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PubMed2002

A double standard in bioethical reasoning for disclosure of advanced cancer diagnoses in Japan.

This article examines the Japanese double standard in bioethical reasoning with respect to disclosure of advanced cancer diagnoses. This article is devoted to the analysis of communication styles preferred among the Japanese across different hypothetical situations involving cancer as one's own illness as opposed to cancer as a family member's illness. Generally, the Japanese prefer the use of a direct communication style, involving disclosure of the true diagnosis for their own cancer. When cancer is a family member's illness, however, many Japanese perceive the use of an indirect communication style, involving no disclosure or ambiguous disclosure to the patient more ethical than direct communication of the diagnosis. This article explores how and why the Japanese use this double standard when making judgments about the morality of disclosing an advanced cancer diagnosis to the patient. Policy and educational implications for reconciling such a double standard in bioethical reasoning for cancer disclosure are discussed as conclusions.

Bioethics↗
PubMed1996

Coming-out issues for adult lesbians: a group intervention.

This study investigated the effects of a 10-week, educational-experiential group intervention--the Coming Out Issues Group--designed to address issues pertinent to adult lesbians, including lesbian identity development, homophobia and heterosexism, religious concerns, career concerns, family issues, sexism and racism, and assertiveness skills development. The impact of the intervention was assessed using various instruments in four areas: (1) ego development, (2) lesbian identity development, (3) empowerment, and (4) disclosure. The results indicated modest gains in ego development and lesbian identity development and major gains in empowerment and disclosure.

Adult↗
PubMed1996

The effect of legislative requirements on the use of breast-conserving surgery.

BACKGROUND: We studied the effect of state legislation requiring the disclosure of options for the treatment of breast cancer on the use of breast-conserving surgery in clinical practice. METHODS: The National Cancer Institute's Surveillance, Epidemiology, and End Results registry provided data on women from 30 through 79 years of age who underwent breast-conserving surgery or mastectomy for local or regional breast cancer from 1983 through 1990. We examined the trend over time in use of breast-conserving surgery among patients in four sites (Connecticut, Iowa, Seattle, and Utah) where there were no state laws specifically requiring the disclosure of options for the treatment of breast cancer by physicians. For four additional sites (Detroit, Atlanta, New Mexico, and Hawaii) that had such legislation, we determined whether the rate of breast-conserving surgery after the legislation was different from the expected rate. RESULTS: An attorney rated the legislation as giving most direction to physicians in Michigan, followed by Hawaii, Georgia, and New Mexico. The rate of breast-conserving surgery was up to 8.7 percent higher than expected in Detroit for six months after the passage of the Michigan law (P<0.01). The rate was up to 13.2 percent higher than expected in Hawaii for 12 months after that state's law was passed (P<0.05) and up to 6.0 percent higher than expected in Atlanta for 3 months after the passage of the Georgia law (P<0.01). After these transient increases, the surgery rates reverted to the expected levels. No significant effect was detected in New Mexico, where only a resolution without legal force was passed. CONCLUSION: Legislation requiring physicians to disclose options for the treatment of breast cancer appeared to have only a slight and transient effect on the rate of use of breast-conserving surgery.

Adult↗
PubMed2005

Scientific analysis of second-hand smoke by the tobacco industry, 1929-1972.

The 1972 U.S. surgeon general's report The Health Consequences of Smoking was the first to include a warning about exposure to second-hand smoke. Because the tobacco industry has a record of withholding the results of their research from the public, we searched the internal tobacco industry documents and compared internal industry research on second-hand smoke to what the industry published in the open scientific literature through 1972. We found chemical analyses, sensory evaluations, and discussions of sidestream cigarette smoke (the smoke emitted by the cigarette between puffs, the main component of second-hand smoke), beginning in 1929. American Tobacco Company research in the 1930s indicated that, compared with mainstream smoke, sidestream smoke was produced in larger quantities and contained, per cigarette, 2 times more nicotine and 12 times more ammonia. Research funded by the Tobacco Industry Research Committee in the 1950s revealed that sidestream smoke contained, per unit cigarette, higher concentrations of carcinogenic polycyclic aromatic hydrocarbons, per unit mass, including four times more 3,4 benzopyrene. In 1956 and 1957, respectively, Philip Morris and R. J. Reynolds also began to research sidestream smoke. In 1961, Philip Morris began to do sensory evaluation and modification of sidestream odor during product development. This sensory evaluation of sidestream smoke was the first biological testing of sidestream smoke by a tobacco company. Prior to the release of the 1972 U.S. surgeon general's report, the tobacco industry published the majority of its findings in the open scientific literature and does not appear to have perceived second-hand smoke as a threat to human health.

Disclosure↗
PubMed2006

Healthcare providers' perspectives on discussing HIV status with infected children.

The disclosure of HIV status to infected children has received relatively little attention to date in sub-Saharan Africa. We conducted 40 semi-structured interviews with healthcare providers working in a large paediatric HIV clinic in Cape Town, South Africa regarding attitudes and experiences around discussing HIV with infected children. Most providers felt that the optimal age for general discussions about an HIV-infected child's health should happen around age 6, but that specific discussions regarding HIV infection should be delayed to a median of 10 years. Though most providers said that primary caregivers were the most appropriate individuals to lead disclosure discussions, there were strong views that caregivers require support from healthcare providers. These findings indicate the complexities involved in the disclosure of HIV status to infected children, and point to the need for interventions to support caregivers and providers in disclosure discussions.

Adolescent↗