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PubMed2000

Sociocultural conceptions of the borderline personality.

Although sympathetic to most analytic conceptions of the origins of borderline personality disorder, an addendum reflecting the recent and divisive impact of rapid social and cultural changes is proposed. Specifically noted are social customs that exacerbate rather than remediate early errant parent-child relationships and the diminished power of once reparative institutions that no longer compensate for these ubiquitous early problems.

Adult↗
PubMed2002

Sister cities and easy passage: HIV, mobility and economies of desire in a Thai/Lao border zone.

It is recognised that people movement can increase potential risk of HIV transmission. In recent years, mobile populations moving across national borders have become a focus for HIV/AIDS prevention campaigns. These programs generally target border "hot zones" that produce high levels of HIV vulnerability due to the degree of mobility and the risk behaviours fostered by these marginal environments. However, high degrees of movement and social exploitation need not be the only criteria for borders to exacerbate HIV vulnerability. The types of social interactions promoted by mobility take many forms. In this paper we consider a border zone between Thailand and Laos to show that the links between movement and HIV vulnerability are not confined to stereotypical instances of coercion and exploitation. Rather we demonstrate that HIV risk in this area is a product of both a sense of community and a sense of difference that together foster a range of interactions based on mobility back and forth across the border. As HIV/AIDS prevention programs increasingly control forms of sexual interaction, the border provides a practical and symbolic opportunity to establish new forms of sexual relationship falling outside these constraints. This tendency to move outside bounds is not limited to border areas but has implications for prevention programs everywhere.

Cities↗
PubMed2003

Perceptions of health hazards in the narratives of Italian migrant workers at an Australian asbestos mine (1943-1966).

This article reconstructs how workers perceived asbestos hazards, using narratives from a group of migrant workers at the crocidolite mine of Wittenoom Gorge, Western Australia. The mine employed about 7000 workers over the entire period of its operation from 1943 to 1966-relying heavily on migrant workers. The exposure to asbestos dust caused a huge number of occupational respiratory diseases in workers, leading Wittenoom later to be labelled as a modern industrial disaster. Fieldwork involved 137 interviews with Italians who had worked at Wittenoom. They constituted 18% of the mine's work-force and were employed as miners or millers between 1951 and 1966. We interviewed workers who had returned to Italy, relatives of Italian workers now deceased, and workers who had settled in Australia. The results confirm the seriousness of the occupational exposure to asbestos and the weaknesses of the health surveillance program. Although workers were given no health-related information, they felt they were at risk and left the job as soon as possible. From the early 1950s onward, some of the workers became aware of a long-term connection between work at Wittenoom and lung illnesses that required hospitalisation and caused deaths. However, up to the early 1960s, workers at the mine were led to believe that the respiratory disease spreading among them was tuberculosis.

Adult↗
PubMed1999

The 'dop' system, alcohol abuse and social control amongst farm workers in South Africa: a public health challenge.

Many farm workers in South Africa continue to live and work under adverse conditions that are the legacy of apartheid policies. Despite its official prohibition, the arrangement by which workers are given alcohol' as a benefit of employment, known as the 'dop' system, appears to persist. Even though it is a minority of farms that currently actively practice the dop system, the ramifications of the historical 'institutionalisation of massive alcohol consumption are widespread. Heavy alcohol consumption is not only directly injurious to the health of farm workers and their families, but places them at risk to various social and environmental hazards. This is illustrated in a case of pesticide poisoning in which 24 workers were poisoned when given wine contaminated with the carbamate insecticide aldicarb. The case illustrates (i) the ongoing application of the dop system on farms in South Africa and (ii) the interaction between social factors and chemical exposures amongst farm workers. Public perceptions about the natural tendencies of 'coloured' people to drink heavily have much to do with perpetuating the dop system, and reinforcing a system geared towards the social control of rural farm workers and their families. The dop system poses a major challenge to the public health authorities in South Africa who are charged with the task of restructuring health services to address the human rights and health needs of marginal farming communities within a primary health care framework.

Agriculture↗
PubMedDate not supplied

Community prevention of alcohol problems.

Local communities have begun using policy to affect the drinking environment itself as an approach to reducing alcohol involved trauma. That is, policy is used to produce structural changes in the drinking environment. In turn, changes in the environment effect changes in drinking behavior. This paper describes an effort in three communities in two states to reduce alcohol problems at the community level, "Preventing Alcohol Trauma: A Community Trial." This trial was a 5-year research project with a goal to reduce local alcohol-involved injuries and deaths in three experimental communities with populations of approximately 100,000 each (one in northern California, one in southern California, and one in South Carolina). The communities contained racial and ethnic diversity as well as a mix of urban, suburban, and rural settings. Each of these three communities had a control community that did not receive the prevention interventions. The project used an environmental policy approach to prevention and five mutually reinforcing components were implemented: (1) community mobilization to develop community organization and support, (2) responsible beverage service to establish standards for servers and owners/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants. (3) a drinking and driving component to increase local drunk-driving enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) an underage drinking component to reduce retail availability of alcohol to minors, and (5) an alcohol access component to use local zoning powers and other municipal controls of outlet numbers and density to reduce availability of alcohol. Results show that the project reduced alcohol-involved crashes, lowered sales to minors, increased the responsible alcohol serving practices of bars and restaurants, and increased community support and awareness of alcohol problems.

Accidents, Traffic↗
PubMed1991

Autonomy and its limitations in artificial reproduction.

We have examined the concept of autonomy and some of its limitations. The choice between comprehensive and paternalistically modified information giving is not necessarily easy and the competence of a patient to comprehend and give informed consent in medically complex issues may be limited. In extreme cases, such as mentally defective persons, the consent-giver is unarguably incompetent to directly exercise autonomy and a substitute consent-giver or decision-maker is required. In most circumstances decision-making should be devolved to patients as much as possible, notwithstanding the faulty heuristics frequently displayed. This is not only because autonomy is an important principle in its own right but because an internally inconsistent decision is still likely to be closer to an individual's theoretical ideal decision than a decision based on a substitute decision-maker's values. We can see from the examples discussed that there are many instances where principles, guidelines, rules or laws propounded for the benefit of one party may restrain autonomy, beneficence and justice done to another. We would not wish to see anarchy occur in any branch of medicine but is there evidence that restricting the autonomy of the parties involved will necessarily prevent that? We argue that restraint on the autonomy of individuals in reproductive medicine should be kept to a minimum and that society is strongest where individuals have the greatest freedom to follow their personal beliefs.

Advisory Committees↗
PubMed1991

Embryo manipulation and experimentation.

I have argued that early human embryos are not human beings, and do not have normal rights. Like human sperm and ova, they are both alive and biologically human. However, they lack the physiological development necessary to sustain a capacity for sentience. If Ford is right, then they are not yet individual human organisms. But the more important point is that their lack of a capacity for sentience makes them inappropriate candidates for the ascription of moral rights. Thus, research on human embryos produced in vitro is not a wrong against them--at least so long as experimentally manipulated embryos are not returned to the womb, or artificially gestated to a stage at which they might become sentient. Some of the more difficult issues about embryo experimentation involve the rights of women as experimental subject and donors. The consent of both male and female gamete donors should normally be required for the production or experimental use of IVF embryos. (Possible exceptions might include cases in which one or both progenitors have died, and the survivor or other responsible family member wished to donate the (frozen) IVF embryos for research or other uses.) However, it is women's rights that are most apt to be endangered, for example, if the large scale therapeutic or commercial use of human embryos leads to a demand for large numbers of ova. Thus, it is vital that researchers and policy-makers heed feminist concerns about embryo research and the new biomedical technologies it may yield. Given adequate information and appropriate procedural protections, women are capable of making autonomous decisions about donating ova or embryos for biomedical research. But regulatory safeguards are needed to ensure against their being coerced, deceived, or manipulated into becoming ovum or embryo donors. As Daniel Callahan has detailed, biomedical technology has reached the point where we can no longer afford to provide everyone with all of the innovative therapies that might prove beneficial (Callahan, 1989, p 523). Thus, questions about the just and cost-effective distribution of medical resources will become increasingly difficult and important. Among these questions will be whether it is wise or just to invest large sums in the development of innovative methods of assisting human reproduction. We must also consider the interests of future persons who may suffer because of the methods used to bring them into existence.(ABSTRACT TRUNCATED AT 400 WORDS)

Beginning of Human Life↗
PubMed2005

Choosing children: intergenerational justice?

In this discussion, we argue that the concept of intergenerational justice, usually used in environmental matters, is applicable to reproductive decisions also. Additionally, we propose that this permits certain reproductive choices to be made prior to conception or during the pregnancy, and that these choices should not be confined to clinical concerns. In particular, we argue that consideration of the interests of future children should be viewed from the perspective of objective well-being. That being the case, decisions about the sex of future offspring can, in terms of intergenerational justice, be legitimate. We do not argue that every reproductive choice is legitimate; for example it would not be legitimate deliberately to choose characteristics that prevent future children from potentially successful participation in social life.

Human Rights↗