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PubMed1983

Informed consent: what does it mean?

The editorial in the September 1982 issue of this journal and many articles before and since have addressed the problem of informed consent. Is it possible? Is it a useful concept? Is there anything new to be said about it? In this article the basic rationale of the rule (patient autonomy) is explained and the extent of the rule explored. Various exceptions have been offered by the law and an attempt is made to catalogue the chief of these. A number of specially vulnerable groups are then identified, the most important, and vexed, being children. How can informed consent be secured in the case of young patients? Finally, a few problems are mentioned in an attempt to get this subject back to reality. The appeal to the principle primum non nocere may be medical paternalism in disguise. Informed consent is the competing principle that reminds us of the primacy of human autonomy. A pointer is given to the future: even the use of sound recordings to explain medical procedures and to activate informed consent so that it may become a reality and not just a lawyer's myth, should be considered.

Australia↗
PubMed1992

Utilization of image-derived computer-assisted stereotaxis in a community-based practice setting.

The success of a community-based stereotactic program is dependent upon community commitment, technological capability, referral base, patient/family support and, most importantly, proper patient selection. To develop a program of superior quality requires not only a substantial financial commitment, but also a basic philosophical approach which fully supports acquisition and education of support staff, physical plant renovation and an establishment of an expanding referral base. This report details the development of a highly sophisticated stereotactic program in Cedar Rapids, Iowa, a semirural community with a base referral population of approximately 300,000.

Brain Diseases↗
PubMed1991

Organic unity theory: the mind-body problem revisited.

The purpose of this essay is to delineate the conceptual framework for psychiatry as an integrated and integrative science that unites the mental and the physical. Four basic philosophical perspectives concerning the relationship between mind and body are introduced. The biopsychosocial model, at this time the preeminent model in medical science that addresses this relationship, is examined and found to be flawed. Mental-physical identity theory is presented as the most valid philosophical approach to understanding the relationship between mind and body. Organic unity theory is then proposed as a synthesis of the biopsychosocial model and mental-physical identity theory in which the difficulties of the biopsychosocial model are resolved. Finally, some implications of organic unity theory for psychiatry are considered. 1) The conventional dichotomy between physical (organic) and mental (functional) is linguistic/conceptual rather than inherent in nature, and all events and processes involved in the etiology, pathogenesis, symptomatic manifestation, and treatment of psychiatric disorders are simultaneously biological and psychological. 2) Neuroscience requires new conceptual models to comprehend the integrated and emergent physiological processes to which psychological phenomena correspond. 3) Introspective awareness provides data that are valid for scientific inquiry and is the most direct method of knowing psychophysical events. 4) Energy currently being expended in disputes between biological and psychological psychiatry would be more productively invested in attempting to formulate the conditions under which each approach is maximally effective.

Biological Psychiatry↗
PubMed2002

The integration of neurology, psychiatry, and neuroscience in the 21st century.

OBJECTIVE: This article examines the historical basis for the divergence of neurology and psychiatry over the past century and discusses prospects for a rapprochement and potential convergence of the two specialties in the next century. METHOD: The author presents a brief historical overview of developments in neurology and psychiatry from the late 19th century. The histories of research and prevailing scientific opinion on two neuropsychiatric disorders, Alzheimer's disease and Tourette's syndrome, are compared to illustrate the effects of viewing a disease process from, respectively, the neurologic/organic and psychiatric/functional perspectives. RESULTS: Research on Alzheimer's disease, because of its early pathologic demonstration, moved rapidly toward identification of associated synaptic abnormalities and genetic mutations. In Tourette's syndrome, the absence of evident brain pathology resulted in vacillation between organic and functional explanations and persistent controversy about the nature of the illness. CONCLUSIONS: Neurology and psychiatry have, for much of the past century, been separated by an artificial wall created by the divergence of their philosophical approaches and research and treatment methods. Scientific advances in recent decades have made it clear that this separation is arbitrary and counterproductive. Neurologic and psychiatric research are moving closer together in the tools they use, the questions they ask, and the theoretical frameworks they employ. The interests of neurology and psychiatry converge within the framework of modern neuroscience. Further progress in understanding brain diseases and behavior demands fuller collaboration and integration of these fields. Leaders in academic medicine and science must work to break down the barriers between disciplines.

Alzheimer Disease↗
PubMed1995

Delivering comprehensive services to homeless mentally ill offenders.

A consortium of social services agencies developed a comprehensive community mental health services program for homeless mentally ill offenders in Portland, Oregon. Residential services were provided in a single-room-occupancy hotel. Forty-seven clients were accepted for the program, 38 actually entered the program, and 14 graduated--that is, attained sobriety and were placed in community housing. Problems complicating program implementation included differing philosophical approaches of key agencies, staff turnover, and financial shortfalls. Many potential clients were not accepted into the program because of recent violence or potential violence; some clients were expelled or reincarcerated because of violent behavior.

Adult↗
PubMed1979

Perspectives from tomorrow's therapists.

This paper investigates the need for Occupational Therapy to establish a philosophy of its own. Two of the Eleanor CLarke Slagle Lectures, Reilly's of 1961 and Yerxa's of 1966, are examined as being representative of the philosophies of pragmatism and existentialism, respectively. Their philosophical approaches are compared in terms of their relevance to Occupational Therapy. A base is proposed from which a new philosophy could be generated, and a personal philosophy and opinion is stated from a student's point of view.

Canada↗
PubMed2003

Legal forms and reproductive norms.

This article draws on Pashukanis's concept of legal form and on O'Brien's concept of synthetic value to argue that legal form plays a role in reproductive relations by constructing legal subjects as the bearers of reproductive responsibilities. Pashukanis conceived of legal form as playing a particular role in capitalist exchange relations by interpellating subjects as the bearers of property rights. O'Brien argued that reproduction's specific value is synthetic value, which represents the value of integrating nature and reason in species continuity. Synthetic value is distinct from exchange value or emotional value which may also attach to reproductive process. By working through Pashukanis's method of extracting legal form from specific social relations and by adapting it to reproductive relations, an example is provided of how legal form analysis can be extended beyond the particular context of capitalist exchange relations. Just as legal form constitutes owners and non-owners as legal subjects, so it constitutes reproducers and non-reproducers. By tracing the way in which law attributes reproductive responsibility, legal form analysis shows us how law draws a line between wanting to attribute responsibility and not to attribute it, and this contradiction is a hook which social forces such as sexuality, gender, race, class and disability can latch on to in pushing legal form to shape reproductive responsibilities in a particular way. Each legal form is also externally contradicted by other legal forms. When law negotiates a balance between the reproductive norms of responsibilities and rights, it demonstrates how particular legal forms manage the interaction of different sets of social relations, such as reproduction and exchange.

Capitalism↗
PubMedDate not supplied

Cultural discovery: an innovative philosophy for creative learning activities.

The purpose of this article is to describe a philosophical approach for integrating general transcultural nursing concepts and skills within a first semester associate degree nursing course. The authors wished to design a learning activity that would provide meaningful experiences and stimulate critical thinking among nontraditional, culturally diverse students who must learn to care for many clients of diverse cultural backgrounds. With a focus on culture, aging, and health, this creative learner-centered approach, called Cultural Discovery, emphasizes learning outcomes in both the cognitive and affective domains. Cultural Discovery includes several components in conjunction with the Leininger Acculturation Health Care Assessment Enabler for Cultural patterns in Traditional and Nontraditional Lifeways, specifically: background reading assignments, classroom activity component, collaborative library introductory program, videotape program, interview, literature review, reflection, and written paper assignment. Implemented over an eight week period, Cultural Discovery assisted beginning nursing students to systematically conduct a basic general cultural assessment, identify some similarities and differences among individuals within cultural groups, distinguish between varying dimensions of acculturation, and discover the importance of culturally congruent nursing care.

Acculturation↗
PubMed2001

Square pegs in round holes: the dilemma of conjoined twins and individual rights.

The judgment in the English Court of Appeal case of Re A (Conjoined Twins: Surgical Separation) highlights forcefully the highly individualistic and abstract assumptions that commonly shape the deployment of rights discourse in liberal legal adjudication. Forced by the all-or-nothing nature of this discourse into a dilemma between perceiving of the twins as separate right-bearers or perceiving of the stronger twin, Jodie, as the singular right-bearer and of Mary, her weaker sibling, as a non-legal entity, the court chose the former option. Perceiving of the twins as distinct and equal legal persons forced the court to employ a balancing of incommensurate interests, implicitly accepting a utilitarian analysis within the strongly deontological confines of law and medicine. The implications of this turn towards utilitarianism are significant. Within the confines of this article, it will be argued, however, that these implications are avoidable if the law concedes a more flexible approach to the dominant notion of the distinct and autonomous right-bearer.

Civil Rights↗
PubMed2004

Exploring ethical perspectives of nurses and nurse managers.

With nursing shortages reaching crisis proportions, staff nurses need to believe that nurse managers are supportive. However, evidence exists that staff nurses view nurse managers as moving away from basic nursing values. Using an exploratory philosophical approach, the authors examine this issue as a function of differing ethical frameworks used by nurses and nurse managers. The main question is whether nurse managers are expected to subscribe to a corporate ethic versus a nursing ethic in making decisions, and whether these approaches are fundamentally different. The authors' supposition was that exposing differences might account for some dissatisfaction that nurses express with regard to nursing leadership. They conclude that there are differences of emphasis in ethical principles that may cause tension. Incongruencies between corporate and individual values emerge under fiscal constraints and with differing perceptions, expectations and decision-making criteria. This paper offers suggestions to help staff nurses and nurse managers reduce tensions experienced when difficult choices, particularly those of resource allocation, are required.

Attitude of Health Personnel↗
PubMed2000

Exploring rehabilitation within lymphoedema management.

A review of the literature reveals rehabilitation to be a complex concept. Rehabilitation is more than a global term used to encompass the different types of therapy employed to reduce the effects of disability or chronic illness; it is a philosophical approach which provides a framework for care. This framework promotes an environment in which the individual is enabled to attain his/her own ideal of health. The concept of rehabilitation is explored within the mainstream management of lymphoedema to identify implications for improving practice. Areas in which lymphoedema therapists could strive to achieve a more rehabilitative approach to care include: implementing an organized and standardized approach to lymphoedema management, improving interdisciplinary working, developing the holistic scope of care, and acknowledging the central importance of the patient and family in clinical practice. Adopting a rehabilitative approach to lymphoedema management will help to promote greater patient satisfaction with treatment.

Holistic Health↗
PubMed1994

Patient choices, family interests, and physician obligations.

Recent articles in biomedical ethics have begun to explore both the relevance of family interests in treatment decisions and the resultant ramifications for physicians' obligations to patients. This article addresses two important questions regarding physicians' obligations vis-à-vis family interests: (1) What should a physician do when the exercise of patient autonomy threatens to negate the patient's moral obligations to other family members? (2) Does respect for patient autonomy typically require efforts on the part of physicians to keep patients' treatment decisions from being influenced by family considerations? A series of clarifications about the concept of autonomy is also presented.

Altruism↗
PubMed2005

Engelhardt and children: the failure of libertarian bioethics in pediatric interactions.

In Engelhardt's secular bioethics, moral obligations derive from contracts and agreements between rational persons, and no infants or children and few adolescents meet Engelhardt's requirements for being a rational person. This is a problem, as one cannot have any direct secular moral obligations toward nonpersons such as infants and adolescents. The Engelhardtian concepts of ownership, indenture, and social personhood, which are meant to allow the theory to accommodate children and adolescents adequately, fail to give an Engelhardtian any actual means of determining the right action to take in difficult cases, even on his or her own terms. Thus, the theory is incapable of determining the morally correct action to take in cases involving children and therefore is unhelpful in dealing with moral questions involving children.

Adolescent↗
PubMed2003

Sick autonomy.

Complex social and economic forces have placed patient autonomy at the center of medical ethics, and thereby displaced an older ethic of physician beneficence. This development arose, and is sustained, by waning trust in the traditional doctor-patient relationship. As patients have increasingly become clients and consumers, a contract basis for medical care has put the ancient covenant of care in jeopardy. Here, a philosophical approach to harmonize the apparent conflicting claims of patient autonomy and physician beneficence is offered by demonstrating that autonomy need not be understood as protecting a threatened identity. If persons are regarded as atomistic, certain defensive notions of individualistic rights-based autonomy prevail; if a relational construction of personal identity is employed instead, then respect for autonomy becomes part of a wider morality of relationship and care. By reconfiguring trust within this latter understanding of personhood, bioethics better balances its concerns over choices and actions with those of relationship and responsibility. Neither atomistic autonomy nor the ethics of responsibility can claim hegemony, for they are mutually interdependent, and a complete account of medicine's moral axis requires that they be integrated. This reorientation is crucial for reasserting the ethos of clinical medicine, whose fundamental mandate remains the care of others.

Ethics, Medical↗
PubMed2004

Mechanism targeted discovery of antitumor marine natural products.

Antitumor drug discovery programs aim to identify chemical entities for use in the treatment of cancer. Many strategies have been used to achieve this objective. Natural products have always played a major role in anticancer medicine and the unique metabolites produced by marine organisms have increasingly become major players in antitumor drug discovery. Rapid advances have occurred in the understanding of tumor biology and molecular medicine. New insights into mechanisms responsible for neoplastic disease are significantly changing the general philosophical approach towards cancer treatment. Recently identified molecular targets have created exciting new means for disrupting tumor-specific cell signaling, cell division, energy metabolism, gene expression, drug resistance and blood supply. Such tumor-specific treatments could someday decrease our reliance on traditional cytotoxicity-based chemotherapy and provide new less toxic treatment options with significantly fewer side effects. Novel molecular targets and state-of-the-art, molecular mechanism-based screening methods have revitalized antitumor research and these changes are becoming an ever-increasing component of modern antitumor marine natural products research. This review describes marine natural products identified using tumor-specific mechanism-based assays for regulators of angiogenesis, apoptosis, cell cycle, macromolecule synthesis, mitochondrial respiration, mitosis, multidrug efflux and signal transduction. Special emphasis is placed on natural products directly discovered using molecular mechanism-based screening.

Angiogenesis Inhibitors↗