among the reasons why obtaining informed consent for transfusion can be difficult, the response that standardized consent form is unavailable decreased from 51.2% to 26.9%. CONCLUSION: The transfusion guideline and the standard consent form have contributed greatly to the improvement of obtaining informed consent before blood transfusion at medical institutions in Korea.
Blood Transfusion* ; Consent Forms ; Electronic Mail ; Informed Consent* ; Korea ; Personal Autonomy ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to construct and test a structural equation model for Diabetes self-management (DSM) behavior and Quality of life (QoL) in older adults with diabetes who use Citizen Health Promotion Centers. The theory used this study was a combination of the Information-Motivation-Behavioral Model (IMB) and Self-Determination Theory (SDT) to reflect autonomous characteristics of participants. METHODS: Data were collected from April 20 to August 31, 2015 using a self-report questionnaire. The sample was 205 patients with type 2 Diabetes who regularly visited a Citizen Health Promotion Center. SPSS 22.0 and AMOS 22.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factor affecting the participants' DSM behavior and QoL. RESULTS: The supported hypotheses were as follows; 1) The variable that had a direct effect on QoL was health behavior adherence (γ=.55, p=.007). 2) The variables that had a direct effect on DSM behavior were DSM information (γ=.15, p=.023), DSM confidence (γ=.25, p<.001), and autonomous motivation (γ=.13, p=.048). 3) The variable that had a direct effect on DSM confidence was autonomy support (γ=.33, p<.001). CONCLUSION: The major findings of this study are that supporting patient's autonomous motivation is an influential predictor for adherence to DSM behavior, and integrative intervention strategies which include knowledge, experience and psychosocial support are essential for older adults with diabetes to continue DSM behavior and improve QoL.
Adult* ; Health Behavior ; Health Promotion* ; Humans ; Motivation ; Personal Autonomy ; Quality of Life* ; Self Care*

Several case reports suggest that neurosurgical operations can improve symptoms in patients with severe treatment-refractory obsessive-compulsive disorder (OCD). However, it is unclear which procedure is best and which may produce the most side-effects. We also review recent ethical issues related to the procedures. We review the literature on the efficacy and complications of frequently used neurosurgical procedures that are used to treat refractory OCD and related ethical issues. Since the vast majority of patients who underwent surgery were severely and chronically disabled, it is likely that these procedure were of assistance in alleviating some of their symptoms. It is currently impossible to determine which surgical procedure is the best for a particular patient. Since the psychosurgery is reported as effective in the area of human behavior and psychopathology, the indication for operation demand strict ethical process. Recent studies report that strict informed consent and the evaluation for competence to decide whether to get operation with free will should be taken so as to stress the autonomy of patients for the treatment. Despite a lack of controlled data and inconsistencies in the literature, it appears that when nonsurgical treatments have failed to improve OCD symptoms significantly in severely ill patients, at least partial relief can be obtained by some people with OCD by neurosurgery. Results of cumulative studies strongly support the need for continued research in this area.
Ethics* ; Humans ; Informed Consent ; Mental Competency ; Neurosurgery ; Neurosurgical Procedures ; Obsessive-Compulsive Disorder* ; Personal Autonomy ; Psychopathology ; Psychosurgery