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PubMed1998

Professional ethics: are we on the wrong track?

Are we on the wrong track, in terms of our expectations of a code of practice, professional ethics teaching or the wider field of moral philosophy, in our search for clear answers to the ethical problems that arise in clinical practice; or are we simply wrong in believing that there are always clear answers? This article examines a particular case, an account of which appeared in Nursing Standard at the end of 1996. The conclusion reached is that we are likely to be misguided in assuming that there are always clear, straightforward answers to the ethical problems of clinical practice. However, more than a fleeting acquaintance with the field of ethics may help us to begin to think with greater clarity about what we do and why we do it. The hope is that this might lead to considered, humane practice by design, with the critical understanding and support of our professional peers and employers.

Aged↗
PubMed2000

Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women.

Developed by Robert Connell, the theory of gender and power is a social structural theory based on existing philosophical writings of sexual inequality and gender and power imbalance. According to the theory of gender and power, there are three major social structures that characterize the gendered relationships between men and women: the sexual division of labor, the sexual division of power, and the structure of cathexis. The aim of this article is to apply an extended version of the theory of gender and power to examine the exposures, social/behavioral risk factors, and biological properties that increase women's vulnerability for acquiring HIV. Subsequently, the authors review several public health level HIV interventions aimed at reducing women's HIV risk. Employing the theory of gender and power among women marshals new kinds of data, asks new and broader questions with regard to women and their risk of HIV, and, most important, creates new options for prevention.

Communicable Disease Control↗
PubMed1995

Mobilizing a low-income African-American community around tobacco control: a force field analysis.

A statewide tobacco control campaign in California has been highly successful in reducing public exposure to the health hazards of secondhand smoke. Over 250 cities and counties in California have enacted local ordinances to regulate smoking in public places and workplaces. Although low-income people of color are disproportionately affected by the use of tobacco, the issue of regulating secondhand smoke tends to be a lower priority in communities that are confronted by other, more immediately pressing social justice issues, such as high rates of violence and lack of economic opportunity. This article describes the process undertaken by a county health department to mobilize a low-income African American community in a San Francisco Bay Area city to support a local ordinance mandating 100% smoke-free workplaces and restaurants. These efforts are more likely to succeed if health advocates (1) reframe issues in a context that acknowledges the political, economic, and social justice realities and strengths of the community; (2) organize within existing local networks and foster the integration of tobacco issues into the group's existing work; and (3) can defer their own agendas during times of community grieving and healing.

Advertising↗
PubMed2006

Protective orders: questions and conundrums.

Current media portrayal of protective orders is often negative, focusing on weaknesses in how protective orders are obtained and enforced. This review of research findings on protective orders examines issues and suggests areas in need of future research to clarify and improve public policy. More specifically, this review has five main objectives: (a) to provide background information about partner violence and the need for protective orders; (b) to describe what protective orders are, how many women obtain them, and the advantages and disadvantages of obtaining protective orders; (c) to examine characteristics of women who seek protective orders; (d) to explore research on whether protective orders actually increase women's safety; and (e) to highlight opportunities and gaps in the practice and research literature regarding the use of protective orders for women with violent partners or ex-partners.

Battered Women↗
PubMed1976

Homicide in the West of Scotland.

Between 1953 and 1974 the author made psychiatric examinations for the prosecution of 400 persons, 367 males and 33 females, accused of the murders of 307 victims, 194 males and 113 females. The 367 males were accused of 273 murders, 172 male and 101 female victims, and the 33 females were accused of 34 murders, 22 male and 13 females victims. The salient features amongst the accused were maleness, youthfulness, the causal importance of alcohol, the rarity of suicide after murder an the high percentage of psychiatrically normal persons: in these last two respects the picture differed from that reported in England and Wales. The normality of these Scottish accused was further shown by the finding that in the decade 1965 to 1974 no material psychiatric abnormality was seen in 90 per cent of the males examined.

Age Factors↗
PubMed2000

Ethnic differences in admissions to secure forensic psychiatry services.

BACKGROUND: Persons of African-Caribbean origin are more frequently imprisoned, and increasing evidence suggests they are detained more frequently in psychiatric hospitals, following offending behaviour. AIMS: To estimate population-based prevalence rates of treated mental disorder in different ethnic groups compulsorily admitted to secure forensic psychiatry services. METHOD: A survey was recorded of 3155 first admissions, from 1988 to 1994, from half of England and Wales, with 1991 census data as the denominator adjusted for under-enumeration. RESULTS: Compulsory admissions for Black males were 5.6 (CI 5.1-6.3) times as high as, and for Asian males were half, those for White males; for Black females, 2.9 (CI 2.4-4.6) times as high and for Asian females one-third of those for White females. Admissions of non-Whites rose over the study period. Patterns of offending and diagnoses differed between ethnic groups. CONCLUSIONS: Variations in compulsory hospitalisation cannot be entirely attributed to racial bias. Community-based services may be less effective in preventing escalating criminal and dangerous behaviour associated with mental illness in African-Caribbeans.

Adolescent↗
PubMed1991

A systems approach to ethical problems.

Codes of professional ethics and cases designed to teach ethical decision making are written for individual professionals and ignore the systems level of analysis. They typically employ a lineal view of causality and overvalue placement of blame as a component of ethical problem solving. This article takes a systems approach to ethical problems and identifies aspects of systems that promote or impede ethical decision making. Psychological abuse of children is used as an example of a problem requiring a coordinated, systemic response to ethical issues such as autonomy, privacy, and confidentiality.

Child↗
PubMed1991

Case vignette -- mandated child abuse reporting.

Case Vignette: Martha Harris has been a licensed mental health professional for nearly a decade. As she arrived at her office early this morning, the phone was ringing. Speaking in a tremulous voice, the caller stated, "I was given your name by my internist, Dr. Williams. I think my husband may be abusing our 5-year-old sexually. Can you help?" After a few minutes of conversation, Martha offers to schedule a prompt appointment. The caller interrupts and asks, "You won't have to report this will you?" As a mandated reporter under the state's child protection statute, Martha has no choice but to inform the authorities; she tells the caller, who immediately hangs up. Suddenly, Martha realizes that she does not have the name or any other identifying information about the caller. A call to Dr. Williams results in a response that the internist does not want to "get involved." Commentators on this case are Richard Bourne, JD, PhD, one of whose special areas of expertise is child protection and related professional obligations; Eli H. Newberger, MD, a pediatrician with a special interest in child maltreatment; and C. Sue White, PhD, one of whose primary interests is how clinicians may inappropriately use techniques to interview children suspected of child sexual abuse, causing contaminating influences to interfere with children's memories for their own experiences.

Child Abuse↗
PubMed1995

Five points and a lament about Range and Cotton's "Reports of assent and permission in research with children: illustrations and suggestions.

This comment responds to an article by Range and Cotton (1995) on reporting of parental permission and child assent procedures in published articles for 4 psychology journals. Issue is taken with the assumptions, methodology, interpretations, and implications of listing researchers in the Range and Cotton article. There is no evidence researchers failed in their ethical obligations or that children were put at risk. Reporting permission/assent in publications is not an ethical requirement. Listing researchers as "failing" to do something not part of an ethical code is lamentable. Too many unfortunate implications and problems can be derived from Range and Cotton's analysis and conclusions.

Age Factors↗
PubMed1998

Ethical dilemmas in the treatment of adolescent gang members.

Therapists treating adolescent gang members face unique ethical dilemmas. These dilemmas arise from clinical issues that inevitably emerge in the treatment of this population. Clinical issues related to the adolescent gang member having great difficulty trusting, having experienced and observed much violence, and usually having participated in criminal activities are central to the treatment process. In this article I discuss the ethical problems that subsequently emerge: maintaining confidentiality, discharging one's duty to warn or protect, and imposing one's personal values. Suggestions for future research are offered.

Adolescent↗