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Biomedical subjects

B Gert

Publications and source records attributed to B Gert.

17 recordsLinked to original sources
PubMed1992

A sex caused inconsistency in DSM-III-R: the definition of mental disorder and the definition of paraphilias.

The DSM-III-R definition of mental disorder is inconsistent with the DSM-III-R definition of paraphilias. The former requires the suffering or increased risk of suffering some harm while the latter allows that deviance, by itself, is sufficient to classify a behavioral syndrome as a paraphilia. This inconsistency is particularly clear when examining the DSM-III-R account of a specific paraphilia, Transvestic Fetishism. The author defends the DSM-III-R definition of mental disorder and argues that the DSM-III-R definition of paraphilias should be changed. He recommends that the diagnostic criteria for specific paraphilias, particularly that for Transvestic Fetishism, be changed to make them consistent with the DSM-III-R definition of mental disorder.

Female↗
PubMed1990

A critique of principlism.

The authors use the term "principlism" to refer to the practice of using "principles" to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these "principles" do not function as claimed, and that their use is misleading both practically and theoretically. The "principles" are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for consideration when dealing with a moral problem. The "principles" lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory.

Beneficence↗
PubMed1990

The inadequacy of incompetence.

Patients' competence to make medical decisions, analysts frequently hold, is the key concept for determining whether those decisions may be overruled. Competence, however, is neither a necessary nor a sufficient condition for concluding when it is morally admissible to supersede refusals of treatment. People may be able to reach kinds of decisions involving immediate medical consequences, but not ones entailing long-term outcomes. Open recognition of the limited but important exceptions to the principle of never overruling competent patients' refusal of care would better preserve their autonomy than unduly accepting the absoluteness of the principle.

Beneficence↗
PubMed1989

Moral theory and neurology.

This article presents an outline of a general moral theory and shows its relationship to the concepts of paternalism and that of valid consent and refusal. The authors then show how this theory and these concepts can be usefully applied to the moral problems that neurologists often face in determining how to act when they have distressing information for their patients. Finally, a procedure is provided for determining when it is morally justified to deceive patients by withholding information about their diagnoses, prognoses, or about their prospective treatments.

Comprehension↗
PubMed1986

Rationality in medicine: an explication.

Various meanings of "rational" implicitly and explicitly suggested in this issue's articles are abstracted and stated. Two accounts of rationality are shown to be able to explain most uses of "rational": the "cool moment" account and a more objective account. The former is examined and modified, but still found inadequate. The objective account of rational is developed, taking "irrational" as the basic concept. "Irrational" is given content in terms of a list, and "rational" is subsequently defined as "not irrational". Reasons and motives are defined and distinguished. The advantages of the objective account are explored and some challenges to it are answered.

Consumer Behavior↗
PubMed1986

Ethics in dental practice.

To gain patients' confidence, these moral guidelines offer specific consideration in presenting treatment choices, gaining consent, and responding to patients' decisions. When the dentist-patient relationship is one of mutual trust, unusual and difficult situations are easier to solve.

Adult↗
PubMed1986

Distinguishing between active and passive euthanasia.

The standard ways of distinguishing between active and passive euthanasia, act versus omission, and removal of ordinary versus removal of extraordinary care, do not have any clear moral significance. We have used particular aspects of the physician-patient relationship to make a morally significant distinction between active and passive euthanasia. Passive euthanasia is defined as the physician's abiding by the rational valid refusal of life-sustaining treatment of a patient or his surrogate decision-maker. Understanding passive euthanasia in this way makes it clear why, everything else being equal, there is no morally significant difference between discontinuing a treatment and not starting it, for example, taking a patient off a respirator versus not putting him on in the first place. It also makes clear why stopping the feeding and hydration of some patients is not merely morally permissible but is morally required. Patients may make a rational valid refusal of food and fluids just as they may of other kinds of life support, and what patients rationally refuse when competent holds its force when they become incompetent. By basing the distinction between active and passive euthanasia on the universally recognized moral force of a rational valid refusal, we have provided a clear foundation for the moral significance of this distinction. Our way of making the distinction preserves for patients the control over their lives that has sometimes been unjustifiably taken from them. It also eases the burden on doctors who no longer are forced to make use of ad hoc and confused distinctions in which they justifiably have little faith.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Definitive birth control and the physician--ethical issues.

We analyze the ethical issues related to the physician's role in informing about, advising, rejecting, or performing a definitive birth control procedure (sterilization). We define a rational request for tubal ligation, the limited delaying (or facilitating) role that guidelines for deciding on ligation should have, the justifiable reasons for rejecting a request, and the physician's obligations and options. We also consider the need to supply adequate information, the implications of recommending a second-best treatment, and the pivotal place of the "likelihood of regret" in medical decision-making.

Contraception↗
PubMed1984

Medical ethics.

Explore the source record for details and available documents.

Ethical Analysis↗
PubMed1984

Volitional disability and physician attitudes toward noncompliance.

We develop the concept of a volitional disability as an aid in understanding those patients who behave in ways that are harmful to themselves in spite of their desire to do otherwise. Using this concept enables us to describe their behavior as intentional but 'involuntary'. We demonstrate the clinical reality of such behavior by giving clinical examples of the behavior of those with phobic, compulsive, and addictive disorders. We then attempt to show how some kinds of self-harming behavior of noncompliant patients are similar to phobic and compulsive behavior. We propose use of the concept of volitional disability to make it easier for physicians to work with these noncompliant patients and thus to improve their ability to provide better care for them.

Adolescent↗