IRBs: protecting the well-being of subject-participants with mental disorders that may affect decisionmaking capacity.
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Advisory Committees↗
SEARCH · PubMed Health
Results for “Personal Autonomy”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Giving away the grog: an ethnography of Aboriginal drinkers who quit without help.
The paper presents preliminary findings from a qualitative study of Australian Aboriginal men who have stopped drinking without the assistance of residential treatment, counselling or other programs. Main reasons advanced by interviewees for ceasing drinking were one or more of: medical condition and/or doctor's warning; family factors; trauma from accidents; conversion to Christianity. The author concludes that employment both helps and hinders abstention from drinking, and that social ties often pose major difficulties for those trying to give up drinking. The paper also discusses the importance of Aboriginal beliefs regarding personal autonomy.
Journal Article↗
Psychosocial impact of electronic aids to daily living.
Electronic aids to daily living (EADLs) allow persons who have a degenerative neuromuscular condition such as Duchenne's muscular dystrophy to operate a wide variety of household and workplace appliances without assistance (independent of family members or other caregivers). There is very little published research to describe how well EADLs are perceived by users to enhance their sense of personal autonomy, functional independence, and psychological well being. Psychosocial impact is a significant determinant of how users perceive the benefit of assistive devices to their quality of life. This study compared the perceived psychosocial impact of EADLs on a group of device users with the anticipated impact of EADLs reported by a group who were eligible for, but had not yet received, these devices. The perceptions of the user group were measured at two points in time, approximately 6 to 9 months apart, to examine the stability of psychosocial impact. The Psychosocial Impact of Assistive Devices Scale was the instrument used to assess perceived impact. EADLs were found to produce similar degrees of positive impact on users and positive perceptions of anticipated impact on those without devices. The psychosocial impact on users was stable over time. The results indicate that the perceived benefits of EADLs to the autonomy, functional independence, and psychological well being of both users and nonusers are positive and strikingly similar. The study is an important first step in attempting to quantify psychosocial outcomes for EADLs in a way that might facilitate economic analysis of these devices in the future.
Activities of Daily Living↗
What is the great benefit of legalizing euthanasia or physician-assisted suicide?
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Attitude↗
Discussion points to consider in research related to the human genome.
The advances in DNA technology and molecular genetics, spurred by the Human Genome Project, have created new challenges for human subjects research and the system of institutional review board (IRB) review. The populations to be studied are vulnerable because of genetic diseases or risk for them; until now, IRB review has concentrated on overt physical and medical hazards. Attention to the interests of individuals and families participating in, or affected by, research on the human genome frames the agenda for IRB deliberations and suggests the information to be conveyed to prospective participants. By a series of questions, this article explores how human genome research involves a distinct paradigm in human subjects research with its own imperatives for researchers and IRBs.
Beneficence↗
The failure of the freedom-based and utilitarian arguments for assisted suicide.
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Ethical Theory↗
Ethical issues in managed care: a Catholic Christian perspective.
A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics of health care. The moral status of any system of managed care ought to be judged with respect to its congruence with Gospel teachings about the care of the sick, Papal Encyclicals, and the documents of the Second Vatican Council. In this essay, I look at the important conceptual or definitional issues of managed care, assess these concerns over against the source and content of a Catholic ethic of health care, and outline the necessary moral requirements of any licit system of health care.
Administrative Personnel↗
A qualitative study of factors influencing antimicrobial prescribing by non-consultant hospital doctors.
OBJECTIVES: To determine the factors that influence non-consultant hospital doctors (NCHDs) in their decision to prescribe antimicrobial agents. METHODS: A qualitative study using semi-structured interviews centred on a life grid tracking the medical career of 22 NCHDs employed by a university teaching hospital in the west of Ireland. RESULTS: Early in their careers NCHD prescribing is based primarily on the immediate influence of more senior colleagues. Recollection of formalized undergraduate teaching and hospital guidelines are a very minor influence. As their career progressed and they exercise greater autonomy, personal experience becomes the major influence on prescribing decisions. Hospital guidelines are a minor influence. Participants consider that undergraduate teaching needs to be more practical and taught in a way that is easier to apply to on-ward situations and that hospital prescribing guidelines need to be presented in a 'user-friendly' format and adherence to the guidelines needs to be promoted. CONCLUSIONS: The key influences on antimicrobial prescribing by NCHDs are informal. New approaches are required to ensure that formal training and hospital guidelines on antimicrobial prescribing are more influential in shaping antimicrobial prescribing practice.
Anti-Bacterial Agents↗
Setting the agenda for urban bioethics.
Urban bioethics has two goals. First, it aims to focus attention on neglected bioethical problems that have particular salience in urban settings. Three problems are highlighted: socioeconomic inequality as a major determinant of health inequality, the foundations of an ethic for public health, and the impact of social context on the therapeutic alliance between patients and physicians. Second, urban bioethics serves as a vehicle for raising deep theoretical and methodological questions about the dominant assumptions and approaches of contemporary bioethics. Demands for cultural sensitivity, so pronounced in the urban context, compel us to reexamine the central commitment in bioethics to personal autonomy. The multiculturalism of urban life also argues for a dialogic approach to bioethical problem solving rather than the monologic approach that characterizes most bioethical thinking. Although my brief for redirecting bioethics will resonate with many critics who do not consider themselves urban bioethicists, I argue that there are special advantages in using urban bioethics to expose the limitations of contemporary bioethical paradigms.
Attitude to Health↗
Impact of the term schizophrenia on the culture of ideograph: the Japanese experience.
The ideographic Chinese writing system (in use in Asian countries that account for about a quarter of the world's population) directly expresses the meaning of schizophrenia as "the disease of disorganized mind." The term directly challenges a deeply ingrained concept of personal autonomy, and this is stigmatizing. Japanese psychiatrists are thus reluctant to tell their patients that they are suffering from schizophrenia, and, as a result, no more than 20 percent of sufferers actually do know about their diagnosis. Because taking medication is based on informed consent and the exercise of the patient's autonomy, such lack of information has important negative effects. It is unlikely that this problem can be resolved by education or information alone, and it may well be the case that in cultures using ideographs, the illness will need to be renamed. This article suggests some alternatives.
Attitude to Health↗
Ethics, scientific validity, and the design of epidemiologic studies.
Ethical conflicts between moral principles and methodologic standards sometimes occur in epidemiologic research. When dilemmas are discerned, they may be analyzed using the ethical principles of beneficence, nonmaleficence, justice, and respect for the autonomy of persons. We argue that, in addition to scientific validity, the welfare and rights of research subjects should be taken into account in making decisions regarding all aspects of the design and conduct of epidemiologic studies, and that the commitment of epidemiologists to the advancement of scientific knowledge should not outweigh or override all other considerations.
Beneficence↗
End-of-life decisions in critical care medicine--where are we headed?
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Attitude to Death↗
Substance abuse by pregnant women: legal and ethical concerns.
Court-ordered detention and prosecution of a pregnant woman for substance abuse is an unusual but increasing occurrence in the United States. At least 24 states have attempted to prosecute a pregnant woman on a variety of charges for suspected harm to the fetus. This article reviews the issues involved including personal autonomy duty of caregivers to women and fetuses, and ethical frameworks for discussion.
Crime↗
Ending the silent conspiracy: sexual harassment in nursing.
Sexual harassment in health care institutions presents a formidable challenge for nurse leaders as solutions and accountabilities get mired in power, politics, and a historical tradition of secrecy and silence. Harassment is devastating to all individuals, but especially to women because it blatantly violates the victim's personal autonomy and individual sense of equality. Sexual harassment lingers in the corridors of all types of organizations, preying on women as they struggle to overcome cultural and socially imposed barriers. Nurse executives must learn the subtle complexities surrounding harassment, voice strong opposition against harassment, and take swift and comprehensive action to prevent sexual harassment.
Female↗
Personal and interpersonal perceived control and the quality of life of persons with severe mental illness.
Studies have been carried out to explore the impact of sense of control on the outcome of persons with severe mental illness (SMI). However, few studies have compared the differential effects of perceived personal control (control of the self) and perceived interpersonal control (the control of significant others). In the present study, we investigated the relations between perceived personal and perceived interpersonal control and different domains of quality of life (QOL) of persons with SMI. Measures of perceived personal and interpersonal control and QOL were administered to 145 participants with a diagnosis of SMI (schizophrenia, affective disorders, anxiety disorders, personality disorders). The results showed personal control to be positively related to various domains of QOL (beta = .28-.31, p < 0.001-0.01) while interpersonal control was negatively related to the physical domain of QOL (beta= -.20, p < 0.05). Theoretical, empirical, and clinical implications of the distinction between personal and interpersonal control for persons with SMI are discussed.
Adult↗
The injustice of unsafe motherhood.
This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women's powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously-based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of 'reproductive health' as one that supports women's reproductive self-determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone-marrow or blood donations for their children's survival. Women's unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity.
Abortion, Legal↗
International comparison of baccalaureate nursing degrees: collaboration in qualitative analysis.
This paper describes a study which investigated the perceived similarities and differences of a selection of baccalaureate nursing degrees from different continents. An international research team was formed, and by using a modified version of the Delphi process and nominal group techniques the group undertook a qualitative analysis of curriculum documents. The major areas analysis were: aims, content, methods and assessment. Under these headings the group produced a list of key issues supported by a number of indicative statements by collating the independent analyses undertaken by each of the team members. Examples of findings are that critical thinking and personal development are most obvious in aims but that the progression of curricula may not achieve this, there are differences in 'western' and 'asian' orientations to the concept of personal autonomy. Sciences are valued more than arts or humanities. The lecture method as well as practice placement dominate the teaching methods. Transcultural nursing is not significant except where there are two therapeutic ideologies in existence. Assessment methods are largely summative. The findings have application in the development of credit transfer and international exchange schemes. The conclusions highlight areas of special considerations when designing such schemes.
China↗