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PubMed2006

The power gap: freedom, power and mental illness.

Up to one in four individuals in the US meet the diagnostic criteria for a mental illness in any given year and a significant proportion have severe or recurring illnesses (e.g. schizophrenia). Despite this prevalence, mental health services remain poorly funded, mental illness remains misunderstood and individuals with recurring illness are constrained to live lives characterized by isolation, under-employment, stigma and denial of rights. Here I examine the idea that this situation is attributable, at least in part, to the ways in which the freedom and power of the mentally ill are undermined by a range of factors, including: (i) dispersion of political power amongst interest groups, which, combined with the relatively wide distribution of the 'interest' of mental illness, has the paradoxical result that mental health interest groups do not command political power proportional to the number affected; (ii) systematic exclusion of the mentally ill from full participation in civic, social and political life (structural violence), resulting in a lack of emphasis on mental health on political agendas and the exclusion of certain policy options as possible responses and (iii) difficulties the mentally ill may experience recognizing or articulating their own needs the absence of effective health-care systems, and the absence of knowledge about alternative systems. I argue that the enhancement of individual agency is central to efforts to address this power gap, including: (i) rights-based approaches, involving the enhancement of national mental health legislation, improvement of advocacy, empowerment and guardianship processes and development of governance, accountability and quality procedures in mental health services; (ii) approaches based on enhancing direct political participation, including voter-registration programmes and development of larger, more effective interest groups and (iii) additional approaches, including increasing accountability throughout services, recognizing the effects of socio-political change on the context of care and adapting the concept of 'soft power' to strengthen advocacy programmes.

Attitude to Health↗

PubMed1983

Reactance and the coronary-prone behavior pattern: the role of self-attribution in responses to reduced behavioral freedom.

An experiment is reported that explored the role of self-attributional differences as mediators of reactions to threats to control in Type A and Type B individuals. Both Type A and Type B subjects were placed in a choice elimination reactance paradigm. In addition to the standard control and choice elimination conditions, subjects were induced to attribute having a choice among evaluated items either to themselves or to the situation prior to experiencing the elimination of choice. Reactance was measured by the subjects' reevaluations of the eliminated choice alternative. Results indicated that when a behavioral freedom is blocked, without manipulating attributions, only Type As experienced reactance. When subjects were induced to attribute having a choice to themselves, the magnitude of the reactance responses increased for both Type As and Type Bs. In contrast, when Type As and Type Bs were induced to attribute having choice to the situation, neither group reacted to the loss of choice. These results are integrated with previous findings on the coronary-prone behavior pattern.

Choice Behavior↗

PubMed1994

New nursing: the road to freedom?

The consequences that recent developments in nursing have had for the nurse-patient relationship are the concern of this paper. It is argued that, by attempting to reduce the power differentials that exist between nurse and patient, 'new nursing' reforms encourage rational, rather than distorted, communication between lay and professional participants in health care encounters. The significance of these developments is underlined by framing them within the theoretical framework developed by Jürgen Habermas, who argues that, because symbolic communication is a defining feature of our essential humanity, distortion of communication by means of coercive power is a denial of that humanity. Conversely, rational communication is the stuff of truth, freedom and justice. Empirical evidence from in-depth interviews with nurses is used to demonstrate that there have been significant changes in the nurse-patient relationship, which have led to improvements in communication and to the empowerment of patients. Despite the fact that the reforms face significant obstacles, nurses can be proud of the fact that their efforts have contributed to the re-affirmation of the full humanity of people requiring health care.

Communication↗

PubMed1997

Evidence-based medicine, practice variations and clinical freedom.

Much of cardiovascular disease can be treated on the basis of the results of large clinical trials and can be considered 'evidence-based'. However, trial results are not infallible and it is important to recognize their limitations. Despite the evidence, widespread variation exists in medical practice between and within countries; the reasons may be cultural, or may indicate poor medical education. Purchasing authorities have to do the best they can with available evidence, and our full evidence base needs to include costs; in some instances we now have evidence of benefit from treatment that we almost certainly cannot afford. Evidence-based medicine is a further - but possibly an acceptable - limitation to clinical freedom.

Cardiovascular Diseases↗

PubMedDate not supplied

Balancing freedom with risks: the experience of nursing task delegation in community-based residential care settings.

BACKGROUND: In 1995, Washington State implemented law reforming the state's long-term care system, favoring provision of service in less restrictive, lower-cost settings. PURPOSE: The purpose was to systematically evaluate one facet of the new law regarding the implementation of a policy authorizing delegation of designated nursing tasks by registered nurses in community-based residential care settings. METHOD: This was a descriptive study driven by the inductive process of grounded theory. Qualitative data sources included interviews, public forums, document review, and open-ended survey questions to facility operators, nurses, nursing assistants, and inspectors. DISCUSSION: The study identified an overarching social process, balancing freedom with risks involving tension at the intersections, which is evident from 3 main perspectives: consumer, professional, and the health care system. CONCLUSIONS: The study has implications for regulatory consistency, nursing practice and education, collaboration between overlapping providers of skilled nursing services in residential settings, and subsequent health policy.

Attitude of Health Personnel↗

PubMed2000

A preliminary study of the effect of imaginary sexual stimulation on the perceived covariation between freedom and responsibility.

The authors evaluated subjective estimates of the relationship between freedom and responsibility under predictions made in accordance with cognitive-experiential self-theory (CEST; V. Denes-Raj & S. Epstein, 1994; S. Epstein, A. Lipson, C. Holstein, & E. Huh, 1992; S. Epstein, R. Pacini, V. Denes-Raj, & H. Meier, 1996; L. A. Kirkpatrick & S. Epstein, 1992). Half of the participants viewed sexually stimulating primes before making judgments. The other participants viewed neutral stimuli before making judgments. Two dependent measures were used: A set of alternate-forms propositions measured perceived relationships between the variables, and response latencies were used to evaluate the hypothesis that persons operating experientially would make judgments faster than persons operating rationally. Results indicated a significant effect for the priming condition with respect to the within-subject dependent variable. In accordance with predictions, further analysis indicated that positive contingency items were endorsed less often by primed participants, and negative contingency items were endorsed more often by primed participants. Results are in line with predictions afforded by the CEST model. Implications are discussed.

Adult↗

PubMed1991

Tyranny and freedom: looking at ideas in the practice of family therapy.

This article comments upon recent "second-order" family therapy concerns about the nature of the therapeutic relationship, and explores how ideas held by therapists may rule and restrict therapeutic conversations. Ideas are examined in the light of how adherence to them might open space (free) or close space (tyrannize) with respect to the therapeutic relationship. The authors propose a philosophical viewpoint, a methodology, and practical suggestions for therapists wishing to maintain a stance of relative freedom with respect to ideas in their work with clients.

Attitude of Health Personnel↗

PubMed2004

Prescribing cannabis: freedom, autonomy, and values.

In many Western jurisdictions cannabis, unlike most other psychoactive drugs, cannot be prescribed to patients even in cases where medical professionals believe that it would ease the patient's pain or anxiety. The reasons for this prohibition are mostly ideological, although medical and moral arguments have been formulated to support it. In this paper, it is argued that freedom, properly understood, provides a sound ethical reason to allow the use of cannabis in medicine. Scientific facts, appeals to harm and autonomy, and considerations of symbolic value cannot consistently justify prohibitions.

Cannabis↗

PubMed1998

Freedom to box.

The british Medical Association wants to criminalise all boxing. This article examines the logic of the arguments it uses and finds them wanting. The move from medical evidence about the risk of brain damage to the conclusion that boxing should be banned is not warranted. The BMA's arguments are a combination of inconsistent paternalism and legal moralism. Consistent application of the principles implicit in the BMA's arguments would lead to absurd consequences and to severe limitations being put on individual freedom.

Athletic Injuries↗

PubMed2007

Information and human freedom: nursing implications and ethical decision-making in the 21st century.

With globalization and the increasing volume of healthcare information available to people, questions surface as nurses contemplate and envision what role and how our nursing theory-guided discipline ought to be lived with colleagues of other disciplines, each other, and those we serve in the 21(st) century. This column begins a path of ethical exploration and possible implications for the opportunities and challenges associated with the information age in nursing research, practice, and education. Discussion focuses on the disciplinary responsibilities for information giving and receiving; coming to know, human freedom, and decision-making in the human-universe-health process.

Access to Information↗

PubMed2002

HIV/AIDS and professional freedom of expression in Japan.

A senior physician with a government role in Japan made a widely reported and misleading statement about Thailand's policy on HIV/AIDS patients. He claimed that in Thailand the policy is to spend public money on the prevention of HIV infection while allowing AIDS patients to die untreated. The author, a community nursing specialist in Japan with first-hand knowledge of HIV/AIDS policy in Thailand, thought that this statement would influence attitudes negatively in Japan. However, speaking out about this misrepresentation of the facts carried certain risks. Although freedom of expression is valued in Japan, in practice it is not easy to contradict senior medical professionals. The author uses his experience of this difficult professional situation to teach nurses how to approach speaking out in the public interest.

Community Health Nursing↗

PubMed2003

Intellectual freedom and editorial responsibilities within the context of controversial research.

The primary purpose of this article is to explore the limits that an agent, such as the government or the American Psychological Association, may place on one's right to pursue a program of research or to share the findings of a research project. The primary argument that evolves here is that researchers' rights to pursue an interesting hypothesis, and their freedom of expression, are conditional. The author examines the potential pragmatic and epistemological barriers to a program of research and the responsibilities that researchers bear to address epistemological and nonepistemological matters while reviewing the implications of their work.

Behavioral Research↗

PubMed1981

Professional Standards Review Organizations and confidentiality: the question of public access to medical peer review data through the Freedom of Information Act.

The degree of confidentiality to be accorded data gathered and analyzed by Professional Standards Review Organizations (PSROs) in the course of their medical peer review activities is a crucial and controversial issue in health policy. In late 1977, a consumer organization in Washington, D.C. sought access to data in the hands of the local PSRO through a lawsuit under the Freedom of Information Act, touching off a continuing debate throughout the country. That lawsuit is now on appeal. The courts, the Congress, and the Department of Health and Human Services have all been involved in the ongoing controversy. PSROs, practicing physicians, and health care consumers all have an interest in the outcome. This article analyzes the PSRO Program and its data confidentiality problems, examines in detail the lawsuit that sparked the controversy, and assesses the overall impact of this case on the PSRO program and on federal regulation of the health care system in general.

Civil Rights↗

PubMed1984

The conflict of patient privacy and the Freedom of Information Act.

The purpose behind the Freedom of Information Act was to permit greater access by the public to information held by the federal government. In promoting this democratic ideal, little attention was focused on a potential problem that this access to government-held information might cause: violation of another individual's right to privacy. This article examines a recent case in which these two goals came into conflict.

Civil Rights↗

PubMed1998

Internet in the workplace: censorship, liability, and freedom of speech.

Most hospital medical libraries are supported by private, corporate funds and thus fall under the corporation's policies in regard to discrimination, harassment, and sexual harassment. With the free flow of information available on the Internet and through e-mail, it is mandatory to create a corporate policy for appropriate use and review of materials. Access to "questionable" or inappropriate Internet sites is not a freedom of speech issue in a private corporation; it is a potential liability for the corporation, the library, and the librarian. It is also a misuse of company resources.

Florida↗

PubMed2003

Between the frontier and the network: notes for a metapsychology of freedom.

The author examines the paradigm of the frontier and encounters the establishment of the paradigm of the network, a tendency that currently runs through diverse fields of thought. The network is not proposed as a globalising structure that would neutralise what is different, but as integration based on preservation of what is plural and its transformations. The author moves between these two paradigms in psychoanalytic metapsychology and clinical practice. The concept of frontier is intrinsic to the entire theory: repression, which separates the unconscious from the preconscious, the barrier against stimuli, the delimitation of spaces and agencies. But psychoanalysis is also a precursor of the paradigm of the network, with its concepts of unconscious, free association and evenly suspended attention. She points out that it is psychoanalysis that, in the area of scientific thought, subverts the radical split between subjects and their objects of observation, through the concepts of transference and countertransference, thus inaugurating a revolutionary theory of knowledge. This perspective can later be seen as a forerunner of changes in other disciplines. This text legitimises the contribution of psychoanalysis to thinking and knowledge, as well as the potential of a therapeutic method that provides the tools for crossing frontiers, unknotting and weaving networks, operating in the face of risks of pathological consolidations, thus holding to its unavoidable commitment to freedom.

Attention↗

PubMedDate not supplied

[There should be freedom in nursing].

The title of this effort has reminded us of the Inconfidência Mineira, that had José Joaquim da Silva Xavier, the Tiradentes as its leader. It was a movement that longed for freedom, like nursing that, along the years, has been building its history and has been walking in search of its autonomy. This study has aims at investigating the ways nursing has gone through, while a science, it searches for its autonomy and mediates about nurse's performance while an autonomous and creative professional. This study had the historical materialism as support. It was accomplished from May to August, 1997 with nurses from Ceará that were involved with the profession historical process. The results originated a central category, professional practice, and the other three ones: autonomy, creativity and disposition to face challenges, that favour a better comprehension about the paths nursing tracked, besides permitting us to understand that the nurse can be autonomous and free.

Brazil↗

PubMed2002

Expressive freedom and tobacco advertising: a Canadian perspective.

In 1989, Canada enacted the Tobacco Products Control Act (TPCA), which prohibited tobacco advertising, required health warnings on tobacco packaging, and restricted promotional activities. Canada's tobacco companies challenged the TPCA's constitutionality, arguing that it infringed on freedom of expression. Although it seemed likely that the Canadian Supreme Court would uphold the legislation, in 1995 the court declared the impugned provisions to be unconstitutional. The decision is testimony to the constraining force of liberalism on tobacco regulation, but it is also evidence of the power of political will. While the Canadian government could have used the decision to justify withdrawing from further confrontations with powerful commercial interests, it chose instead to enact new tobacco control legislation in 1997.

Adolescent↗