Search PubMed⌕ Search

Biomedical subjects

D C Wertz

Publications and source records attributed to D C Wertz.

At least 55 records · Page 3Linked to original sources
PubMed1989

Moral reasoning among medical geneticists in eighteen nations.

We surveyed the approaches of 661 geneticists in 18 nations to 14 clinical cases and asked them to give their ethical reasons for choosing these approaches. Patient autonomy was the dominant value in clinical decision-making, with 59% of responses, followed by non-maleficence (20%), beneficence (11%) and justice (5%). In all, 39% described the consequences of their actions, 26% mentioned conflicts of interest between different parties and 72% placed patient welfare above the welfare of others. The U.S., Canada, Sweden, and U.K. led in responses favoring autonomy. There were substantial international differences in moral reasoning. Gender differences in responses reflected women's greater attention to relationships and supported feminist ethical theories.

Asia↗
PubMed1988

Ethics and medical genetics in the United States: a national survey.

The approaches of 295 medical geneticists in the United States to 14 clinical problems and 3 screening situations that required a moral choice are summarized. These data are part of a survey of 682 geneticists in 19 nations. Of 490 U.S. geneticists asked to participate, 295 (60%) returned anonymous detailed questionnaires. There was strong (greater than 75%) consensus that preserving the mother's confidentiality overrides disclosure of true paternity; that conflicting test results, new/controversial interpretations of results, and ambiguous/artifactual results should be disclosed; that artificial insemination by donor, adoption, taking chances, contraception, sterilization, and in-vitro fertilization with a donor egg should be presented as reproductive options to carriers of disorders not diagnosable prenatally; that prenatal diagnosis should be performed for patients who refuse abortion and for maternal anxiety in the absence of medical indications; that screening in the workplace should be voluntary. There was no consensus about disclosure of a diagnosis of Huntington disease or hemophilia A to relatives at risk, against the patient's wishes, or about disclosure of parental translocations. Geneticists in the U.S. differed from 18 other nations in presenting surrogate motherhood as an option (67%); willingness to perform prenatal diagnosis for sex selection or refer (62%); and disclosure of XY genotype in a female (62%). Men were more likely than women to say that they would give directive counseling. Women were more likely than men to say that they would perform prenatal diagnosis for maternal anxiety or for sex selection.

Confidentiality↗
PubMed1988

Medical genetics.

Explore the source record for details and available documents.

Attitude↗
PubMed1988

Attitudes of genetic counselors: a multinational survey.

Of 1,053 medical geneticists in 18 nations 677 (64%) returned questionnaires on their views on the importance of seven goals of genetic counseling, the appropriateness of five directive/nondirective approaches to counseling, and their choices of action in four situations involving directive/nondirective counseling. The majority (92%-94%) regarded nondirective approaches as appropriate; their views on both goals and approaches were similar to those reported in an earlier survey of 205 genetic counselors in the United States. In clinical situations involving presentation of reproductive options to carriers of disorders not diagnosable prenatally, 74%-85% would present contraception, sterilization, taking one's chances, artificial insemination donor (AID), or adoption as options even if not asked; 66% would present in vitro fertilization (IVF) with a donor egg; and 46% (67% in the United States) would present surrogate motherhood. In regard to three situations involving fetuses with low-burden disorders (Turner syndrome, XYY, and a possible small neural tube defect), 84%-88% would counsel nondirectively. Stepwise logistic regression analyses on professional and personal background variables showed that gender was related, cross-nationally, to self-reported directiveness in counseling, with men more likely than women to regard directive approaches as appropriate, more likely to give advice about fetuses with low-burden disorders, and more likely to present either IVF with donor egg or surrogate motherhood as options. Social and ethical implications of this widespread acceptance of nondirective counseling are discussed.

Allied Health Personnel↗
PubMed1987

Reproductive plans of genetic counseling clients not eligible for prenatal diagnosis.

A prospective study of the reproductive plans of 185 genetic counseling clients at risk for birth defects not diagnosable prenatally found, 6 months after counseling, 1) a small increase in the number of pregnancies initiated and planned, compared to pregnancies planned before counseling; 2) an increase in initiated and planned pregnancies among clients at both high as well as low risk; and 3) reproductive plans after counseling more closely correlated with clients' perceptions of the social, familial, and economic burdens of an affected child than with medically defined risk and specific clinical characteristics of the birth defects. In discussing the burden of a birth defect with clients, counselors are encouraged to discuss not only the medical burden, but the social, familial, and financial burdens as well.

Attitude↗
PubMed1987

Ethical aspects of prenatal diagnosis: views of U.S. medical geneticists.

This article presents data from a study of 295 qualified medical geneticists in the United States. The study's objective was to determine the degree of consensus and variation among practicing medical geneticists about the major ethical problems of prenatal diagnosis. Based on the data presented, the argument has been made that most medical geneticists share a dominant moral approach on three major problems: abortion choices, controversial indications for fetal diagnosis, and problems in disclosure of ambiguous or disputed results. Ethical problems in selective termination in high-risk twin and multiple pregnancies need more study. A preliminary evaluation of the strengths and weaknesses of prevailing standards in prenatal diagnosis was also made. Three weaknesses were noted: neglect of the demands for fairness in access to and distribution of prenatal diagnosis in the United States, unpreparedness for society's growing concerns about developing trends in human genetics, and need for changes in non-directive counseling in order to appreciate the complexities that will accompany the introduction of proven new treatments for genetic disorders.

Attitude of Health Personnel↗
PubMed1986

Couple agreement before and after genetic counseling.

Before receiving genetic counseling, 699 couples completed questionnaires that were identical for both spouses. Of 385 couples where both spouses indicated a major reason for seeking counseling, 45% identified the same major reason while 55% identified different reasons. In 74% of 542 fertile couples, both spouses had identical short-term reproductive plans: 60% desired the same ideal number of children; and 44% perceived the same level of risk of having an affected child. Agreement on the seriousness of eleven potential problems occasioned by an affected child ranged from 55% to 67%. Couples were asked to return questionnaires within 7 to 10 days after counseling. At this time 76% of spouses agreed about short-term reproductive plans; 66% agreed about longer-term reproductive plans; and 60% agreed about ideal number of children. There were statistically significant increases in agreement about risk interpretation and about six of eleven potential problems in raising an affected child. The data suggest that a substantial number of couples come to genetic counseling with varying concerns and reproductive plans. There is, in general, as much disagreement on these issues between spouses after as before counseling. Implications for counseling are discussed.

Genetic Counseling↗
PubMed1986

Client reactions to genetic counseling: self-reports of influence.

Of 628 clients completing questionnaires six months after genetic counseling, 273 (43.5%) reported that their reproductive plans had been influenced by the counseling session. Of those who said that they were influenced, 144 (52.7%) held the same reproductive plans that they reported before counseling: 41 (15%) were planning more pregnancies, 36 (13.2%) were planning fewer, and 52 (19.1%) became reproductively uncertain. A similar pattern of stability and change appeared in the reproductive plans of those who reported that they were not influenced by genetic counseling. Stepwise logistic regression indicated that clients who reported that their plans were influenced: came to counseling to get information for making a decision about whether to have a child; discussed this decision in depth with the counselor; and had more education than clients who said that they were not influenced. We found no evidence that counseling was supplanting clients' own personal values. In the discussion, we suggest several reasons why clients of higher socio-economic status are more likely than others to report that they are influenced, and discuss the ethical implications of these results.

Adolescent↗
PubMed1986

Clients' interpretation of risks provided in genetic counseling.

Clients in 544 genetic counseling sessions who were given numeric risks of having a child with a birth defect between 0% and 50% were asked to interpret these numeric risks on a five-point scale, ranging from very low to very high. Whereas clients' modal interpretation varied directly with numeric risks between 0% and 15%, the modal category of client risk interpretation remained "moderate" at risks between 15% and 50%. Uncertainty about normalcy of the next child increased as numeric risk increased, and few clients were willing to indicate that the child would probably or definitely be affected regardless of the numeric risk. Characteristics associated with clients' "pessimistic" interpretations of risk, identified by stepwise linear regression, included increased numeric risk, discussion in depth during the counseling session of whether they would have a child, have a living affected child, discussion of the effects of an affected child on relationships with client's other children, and seriousness of the disorder in question (causes intellectual impairment). Client interpretations are discussed in terms of recent developments in cognitive theory, including heuristics that influence judgments about risks, and implications for genetic counseling.

Congenital Abnormalities↗
PubMed1984

Genetic counseling and reproductive uncertainty.

Of 836 fertile women seeking genetic counseling, 544 (65%) reported that their major reason for doing so was to obtain information to help in deciding if they should have a child. Thirty-four percent of these 836 women entered counseling uncertain about undertaking a pregnancy in the next 2 years. After counseling, 28% of the 836 had uncertain pregnancy intentions. These included 66% of those who were uncertain and 11% of those who were reproductively certain before counseling. Stepwise logistic regression identified the following as independently and significantly associated with reproductive uncertainty after counseling: 1) uncertainty before counseling; 2) uncertainty about ideal family size; 3) concern about the effects of an affected child on the client's social life; 4) perceived serious problems caring for a child with a birth defect now living at home; and 5) new concerns raised in counseling. Reproductive uncertainty after counseling was not related to characteristics of the risked birth defect, level of risk, treatment potential, or client learning of medical and genetic facts. These data suggest that genetic counseling will not eliminate reproductive uncertainty for many clients, because this uncertainty is related to factors mainly outside the usual scope of counseling.

Adolescent↗
PubMed1983

What birth has done for doctors: a historical view.

Historians have usually described contributions of medicine to birth as if all the benefits accrued to patients. This article explores the contributions that birth and birthing women have made to the professionalization of American medicine and to the social and economic status of doctors during the past 200 years. Birth provided doctors with some of their first valid techniques, giving them a claim to superiority over irregular practitioners and midwives; it also enabled them to become moral authorities and personal confidantes to women. Later it helped to accustom families to the use of hospitals. Finally, maternal and neonatal mortality rates provided an international standard for judging the overall quality of a nation's health care. In the United States, high maternal mortality rates led to the first self-critical investigations by the profession, the first hospital mortality review boards, and the first major specialty board, obstetrics. In the process of gaining these professional advantages in an entrepreneurial climate, American doctors transformed birth from a natural event into an occasion requiring the use of medical art.

Adolescent↗