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PubMed2006

The construction of troubled and credible patients: a study of emotion talk in palliative care settings.

In this article, the authors select two categories of dying patients, "troubled" and "credible," from two larger studies conducted in three palliative care settings. They explore how nurses construct dying patients' moral identities and how they use emotion talk to interpret patients' behavior. The authors carried out a microanalysis of talk-in-action using discourse analysis and conversation analysis. Strategies used for the construction of moral identities include the production of atrocity stories and emotional editing. The authors identify moments when emotions are made relevant in palliative care nurses' daily practices, which serve to smooth social interaction and give a voice to dying patients' words and actions. The dying trajectory, the deteriorating emotional body, and the sound mind are resources used in the characterization of the credible and troubled patient. The authors argue that emotion talk is significant because it reveals how nurses manage conflict and tension in talk-in-interaction.

Conflict, Psychological↗

PubMed2004

Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees.

BACKGROUND: Political instability and the civil war in Southern Sudan have resulted in numerous atrocities, mass violence, and forced migration for vast parts of the civilian population in the West Nile region. High exposure to traumatic experiences has been particularly prominent in the Ugandan and Sudanese of the West Nile Region, representing an indication of the psychological strain posed by years of armed conflict. METHODS: In this study the impact of traumatic events on the prevalence and severity of posttraumatic stress disorder (PTSD) in a random sample of 3.339 Ugandan nationals, Sudanese nationals, and Sudanese refugees (1.831 households) of the West Nile region is assessed. RESULTS: Results show a positive correlation between the number of traumatic events and the number of endorsed PTSD symptoms. Of the 58 respondents who experienced the greatest number of traumatizing experiences, all reported symptoms which met the DSM-IV criteria for PTSD. CONCLUSIONS: There is a clear dose-effect relationship between traumatic exposure and PTSD in the studied populations with high levels of traumatic events. In this context, it is probable that any individual could develop PTSD regardless of other risk-factors once the trauma load reaches a certain threshold.

Adolescent↗

PubMed2003

The practice setting: site of ethical conflict for some mothers and midwives.

Practitioners' ethical orientation and responses vary between practice settings. Yet, currently, the ethics for midwifery practice that is explicit in the literature and which provides the ideals of socialization into practice, is that of bio(medical)ethics. Traditional bioethics, developed because of World War II atrocities and increased scientific research, is based on moral philosophy, normative theory, abstract universal principles and objective problem solving, all of which focus on right and wrong 'action' for resolving dilemmas. They exclude context and relationship. Personal narratives of mothers and midwives contest the appropriateness of these accepted values and systems for childbirth because they induce conflict between workplace/service provider ethics and personal/professional midwifery ethics. In contrast to the disembedded and disembodied approach of biomedical ethics, an ethically adequate response in midwifery practice resonates more with the ethics of intimates, such as feminist virtue ethics.

Attitude of Health Personnel↗

PubMed1994

The impact of HIV infection on society's perception of clinical trials.

All international codes of research ethics and virtually all national legislation and regulation in the field of research involving human subjects project an attitude of protectionism. Written with the aim of avoiding a repetition of atrocities like those committed by the Nazi physician-researchers, calamities like the thalidomide experience, or ethical violations like those of the Tuskegee syphilis study, their dominant concerns are the protection of individuals from injury and from exploitation. In recent years, however, society's perception of clinical research has shifted dramatically. Now, largely as a consequence of the efforts of the AIDS activists, clinical research is widely perceived as benign and beneficial. Although this shift in attitude has resulted in some important improvements in research policies and practices, this new perception is just as wrong-headed as was the earlier excessive protectionism. It is necessary to maintain a balanced perspective; our policies should encourage the conduct of ethical research while maintaining the vigilance necessary to safeguard the rights and welfare of the subjects.

Biomedical Research↗

PubMed2001

Sadistic personality disorder in perpetrators of human rights abuses: a South African case study.

Although state-sponsored human rights abuses have long been commonplace, the psychological profiles of perpetrators are not well delineated. This article examines the utility of the diagnosis of sadistic personality disorder (SPD) in explaining the commission of atrocities. The history of, and controversies surrounding, SPD are briefly reviewed. Using a case study from the amnesty trials of the Truth and Reconciliation Commission (TRC) in South Africa, the relevance of the SPD diagnosis for an infamous perpetrator of political violence is debated. Sources of data include the perpetrator's autobiography, transcripts from the amnesty trial, and Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II; First, Spitzer, Gibbon, & Williams, 1994) ratings provided by four people who had contact with the perpetrator during his trial. The authors provide arguments for and against the use of the SPD diagnosis in this case and in similar contexts of perpetration. It is proposed that neither psychological reductionism nor social reductionism can adequately account for the motivations of political perpetrators, and an integrative approach to the understanding of perpetrators is advocated. Implications for diagnostic criteria are discussed.

Human Rights↗

PubMedDate not supplied

Do German general practitioners support euthanasia? Results of a nation-wide questionnaire survey.

OBJECTIVE: To learn more about the attitudes of German general practitioners (GPs) concerning euthanasia and the frequency of its performance in Germany. METHODS: 500 GPs from all parts of Germany were randomly selected from telephone listings, and were sent a postal questionnaire with anonymous return envelopes. Participants were asked to make decisions based on hypothetical scenarios involving terminally ill patients and were questioned about their attitudes towards active euthanasia or physician assisted suicide (PAS). RESULTS: The questionnaire was returned by 48% of all 481 eligible GPs (mean age 51 years, 68% male). Although the option of performing euthanasia was rarely chosen in hypothetical scenarios, its performance was considered acceptable by 34% (active euthanasia) and 80% (PAS). Seventy-seven percent of respondents believed that a comparison between euthanasia today and the atrocities committed during the 3rd Reich was not appropriate. Sixty-two percent of respondents had received requests for active euthanasia and 73% for PAS. Thirteen percent and 38% of respondents seem to have performed euthanasia themselves in the past. CONCLUSIONS: The majority of German GPs reject active euthanasia and physician-assisted suicide (PAS). Nonetheless, requests for and performance of euthanasia do not seem to be a rare occurrence. Only a small proportion of respondents are willing to perform euthanasia at a patient's request under the current legislation which make these acts illegal in Germany. German history seems to play only a minor role in shaping respondents' attitudes towards active euthanasia or PAS.

Adult↗

PubMedDate not supplied

The complications seen from the treatment by traditional bonesetters.

Traditional bone setters are rampant in the West African subregion but the atrocities committed by them have never been reported hence the need for this article that deals with the menace caused by them. All patients referred to the University College Hospital between 1996 and 2001 were included in this study. Only a few number of the patients have been selected just to illustrate the menace caused by the traditional bonesetters in so many African societies. The deformities, financial loss and amputations resulting from the management by traditional bonesetters have been highlighted. Suggestions are made on how to improve awareness in the way of adequate communications through televisions, radio and the press. Much need to be done in the society as it was found in the study that poverty or lack of education alone is not the major cause of the society seeking the help of the traditional healers, but probably the culture and traditional beliefs of the society.

Aged↗

PubMedDate not supplied

Traditional couching for cataract treatment: a cause of visual impairment.

BACKGROUND: Cataract is the most common cause of blindness both in Nigeria and in the world over. Couching as an ancient method of treatment usually practiced by traditional healer is discouraged and has been abandoned as a result of the attendant complications and also because of the availability of better techniques in the treatment of cataract. STUDY DESIGN: Records of 9 eyes of 6 patients (4 males, 2 females) who presented at the eye clinic of the University of Ilorin Teaching Hospital following traditional treatment of cataract known as couching between April 1999 and December 2001 were reviewed retrospectively. RESULT: The male: female ratio was 2:1. The age range was from 43 years to 80 years. The period between couching and presentation was between 3 months and 10 years. All the patients presented as a result of poor vision in the couched eyes. The complications recorded include glaucoma, optic atrophy and panuveitis. None had previous spectacle correction. Couching was done biocularly in 3 patients and uniocularly in 3 patients. The visual acuity at presentation was less than 3/60 in 8(88.8%) eyes. The patients received treatment, ranging from surgical, medical to optical as indicated. Their visual acuity improved to between 6/36 and 6/18 in 6 (66.6%) eyes, while the remaining 3 (33.3%) eyes remained blind. CONCLUSION: Scientifically proven atrocities performed by those who practice medicine without any medical knowledge often referred to as "traditional doctors" as shown here are reasons enough to discourage such practices as they exist at present.

Adult↗

PubMed1996

Ageing Jewish Holocaust survivors: anxieties in dealing with health professionals.

Jewish Holocaust survivors who emigrated to Australia after World War II are ageing and having more frequent contact with health services. Health professionals often lack the knowledge, training, skill or personal assurance to deal with the effects of massive trauma. Increased awareness of and sensitivity to older Holocaust survivors can lessen their anxieties and, potentially, improve treatment outcome. Such experience may form a useful lesson for health professionals in dealing with refugees from other atrocities as they age.

Anxiety↗

PubMed1995

A leading medical school seriously damaged: Vienna 1938.

Misguided by the notion that the decline of the German race would be prevented by purifying "Aryan blood" and eliminating foreign, particularly Jewish, influences, the Nazis evicted all Jews from universities within their growing empire during the Third Reich. The Medical Faculty of Vienna suffered more than any other European faculty from "race hygiene." Within weeks of the Nazi annexation of Austria in 1938, 153 of the Faculty's 197 members were dismissed. By far the most frequent reason for dismissal was Jewish origin. Most victims managed to emigrate, many died in concentration camps, and others committed suicide. The "cleansing" process encountered little resistance, and the vacant posts were quickly filled with persons known not for their medical expertise but for their political trustworthiness. It was in this climate that medical atrocities could be committed. After the collapse of the Third Reich, most members of the Faculty were burdened with a Nazi past. Most remained in office, and those who had to leave were reinstituted swiftly. The Jews evicted in 1938 were discouraged from returning. These events have significantly--and with long-lasting effects--damaged the quality of a once-leading medical school. This story needs to be told to honor its victims and to fortify us so that history does not repeat itself.

Austria↗

PubMedDate not supplied

Post-traumatic stress counselling.

Public awareness of post-traumatic stress disorder has grown in the wake of the natural and perpetrated disasters of the past 20 years. Sally Meekin's role as nursing adviser to the Police Authority in Northern Ireland has given her a unique perspective of the devastating effects of atrocity on witnesses and survivors. She describes the effects of the condition and the methods health-care staff use to diagnose and treat sufferers.

Counseling↗

PubMed1999

Neurosciences in the Third Reich: from Ivory Tower to death camps.

It is commonly thought that the horrific medical abuses occurring during the era of the Third Reich were limited to fringe physicians acting in extreme locales such as the concentration camps. However, it is becoming increasingly apparent that there was a widespread perversion of medical practice and science that extended to mainstream academic physicians. Scientific thought, specifically the theories of racial hygiene, and the political conditions of a totalitarian dictatorship, acted symbiotically to devalue the intrinsic worth to society of those individuals with mental and physical disabilities. This devaluation served to foster the medical abuses which occurred. Neurosciences in the Third Reich serves as a backdrop to highlight what was the slippery slope of medical practice during that era. Points on this slippery slope included the "dejudification" of medicine, unethical experimentation in university clinics, systematic attempts to sterilize and euthanasize targeted populations, the academic use of specimens obtained through such programs and the experimental atrocities within the camps.

Concentration Camps↗

PubMed1996

Medicine and Human Rights: Reflections on the Fiftieth Anniversary of the Doctors' Trial.

1996 marks the fiftieth anniversary of the commencement of the trial of Nazi physicians at Nuremberg, a trial that has been variously designated as the "Doctors' Trial" and the "Medical Case." In addition to documenting atrocities committed by physicians and scientists during WWII, the most significant contribution of the trial has come to be known as the "Nuremberg Code," a judicial codification of 10 prerequisites for the moral and legal use of human beings in experiments. Anniversaries provide us with an opportunity to reflect upon the past, but they also enable us to renew our efforts to plan for the future. This article describes briefly the historical evolution of the Nuremberg Code, discusses its current relevance and applicability by using a case study example, and proposes future steps to be taken by the international community.

Journal Article↗

PubMed2001

On killing. II: The psychological cost of learning to kill.

Military and law enforcement studies reveal that interpersonal combat is a universal human phobia. Physiological responses include forebrain shutdown and sympathetic arousal. A resistance to killing exists in the midbrain of most healthy members of most species, becoming ascendant when the forebrain shuts down, and can prevent soldiers from performing in combat. The U.S. military has increased participation in killing activities from 20% in World War II to 95% in Vietnam by operantly conditioning responses. Conditioning is achieved through training that closely resembles battle situations and inadvertently occurs when children see violence as entertainment. The price of this conditioning is an increase in post-traumatic stress disorder which can be defrayed through debriefing, social acceptance, and prevention of atrocities. Similar techniques may be used to prevent PTSD in civilian populations involved in tragedies like school shootings.

Arousal↗

PubMed2002

[The current state of law as a mirror of social movements and currents].

The question of what movements and currents in society may have urged the legislator to grant to the life of the pre-implanted embryo complete legal protection, in obvious contradistinction to the total denial of the latter to a post-implantation foetus, when a pregnant woman is deem to be in a legally-recognised pregnancy-related conflict situation, is investigated. To the extent that it exacerbates the difficulties of sterile couples to have children, this state of affairs differs considerably from the legal situation of almost all other countries of the western world. It is dismaying to note the widespread lack of interest of the public regarding the question of how to bridge the inconsistencies of evaluation of the need for protection of human life before and after nidation. Arguments designed to explain this discrepancy in legal or ethical terms do not convince. Apart from the lessening impact of the role of women in reproduction, it is the awareness of the historic burden of national guilt created by the atrocities committed by the Third Reich that is said to account for the scrupulousness and backward as opposed to prospective orientation of large parts of German society. Sterile women and couples are those that suffer most on account of this situation and might ultimately be tempted to look for medical help in more liberal countries, should their wish to have children be thwarted in Germany for legal reasons.

Bioethics↗

PubMed1998

The Nazification of German physicians, 1918-1937.

Physicians were the most over-represented academic profession in the Third Reich. They participated in the Nazi programs of forced sterilization, systematic euthanasia, human experimentation, and mass genocide. Recent research has shifted from documenting the atrocities committed by medical professionals to elucidating the process by which the German medical community became integrated into the Nazi state. The Nazi doctrine attracted a profession in economic and political distress during the Weimar Republic. It drew physicians into its movement by appealing to the medical profession's pride and prosperity in the context of a philosophy that glorified contemporary medical practice. Physicians were attracted to the Nazi party's biologically based tenets that championed biomedical solutions to social problems. They perceived the Nazi regime as instrumental in improving their incomes, reducing unemployment by purging the profession of Jewish physicians, neutralizing the insurance bureaucracy, and re-structuring the profession. The Nazi government's popularity among doctors peaked in 1937, by which time physicians had already played an integral role in the orchestration of the Nazi state.

Complicity↗

PubMed2002

[Workshop of military reconstructive surgery in Conakry May 1999: example of civilian-military cooperation in responding to medical-surgical crisis emergencies].

During the period from 1998 to 1999, civil wars broke out in number of west African countries including Liberia, Sierra Leone, and Guinea Bissau. Due to the situation in surrounding countries, Guinea Conakry was forced to accept nearly 650000 refugees whose presence represented a major risk for the socio-political stability of the country. International organizations and NGOs condemned the atrocities inflicted on civilian populations by the children serving as soldiers in the RUF rebels organizations of Sierra Leone and Liberia. These attacks included murders, gang rapes, abduction of children and young people, and mutilation of extremities of people of all ages ranging from infants to elderly. Treatment of mutilation victims requires the availability of facilities for surgical treatment and prosthetic fitting in Guinea Conakry. The humanitarian action division of the French Foreign Affairs Department and the NGO Handicap International decided to provide specialized training in the management of mutilation injuries to surgical groups in hospitals of Guinea and Sierra Leone. The program consisted in a workshop on reconstructive surgery for war-related injuries to allow optimal prosthetic fitting for reinsertion of mutilation victims into society.

Adolescent↗

PubMed2003

[Torture as a medico-psychological and social problem].

AIM: To investigate and define the consequences of the torture in civilian survivors of state sponsored violence in Bosnia and Herzegovina and to point out that torture is not solely medical and psychological problem but also a social problem requiring various interventions of the society at large. METHODS: The study included 50 subjects who were survivors of torture. For registration of psychopathological symptoms, the Multidimensional Instrument for Symptoms Assessment SCL 90-R comprising 90 items divided in 9 subscales, (L.R. Derogates 1986) was used. The Mississippi Questionnaire containing 35 items, (Kean. et al. 1988) for the registration of the symptoms of the posttraumatic stress disorders, was used and Sociodemographic questionnaire for the registration of the sociodemographic characteristics of the subjects, was used. RESULTS: Our research indicates statistically significant decline in social position of the survivors of the torture compared with their life situation before surviving the atrocities of the war their economic position is weaker, unemployment rate in this population reaches 82% compared with the rate of 24% before the war. They also survived the loss of a great number of family members. The subjects also presented with a variety of somatic and psychological symptoms. CONCLUSIONS: Torture survivors comprise the most vulnerable group in the society after the war and they require multidisciplinary program for their psychosocial rehabilitation. This, comprehensive approach includes social and legal guarantees in order to protect their rights and interests.

Adolescent↗