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PubMed1990

Ethical and legal issues in geriatric nephrology.

Ethical and legal issues affecting geriatric nephrology are conditioned more by individuals' status as elderly, sick people than by the distinctive characteristics of kidney disease or failure. Key ethical issues are the obligation to respect persons, in particular by recognizing competent persons' autonomy of medical choice and affording due protection to dependent or vulnerable individuals, by beneficence or doing good, and by acting with justice, treating like cases alike and avoiding unjust discrimination. The law reinforces ethical obligations through such legal concepts as informed consent and the duty to maintain appropriate confidentiality, which have special applications concerning medication and management of the elderly. Additional legal issues concern advanced care directives and terminal care decisions.

Aged↗
PubMed2003

The meanings of organ donation: Muslims of Pakistani origin and white English nationals living in North England.

This study explores the meanings of organ donation, with emphasis on donating eyes and hearts, comparing people across gender and across two ethnic groups. Four focus group interviews were conducted with people living in the North of England: (1) five Muslim women of Pakistani origin, (2) five Muslim men of Pakistani origin, (3) nine white English women, and (4) eight white English men. The focus group interviews were analysed using grounded theory and a conceptual micro-model created for each group. The main finding was that the act of organ donation can be perceived as involving a personal cost. The Muslims of Pakistani origin related costs with their religious beliefs. In contrast, the white English associated costs with their distrust of the medical system. Women were concerned about the transmission of disease or of personality, whereas the white English men highlighted their personal rights. We conclude that the meaning of organ donation is more than about being and having a body. It is bound up in metaphors of embodiment, religious considerations, and moral judgement of scientific and medical conduct.

Adult↗
PubMed1999

Suicidal patients in the ED: ethical issues.

Emergency physicians frequently are expected to evaluate and develop treatment plans for potentially suicidal patients. The struggle to prevent someone from self-injury while respecting their personal autonomy is frequently present in the ED, as physicians must decide whether to intervene with a patient who does not seek treatment. The implications of this struggle are discussed in the article.

Emergency Medicine↗
PubMedDate not supplied

Health care seeking behaviour of patients with sexually transmitted diseases: determinants of delay behaviour.

The study aimed to determine the factors associated with a delay in seeking health care for symptoms of sexually transmitted diseases (STDs) among a sample of 1482 patients attending STD clinics. Of the sample 78% were male, 58% sought help from the clinic within the first 6 days of noticing symptoms, 24% waited between 7 and 10 days and 17% waited longer than 10 days before seeking health care. Patients who delayed were those who treated themselves prior to seeking health care, who were female, whose friends waited before seeking treatment, who held misconceptions regarding the cause of STDs, who perceived STDs not to be serious and who valued personal autonomy in sexual behaviours less and had less positive outcome expectations of refusing sex. The data suggest that targeted interventions should be directed specifically at women and the youth. Early health care seeking could be facilitated through improved basic knowledge regarding STDs, control over one's own sexual behaviour and social support for early health care seeking.

Adult↗
PubMed2001

Julius Hallervorden's wartime activities: implications for science under dictatorship.

The eponym Hallervorden-Spatz syndrome recalls Julius Hallervorden's and Hugo Spatz's original description of this pediatric neurodegenerative disorder. Julius Hallervorden's important contribution to the practice of neuropathology over a long career cannot be underestimated. However, his work as a pathologist during the Third Reich put him in close proximity with the implementation of biologic solutions (i.e., euthanasia) targeting those individuals with significant intellectual or physical disabilities in chronic-care facilities. The Nazi program of active euthanasia provided a scientific opportunity to gain quick access to pathologic materials. This opportunity was recognized and used by Hallervorden to achieve personal scientific objectives and research efforts. These efforts resulted in a number of postwar scientific publications using materials obtained through the euthanasia program. The participation of distinguished academic physicians in such a program provides a cautionary tale of the potential results of ethical compromise and the effects of the abrogation of personal autonomy in the setting of a totalitarian dictatorship.

Autopsy↗
PubMedDate not supplied

The meaning of sexual satisfaction in pregnant Taiwanese women.

The aim of this qualitative study was to explore Taiwanese women's experience of sexual satisfaction during pregnancy. Twelve participants were recruited through purposive sampling of outpatients registered in the antepartum clinic of a medical center in northern Taiwan. Data collection consisted of semi-structured interviews and tape recordings. A modified phenomenologic methodology and narrative analysis of transcripts yielded four essential themes related to the personal meaning of sexually satisfying experiences in pregnancy: 1) improvement of self-identity, 2) empowerment through sexual relations, 3) strengthening the marital bond, and 4) reinforcement of the value of sexuality. This woman-centered view of the significance of sexually satisfying experiences in pregnancy can help health care professionals understand and educate their clients about women's sexuality during pregnancy.

Adult↗
PubMed2001

Who favors legalizing physician-assisted suicide? The vote on Michigan's Proposal B.

At the November 1998 general election, Michigan citizens were given the opportunity to vote on Proposal B, an initiative that would have legalized physician-assisted suicide (PAS). PAS initiatives also have been held in Washington State, California, Oregon, and Maine, with only Oregon's passing. We use exit poll data to analyze the vote on Proposal B. Attributes associated with social liberalism -- Democratic Party identification, less frequent church attendance, more education, and greater household income -- led to increased odds of a "yes" vote. Attributes associated with social conservatism -- Republican Party identification and frequent church attendance -- led to decreased odds of a "yes" vote. Similar to the abortion issue, PAS's supporters strongly value personal autonomy, whereas its opponents strongly value the sanctity of life. Voter alignments like those in Michigan will likely appear in other states with the initiative process if PAS reaches their ballots.

Data Collection↗
PubMed2000

Ethics applied to pharmacy practice.

This article tries to develop an ethical reasoning that can be applied to (the practice of) pharmacy. Only general principles, based on accepted values in western society, lead to guidelines for ethical behaviour. Such essential values are personal autonomy, democracy and solidarity. The principle of nonmaleficience can be derived from these. Results of this analysis can be applied to health care and pharmacy practice. Subchapters deal with questions such as budget limitations and the autonomy of the patient versus that of the care provider. It concludes that protocols are important tools for ethical behaviour in every day practice. The ethical problem appears to be the unequal access to the health care system. An analysis of pharmaceutical care in the light of ethics can help to formulate the pharmacist's responsibilities. The principle of nonmaleficence is strongly connected to the pharmacy profession. Pharmacists should focus more on possible negative outcomes of pharmacotherapy. Monitoring the patient's medication, identification and prevention of possible adverse effects, medication surveillance, proper communication and information about the use of medicines are therefore priority items within our profession. A definition of target groups for pharmaceutical care will facilitate this task. A suggestion for a general code of ethics for pharmacists is proposed and compared with the code of ethics as currently accepted by the International Pharmaceutical Federation (FIP)-council.

Ethics, Pharmacy↗
PubMed2001

Genetics and culture: the geneticization thesis.

The concept of 'geneticization' has been introduced in the scholarly literature to describe the various interlocking and imperceptible mechanisms of interaction between medicine, genetics, society and culture. It is argued that Western culture currently is deeply involved in a process of geneticization. This process implies a redefinition of individuals in terms of DNA codes, a new language to describe and interpret human life and behavior in a genomic vocabulary of codes, blueprints, traits, dispositions, genetic mapping, and a gentechnological approach to disease, health and the body. This article analyses the thesis of 'geneticization'. Explaining the implications of the thesis, and discussing the critical refutations, it is argued that 'geneticization' primarily is a heuristic tool that can help to re-focus the moral debate on the implications of new genetic knowledge towards interpersonal relations, the power of medicine, the cultural context and social constraints, rather than emphasizing issues as personal autonomy and individual rights.

Bioethics↗
PubMed2001

Suicidal ideation and self-determination in institutionalized elderly.

The right to self-determination is central to the current debate on rational suicide in old age. The goal of this exploratory study was to assess the presence of self-determination in suicidal institutionalized elderly persons. Eleven elderly persons with serious suicidal ideations were matched according to age, sex, and civil status with 11 nonsuicidal persons. The results indicated that suicidal persons did not differ from nonsuicidal persons in level of self-determination. There was, however, a significant difference between groups on the social subscale. Suicidal elderly persons did not seem to take others into account when making a decision or taking action. The results are discussed from a suicide-prevention perspective.

Aged↗