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PubMed1991

Mandatory parental involvement prior to adolescent abortion.

The issue of parental involvement in an adolescent's decision to abort a pregnancy is complex and controversial. Consequently, the impact of legislation to mandate parental involvement is reviewed. Although the costs of such legislation are high, there are at least three important clinical benefits. First, a legal mandate will require many adolescents who would not otherwise involve their parents in this decision process to seek their counsel and emotional support. Second, parent's responsibility for the actions of their adolescent children is acknowledged within the legal system. Third, family unity may be promoted by allowing parents and adolescents an opportunity to deal more openly with the causes and implications of the pregnancy.

Abortion, Legal↗
PubMed1987

Medicalization and its discontents.

This paper raises the question of the ethically proper balance in health care policy between the medical-clinical-high technology model of health service and the grass-roots, community based or traditional models of care. Paradoxical imbalances between the two approaches are traced to political, economic or prestige factors. Case studies examined include the hospitalization of non-contagious leprosy patients while protecting the anonymity of AIDS-infected prostitutes, medical resistance to the adoption of a clinical role by Community Cancer Centers, and the continued preference in some quarters for elaborate (and often delayed) hospital treatment for such problems as infant diarrhea, despite the availability of much simpler solutions, as in the case of the widely successful oral rehydration therapy. A balanced approach to world health problems, we argue, rests not on inflationary lowering of health care standards to achieve nominal victories, nor on stainless steel high technology panaceas but on mobilizing resources around human needs.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The blood transfusion taboo of Jehovah's Witnesses: origin, development and function of a controversial doctrine.

Jehovah's Witnesses are not allowed to accept a blood transfusion. According to the Watch Tower Bible and Tract Society this therapy is a transgression of divine precepts. Additionally, in the judgement of the believers, secular proof is abundant these days; to them AIDS is a powerful justification to abstain from blood. Founded on the work of the anthropologist Mary Douglas, it is argued that the rejection of this medical therapy is based on perceptions of pollution and purity inherent in the Watch Tower Society's ideological concept of anti-worldliness. Rooted in the movement's pre-war opposition to vaccination the implementation of the taboo was triggered by the prevailing social-political climate surrounding the Society during the Second World War, resulting in this intriguing and controversial religious proscription. For the community of Jehovah's Witnesses the blood transfusion taboo still functions as a significant mechanism of sectarian boundary maintenance.

Acquired Immunodeficiency Syndrome↗
PubMed1990

International behavioral responses to a health hazard: AIDS.

This paper expands on Jonathan Mann's third wave of the AIDS pandemic: the epidemic of economic, social, political, and cultural reaction and response to the HIV infection and to AIDS. This worldwide epidemic is a major economic challenge, especially in Third World countries, which can ill afford additional health care costs. AIDS is also a harbinger of political and cultural conflicts between and among nations, states, institutions, and people everywhere. It may ultimately transform law as radically as it has health care practices. In terms of management, it is possible to approach AIDS much as we do natural and technological hazards. The biology and epidemiology of AIDS require a coordinated attack, involving research on vaccines and drugs, modification of human behavior and education of populations to arrest the disease. All of these require money, of which the United States was the major contributor before the Reagan years. Funding to the United Nations and WHO has since languished, jeopardizing the AIDS efforts of those two organizations.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Facing AIDS: reactions among police officers, nurses and the general public in Sweden.

This study compares police officers and registered nurses and the general public concerning their perceptions of the risk of HIV infection, attitudes toward HIV-infected individuals, and attitudes toward measures used to fight the AIDS epidemic. Information was obtained through mail questionnaires sent to random samples of individuals, aged 25-44 years, from the 3 groups. The samples included 525, 501 and 1600 individuals respectively. Response rates were 85, 93 and 74%. The study showed good knowledge concerning verified carriers of HIV infection (blood, sperm, vaginal secretion, etc.). A widespread fear of unverified carriers of infection (public toilets, kissing on the mouth) existed particularly among the public and police officers. Negative attitudes toward HIV-infected individuals and demands for compulsory measures were common among all groups, although least common among nurses and most common among the police. Positive relationships were established between the fear of unverified carriers of infection, repulsive attitudes toward individuals infected by HIV, and demands for compulsory measures.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Ethical and legal implications of the new genetics: issues for discussion.

The so-called 'new genetics,' a phrase sometimes associated with The Human Genome Initiative, poses no really new ethical problems, but exacerbates old ones. The issues of most concern to geneticists and their patients are summarized under the eleven headings below. These issues emerged from a 19-nation study of ethics and genetics in 1985-86 and from preliminary work on a forthcoming 36-nation study by the same authors.

Abortion, Legal↗
PubMed1991

Drug addiction in pregnancy: the interface of science, emotion, and social policy.

The problem of drug addiction in pregnancy has been posed as a conflict between the rights of women and those of their fetuses. This paper presents a framework that incorporates emotion, identification, scientific research, and ethical issues as components to be used in establishing policy with respect to drug addicted pregnant women. Three approaches--voluntary treatment, involuntary treatment or incarceration, and maintaining of the status quo--are discussed with attention to class and economic aspects of women's lives and society's concern for fetal well-being. A model is proposed that addresses the needs of pregnant drug-addicted women and their fetuses, and that serves as an alternative to forced treatment or criminal prosecution.

Attitude↗
PubMed1994

Ethics, epidemiology, and women's health.

Ethical issues arise throughout the conduct of epidemiologic studies, in the processes of determining the study question, designing the protocol, and implementing the study. There also is an ethical dimension when studies are not done, for example, in studies of the effect of drugs and chemicals on male reproductive capacity. Harm as well as risk must be considered in the conduct of epidemiologic studies. The ethical principles that govern research, while independently justifiable, may come into conflict. Principles that govern research also may conflict with those that predominate in clinical practice. An example is the current controversy over unblinding anonymous, newborn human immunodeficiency virus seroprevalence studies to identify potentially infected infants. As women's health becomes more prominent on the research agenda, the resolution of these conflicts will become a complex challenge to epidemiologists, ethicists, clinicians, and the communities they serve.

AIDS Serodiagnosis↗
PubMed2005

Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries.

BACKGROUND: For-profit health plans now enroll the majority of Medicare beneficiaries who select managed care. Prior research has produced conflicting results about whether for-profit health plans provide lower quality of care. OBJECTIVE: The objective was to compare the quality of care delivered by for-profit and not-for-profit health plans using Medicare Health Plan Employer Data and Information Set (HEDIS) clinical measures. RESEARCH DESIGN: This was an observational study comparing HEDIS scores in for-profit and not-for-profit health plans that enrolled Medicare beneficiaries in the United States during 1997. OUTCOME MEASURES: Outcome measures included health plan quality scores on each of 4 clinical services assessed by HEDIS: breast cancer screening, diabetic eye examination, beta-blocker medication after myocardial infarction, and follow-up after hospitalization for mental illness. RESULTS: The quality of care was lower in for-profit health plans than not-for-profit health plans on all 4 of the HEDIS measures we studied (67.5% vs 74.8% for breast cancer screening, 43.7% vs 57.7% for diabetic eye examination, 63.1% vs 75.2% for beta-blocker medication after myocardial infarction, and 42.1% vs 60.4% for follow-up after hospitalization for mental illness). Adjustment for sociodemographic case-mix and health plan characteristics reduced but did not eliminate the differences, which remained statistically significant for 3 of the 4 measures (not beta-blocker medication after myocardial infarction). Different geographic locations of for-profit and not-for-profit health plans did not explain these differences. CONCLUSION: By using standardized performance measures applied in a mandatory measurement program, we found that for-profit health plans provide lower quality of care than not-for-profit health plans. Special efforts to monitor and improve the quality of for-profit health plans may be warranted.

Aged↗