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PubMed2002

Rights not restrictions for learning disabled adults: a response to Spiecker and Steutel.

What follows is a response to an article by Spiecker and Steutel in which they pose the question of whether sex between people with "mental retardation" (sic) is morally permissible and in which they argue that since many such people cannot give "valid consent", the additional consent of caretakers may be required. However, we argue that the term "mental retard" is offensive and that either the UK terminology ("the learning disabled") or the internationally accepted term ("intellectually disabled") are more acceptable. Moreover, we point out that Spiecker and Steutel are mistaken. Many "learning disabled" people can and do give "valid consent". In any case, their question is itself dubious. Why should two learning disabled people who want to have sex together need anyone else's consent? In addition, we briefly address the rights of the learning disabled to the same sexual freedom as others, on the one hand, and to freedom from sexual exploitation on the other hand. Finally, we consider the implications of these issues for moral education. We suggest that carers need to develop empathy and, where necessary, advocacy skills. We point to the existence of training programmes on sexuality and protection issues.

Adult↗
PubMed1999

Alternatives for protecting privacy while respecting patient care and public health needs.

This paper begins with a discussion of the value of privacy, especially for medical records in an age of advancing technology. I then examine three alternative approaches to protection of medical records: reliance on governmental guidelines, the use of corporate self-regulation, and my own third hybrid view on how to maintain a presumption in favor of privacy with respect to medical information, safeguarding privacy as vigorously and comprehensively as possible, without sacrificing the benefits of new information technology in medicine. None of the three models I examine are unproblematic, yet it is crucial to weigh the strengths and weaknesses of these alternative approaches.

Access to Information↗
PubMed1980

Influence of client/colleague dependence on physician performance in patient care.

The study has attempted to determine how client/colleague dependence influences medical care received by patients. We have tested physician compliance with standards of care according to the degree to which the practice is visible to, and dependent upon, colleagues. Physician performance is measured in terms of compliance with established professional standards in five areas of practice: 1) the quality of medical care; 2) appropriateness of hospital admissions; 3) appropriateness of length of hospital stay; 2) overstays and 5) understays. The sample consisted of 3316 hospital episodes from 22 general hospitals in the state of Hawaii, and the analysis was conducted via multiple-classification analysis (MCA). Specifically, it was found that from the more colleague-dependent physicians, patients received care with: 1) higher scores on an index of quality of care; 2) more justified admissions; 3) more appropriate lengths of stay; 4) fewer overstays; but 5) more understays. These results remained even after adjusting for a number of physician, client and type-of-practice variables. The findings of this study suggest the significant role that the informal structure of physician practice plays in influencing physician performance. Various sociological implications for control of professional practice are discussed in terms of 1) provision of incentives to encourage an increase in the formalization of otherwise informal physician relationships, and 2) tying formal control mechanisms to informal processes of control.

Clinical Competence↗