[Reason to believe and reason to hope].
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BACKGROUND: Debate about early obstetric discharge is occurring simultaneously in several different countries. An Australian population-based survey of recent mothers investigated women's views about shorter postnatal stays and assessed the impact of early discharge on important maternal health outcomes. METHOD: Women's views and experiences of length of hospital stay were gathered by means of a statewide postal survey of all women who gave birth in Victoria, Australia, during two weeks in 1993. Questionnaires were mailed to women 6 to 7 months after the birth; 62.5 percent (n = 1336) responded. RESULTS: Most of the sample (64%) stayed in hospital for 5 or more days after the birth, 26.6 percent left on day 3 or 4, and 9.4 percent on day 1 or 2. Compared with women who stayed for 5 or more days, women who left in the first 48 hours were more likely to be multiparous; to have attended public models of care (public hospital clinic, shared care, public general practitioner, birth center); not to have private health insurance; to have experienced a lower level of obstetric intervention; and to have a very low income. Twenty-one percent of women who left within 48 hours, and 26 percent of those who left on day 3 or 4 described their stay as too short. Women who left on day 3 or 4, or within 48 hours, were not more likely to experience any of the adverse outcomes investigated in the study: breastfeeding problems, low confidence about caring for the baby, or depression 6 to 7 months after birth. Women who left on day 3 or 4 had slightly lower rates of breastfeeding at 3 and 6 months than women staying for longer or shorter periods. CONCLUSION: Concerns about possible adverse outcomes resulting from shorter postnatal stays were not borne out by the study findings. Large and carefully designed randomized trials are needed to resolve continuing uncertainties about the safety and possible benefits of shorter hospital stays.
Since the early 1970s the issue of euthanasia has been intensely debated in The Netherlands. Through these debates knowledge about medical practices involving the end of life was no longer confined to medical or legal quarters, but became public to a large extent. Following public opinion changes, the legal reaction to euthanasia changed. By prosecuting test cases the public prosecutors allowed the Dutch Supreme Court to formulate specific conditions in which euthanasia would go unpunished. The political debate about changing the criminal law, which still holds that euthanasia is a serious crime, developed at a much slower pace. Several extensive empirical studies were undertaken to gain valid knowledge about the medical practices. This article is concerned with a presentation of the various debates and the changes that took place in the fields of criminal law, politics, and medicine. The main conclusion is the hypothesis that a more open climate for medical practices concerning the end of life allows society to better control these practices.
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