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PubMed2002

Physician attitudes concerning legal coercion of pregnant alcohol and drug abusers.

OBJECTIVE: We sought to determine the attitudes of obstetricians, pediatricians, and family practice physicians in Michigan concerning involvement of the criminal justice system in preventing drug and alcohol abuse during pregnancy. STUDY DESIGN: Physicians were sent a questionnaire by mail asking for their agreement with statements concerning the involvement of the criminal justice system with respect to substance abuse during pregnancy. RESULTS: Nearly all (95%) agreed that pregnant women have a moral duty to ensure they had healthy babies; 59% agreed that they should also have a legal responsibility to do so. Most physicians (77%) agreed that screening for acquired immunodeficiency syndrome during pregnancy should be mandatory. Almost as high a percentage (61% to 75% depending on subspecialty) were also in favor of mandatory screening for alcohol abuse; agreement for screening for illicit drugs was much lower (43% to 55% depending on subspecialty). Despite their consensus (61%) that fear of prosecution would deter pregnant abusers from seeking prenatal care, most were in agreement that existing laws regarding child abuse and neglect need to be redefined to include alcohol (54%) and drug abuse (61%) during pregnancy; 52% were in favor of enacting a statute that includes drug or alcohol use during pregnancy as "child abuse" for purposes of removing that child from maternal custody. Physicians were highly in favor of compulsory treatment for illicit drug use and alcohol abuse for women already in the criminal justice system (82%-83%), neutral with respect to court-ordered contraception for alcohol- (50%) and drug-abusing women (47%), and opposed to criminal prosecution for either alcohol abuse (18%-31% depending on subspecialty) or illicit drug use (23%-34%) during pregnancy. CONCLUSIONS: Other than criminal prosecution, physicians are not opposed to involvement of the legal justice system in preventing alcohol and drug abuse during pregnancy.

Acquired Immunodeficiency Syndrome↗
PubMed1986

From coercion to collaboration: two weeks in the life of a therapeutic community.

The purpose of this paper is to describe an aspect of the functioning of a therapeutic community conceptualized in terms of a sociotherapy framework as adumbrated, for example, by Edelson (1970), Rapoport (1960), and White et al. (1964). This approach, as distinct from group therapy, is concerned with the social system and social conditions that form the fabric of any given behavior. In the hospital context it is the therapeutic community that provides the fabric in which interpersonal and intergroup tensions can be addressed and clarified. We will illustrate this approach by detailing a discussion between therapy and nursing staff members who consult to, and participate in, the various group meetings of the Therapeutic Community Program (TCP), which together provide the framework of this particular community. Specifically, the discussion was about the evolving nature of the engagement between the community and a borderline patient, who attempted to alter the structure and functioning of an aspect of the community program in order to meet her own needs and avoid inner conflict. The discussion will focus on the way in which the community members adhered to existing structures and functioning, and were able to utilize staff consultation to this end, despite the patient's strong pressure on them to alter it. In describing this particular case we hope to illustrate how a well-functioning therapeutic community can "hold" one of its members in a manner that allows change to take place, and also serves as an important adjunct and facilitator to individual therapy.

Adult↗
PubMed2003

Rape among incarcerated men: sex, coercion and STDs.

Male inmates fear being raped most of all. Criminologists have yet to reach consensus on the prevalence of male inmate-on-inmate rape. The leading prevalence studies found that 7-12% of the responding male inmates had been raped an average of nine times. With a national jail and prison population of 2 million at mid-year 2002, the United States likely exposes tens of thousands of male inmates to rape, and consequently, to HIV/AIDS and other sexually transmitted diseases (STDs). The release of inmates from jails and prisons-estimated at 11.5 million persons in 1998-transforms the consequences of male rape from a correctional matter into a public health crisis. The quest for dominance and control over other inmates-not sexual release-best explains male custodial rape. Prison sexual predators are typically heterosexual. Their victims, however, involuntarily assume female roles in the prison sexual system. Moreover, they experience stigmatization by inmates and staff as well as physical and mental trauma. Civil rights litigation on behalf of victims rarely succeeds and damage awards are usually small. In 2003, Congress provided $13 million for the study and prevention of rape in jails and prisons. Preventing custodial rape and treating its victims will require a sustained commitment by government.

HIV Infections↗
PubMed2004

Capacity and coercion: dilemmas in the discharge of older people with dementia from general hospital settings.

Discharge planning of older people with dementia can present difficult ethical dilemmas to the general hospital clinician. These difficulties may be particularly pronounced for those who are moderately severely affected and for whom hazards are anticipated on discharge home. In many cases the wishes of the individual to return home may differ markedly from those of health care professionals, carers or relatives. In order to reduce these tensions and preserve the choice of the individual as far as possible, we try to put into context a number of different issues. We discuss some of the misconceptions regarding the legal powers available in these situations, the limited and sometimes confusing issue of capacity and the role of Community Mental Health Teams in preserving autonomy and independence of older people with dementia in their own homes.

Aged↗
PubMed2002

Male coercion and convenience polyandry in a calopterygid damselfly.

Copulation in odonates requires female cooperation because females must raise their abdomen to allow intromission. Nevertheless in Calopteryx haemorrhoidalis haemorrhoidalis (Odonata) males commonly grasp ovipositing females and apparently force copulations. This has been interpreted as a consequence of extreme population density and male-male competition. We studied this behavior at two sites on a river that had different densities over three years. As predicted, at high densities most matings were forced (i.e. not preceded by courtship), but at low density most were preceded by courtship. Courtship matings were shorter at high density, but density did not affect the duration of forced matings. Females cooperated in forced matings even if they had very few mature eggs. Furthermore, females mated more times if they experienced higher male harassment during oviposition, and at low density second and subsequent matings were more likely to be forced. We interpret these results to mean that females engage in "convenience polyandry", because they gain more by accepting copulation than by resisting males. The results also suggest that females might trade copulations for male protection, because under extreme population density harassment by males is so intense that they can impede oviposition.

Abdomen↗
PubMed2001

Morality is not a curable disease: probing the history of venereal diseases, morality and prostitution. [Review of: Spongberg, M. Feminizing venereal disease: the body of the prostitute in nineteenth-century discourse, 1997; Fisher, T. Prostitution and the Victorians, 1997; Mooij, A. Out of otherness: characters and narrators in the Dutch venereal disease debates 1850-1990, 1998; Merians, LE. The secret malady: venereal disease in eighteenth century Britain and France, 1996; Brandt, A; Rozin P. Morality and health, 1997; Lewis, M. Thorns on the rose: the history of sexually transmitted diseases in Australia in international perspective, 1998; Lundberg, A. Care and coercion: medical knowledge, social policy and patients with venereal disease in Sweden, 1999].

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Historiography↗