PubMed · 10243271
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R W Rhein. 1979-07-09. Nurses: colleagues or competitors?. https://pubmed.ncbi.nlm.nih.gov/10243271/
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Local health departments often use multidisciplinary top management teams (TMTs) to organize the work of the agency. The purpose of this study was to examine the use of TMTs in North Carolina local health departments and how TMTs use affected agency performance. TMT diversity and TMT performance positively affected the local health departments' (LHDs) performance. As well, the TMTs' agenda affected LHD performance. The more that TMTs discussed community health assessment and political changes in the community, the better the LHD performance on the core functions. Implications for public health practice and leadership in local health departments are discussed.
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Practitioners who care for pregnant women face dilemmas when their patients use illicit drugs, reject medical recommendations, or cause fetal harm. Many ethics scholars characterize those situations as maternal-fetal conflicts. In conflict-based models, maternal rights are considered to conflict with fetal rights, or moral obligations owed to pregnant women are considered to conflict with those owed to their fetuses. I offer an alternative model of pregnancy ethics by applying relational and equality-based moral theories to situations of fetal harm by pregnant women. In this model, clinicians faced with ethical dilemmas should attempt to understand pregnant women and their decisions within their broad social networks and communities, ask how the clinician's personal standpoint influences outcomes judged to be ethical, and determine whether the clinician's ethical formulations reduce or enhance existing gender, class, or racial inequality. This model focuses on the mutual needs of pregnant women and fetuses rather than on their mutually exclusive needs. It also avoids many pitfalls of traditional ethical formulations, specifically their tendency to neglect gender-specific modes of moral reasoning, their implicit assumptions that application of universal principles like autonomy and beneficence results in objective ethical solutions, and their failure to account for the ways that projecting fetal needs perpetuates social inequalities. This model provides the ethical foundations for moving law and policy away from criminalization and toward prevention of prenatal harm.