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Biomedical subjects

D Sellman

Publications and source records attributed to D Sellman.

At least 19 recordsLinked to original sources
PubMed1997

Child B: a case of just care?

The case of Child B as she became known (UK) brought the issue of resource allocation into the public spotlight. Resource allocation is, however, only one of a number of issue raised by the events of this case of a little girl with leukaemia. Child B appeared on, and was the subject of, a BBC Panorama current affairs documentary broadcast in the UK which made it clear that she was neither informed about her prognosis nor about the ensuing legal battle. The little girl was 10 years old. Adults have a duty to protect and promote the interests of children but a suspicion remains that this child's views might usefully have been sought before the clinical decision not to offer further treatment was taken. Even without this it is difficult to justify withholding the decision from her. It is the purpose of this paper to consider some of the moral tensions inherent in nursing someone in this child's position. The ethical arguments that appeared in the press were predictably deontological and utilitarian (relating to duty and the greater good respectively). Watching Child B tell her story served as a reminder that moral decisions are about the lives of people. The case of Child B would seem to be a case to support an ethic of care.

Acute Disease↗
PubMed1997

The virtues in the moral education of nurses: Florence Nightingale revisited.

The virtues have been a neglected aspect of morality; only recently has reference been made to their place in professional ethics. Unfashionable as Florence Nightingale is, it is nonetheless worth noting that she was instrumental in continuing the Aristotelian tradition of being concerned with the moral character of persons. Nurses who came under Nightingale's sphere of influence were expected to develop certain exemplary habits of behaviour. A corollary can be drawn with the current UK professional body: nurses are expected to behave in certain ways and to display particular kinds of disposition. The difference lies in the fact that, while Nightingale was clear about the need for moral education, current emphasis is placed on ethical theory and ethical decision-making.

Education, Nursing↗
PubMed1996

Why teach ethics to nurses?

The Project 2000 diploma course has established ethics as a core component of the nursing curriculum. As a consequence there has been a plethora of nursing ethics books which justify their existence on the notion that nurses are recognizing the ethical nature of their work and seeking ethical guidance. It remains to be seen, however, whether the texts fulfil the perceived need. Ethics, it may be argued, is the current vogue; and the teaching of ethics to nurses is being given prominence. The aims of such teaching would appear to vary both between and within institutions but broadly seem to reflect the notions highlighted above. However, nurses do not approach this subject with one voice and much criticism has suggested that current approaches to the teaching of ethics to nurses do little more than frustrate students in their attempt to deal with matters ethical, and produce a generation of moral sceptics (Baier 1985). It is the aim of this paper to examine the rationale for teaching ethics to nurses.

Curriculum↗
PubMed1996

What is the psychiatrist's role in drugs and alcohol?

OBJECTIVE: This article describes a consensus view of the role of psychiatrists in respect of alcohol and other drug (AOD) problems, in response to the view expressed by Wodak [1]. METHOD: The data were selected on the basis of the knowledge and experience of the authors. RESULTS: Psychiatrists have made major contributions in the primary, secondary and tertiary prevention of AOD problems over many years in Australia and New Zealand. In recent years there has been an explosion of new knowledge in the AOD area and a shift from mental health to primary and public health care for these patients. Substance use disorders (SUD) are highly prevalent in all areas of psychiatric practice, requiring treatment in their own right as well as complicating the treatment of coexisting psychiatric illness. CONCLUSION: It is argued that psychiatrists have important roles in harm reduction, prevention and policy development; brief and early intervention in SUD in liaison and child psychiatry; and systematic treatment for those with dependence and other psychiatric comorbidity. A research and collaborative approach to AOD services and patients should be encouraged, rather than engaging in divisive debate over "ownership' of this area of clinical practice.

Adolescent↗
PubMed1995

Euphemisms for euthanasia.

Many patients are subject to 'do not resuscitate' orders or are 'allowed to die'. The predominant moral position within health care seems to be that this is permissible, while voluntary euthanasia is not. This paper attempts to consider the logic of that position. It is not intended as a case for or against voluntary euthanasia; those cases are made elsewhere. Instead, this is an attempt to challenge implicit assumptions. It is the experience of many nurses that issues relating to matters at the end of life are far from being resolved. This paper does not try to offer any practical solutions but aims at some clarification of the language used. This, it is hoped, will enable nurses to contribute to the debate.

Advisory Committees↗
PubMed1994

Alcoholism: development of the diagnostic concept.

This paper traces the diagnostic concepts of alcoholism featured in the major classification systems over the past 40 years. The description of alcoholism as a diagnostic concept has undergone considerable transformation over this time, but an international consensus now exists in the DSM-IIIR [2] criteria and ICD-10 [3]. Alcoholism is equated with alcohol dependence, and both definitions draw largely on the description of the alcohol dependence syndrome by Edwards and Gross [4]. Although the presence of withdrawal symptoms and relief use (key aspects of so-called physical addiction) is part of both systems, they are not necessary to make the diagnosis in either. Future directions and clinical implications of these developments are discussed.

Alcoholism↗
PubMed1994

Parental bonding in men with alcohol disorders: a relationship with conduct disorder.

Men from a clinical treatment setting suffering from alcohol dependence, and randomly selected men from the community diagnosed as having alcohol abuse and/or dependence, completed the Parental Bonding Instrument. The men from the alcohol treatment setting perceived both parents as having been uncaring and overprotective. In the general population sample, an uncaring and overprotective parental style was strongly associated with childhood conduct disorder, but not with alcohol disorder symptoms. This discrepancy in perceived parenting highlights the difficulties in extrapolating findings about aetiological factors for alcohol disorders from clinical samples. It also suggests that childhood conduct disorder and adult antisocial behaviour could influence which men with alcohol disorders receive inpatient treatment.

Adolescent↗
PubMed1987

The dexamethasone suppression test in psychiatry.

The dexamethasone suppression test (DST) for depression (melancholia) has been the focus of considerable recent interest because of claims that it may be a sensitive and specific biological marker for melancholia. When the data from four separate studies were combined, 52% of our patients with major depression were DST nonsuppressors. However, nonsuppression was also observed in 11% of manic patients, 20% of schizophrenic patients and 15% of nondepressed abstinent alcoholics. These results, in conjunction with other reports, suggest that the specificity of the test is not sufficiently high to make it a satisfactory general diagnostic test.

Alcoholism↗