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The Chinese public medical care system was established after the 1949 revolution. However, there is no necessary connection between Marxism and the public medical care system; and although the current system may be reasonable from an historical point of view, it can no longer be justified ethically as an all-embracing medical system, since it does not provide equitable health care for the people.
Medical ethics has been developing in the German Democratic Republic (GDR) since the 1970's on the basis of the traditional ethics of physicians and the socio-economic fundamentals of our socialist state. Medical care provided in the framework of Marxist-Leninist medical ethics is based on rationality and humanity.
The study of professional ethics has a long tradition in the Soviet Union; medical ethics is a code of conduct as well as an academic discipline. The paper discusses the ethical issues in intensive care, the definition of death, abortion, euthanasia, and the moral aspects of medical mistakes.
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Occupational health services in China occupy a much more central role in public life than they do in North America. The Communist ideology on which the People's Republic was built, and which it almost alone today defends, places an idealized concept of the worker at the centre of the economic, social and political system. The present system in China is a parallel, institutionally separate system of medical care and research on occupational disorders that is in some ways better provided for with resources than the general healthcare system. One of the issues facing China today is how to turn the priorities of this vast, elaborate and incompletely developed system of occupational health care away from the provision of medical care to workers made ill from workplace exposure and towards prevention of the exposures that made them ill in the first place. The prevalence of smoking and the intensity of passive smoke exposure in Chinese workplaces make this exposure one of the most deadly occupational hazards seen. This problem of health promotion can probably only be effectively approached in China by worksite programmes but these are not apparent.
The focus of this article is a comprehensive review of the Russian-Soviet conceptualization of schizophrenia, which can be understood only in the broader historical and cultural context of Russian-Soviet psychiatry. Because of multiple barriers and the political abuse of psychiatry in the former Soviet Union, international psychiatric literature has lacked unbiased data about the scientific merit and historical logic of the Russian-Soviet concept of schizophrenia. This article represents an attempt to examine phenomenology, nosology, and some biological theories of schizophrenia developed in the former U.S.S.R. from historical and scientific points of view and to compare them to the Western theories. The article also addresses historical and cultural antecedents of the abuse of psychiatry. The author suggests that the lack of a democratic tradition in Russia, a totalitarian regime, and oppression and "extermination" of the best psychiatrists during the 1930-50 period prepared the ground for the abuse of psychiatry and Russian-Soviet concept of schizophrenia. Perspectives on the potential changes in the Russian concept of schizophrenia in changing historical conditions are discussed.
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Medical education in the People's Republic of China is described as it was seen on a 10-week trip in 1973. The information was collected from five medical schools which were visited personally as well as from practitioners and citizens. An overview of the health care system indicates the relationships between education and practice. The three-year medical curricula from the five medical schools are reasonably similar; and in the state-controlled system of health care they are integrated with postgraduate training and continuing education. Goals of the educational programs, entrance procedures, and the medical school experience are discussed. The literature on medical education and practice in China is reviewed and compared with the data available during this recent visit. The lessons which might be learned are the methods of offering health care to massive populations and the organization of health professionals and paraprofessionals for such programs.
After World War I, medical education in the Soviet Union and medical education in the United States headed in strikingly divergent directions. In keeping with the recommendations of the Flexner report, medical education in the United States became a university-based academic discipline based in the natural sciences. In contrast, the Soviet Union created a series of free-standing medical institutes whose admission, curricular, and pedagogic policies were centrally controlled in strict conformity with political doctrine. Notable features of the Soviet system were narrowly defined professional education; early specialization, beginning in the first year of medical school; and emphasis on empirical clinical training at the expense of scientifically based education. Despite the historical differences between Soviet and American medical education, there are several issues that face present-day medical educators in both the United States and the Soviet successor states. These include an overabundance of specialists, the need to provide equitable professional opportunities for physicians of both sexes, and the need to provide access to medical education for qualified candidates from underrepresented social or ethnic groups or from geographically remote regions.
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Increasingly, families are being called to provide care to their elderly family members. Nursing has an important role to play in enabling families to assume such responsibilities. In this article, however, it is argued that nursing needs to examine its goals for nursing care and approaches to care delivery in their broader social, political, and economic context. Marxist theory is introduced and used to raise questions about taken-for-granted aspects of nursing practice and trends in health policy as they relate to family carers for the elderly. The article specifically examines assumptions about family, women, and household economies that are inherent in traditional nursing theory. It is argued that nursing needs to move its focus of action beyond work at the individual and family level to include work at system and policy levels. To do so, nursing must examine theoretical perspectives that enable such an inquiry into practice.
Examines the outcomes of attempts to improve health services in the former Communist countries of Eastern Europe and in the West European democracies. Discovers that while the East Europeans focused their efforts on increasing the numbers of doctors and beds per patient, while keeping to relatively low levels of investment in technological advances, West European countries have taken the opposite approach, emphasizing quality of care, particularly advanced care, reducing the numbers of physicians and hospital beds, acquiring advanced technological systems for diagnosis and treatment and spending ten times as much per patient as in Eastern Europe. Concludes that the West European approach has led to far better results.
There is an urgent need for reconstructing models of property to make them more women-friendly. However, we need not start from scratch: both 'canonical' and feminist authors can sometimes provide concepts which we can refine and apply towards women's propertylessness. This paper looks in particular at women's alienation from their reproductive labour, building on Marx and Delphy. Developing an economic and political rather than a psychological reading of alienation, it then considers how the refined and revised concept can be applied to concrete examples in global justice for women: in particular, the commercialisation of embryonic and fetal tissue in the new stem cell technologies.
Consultation based on an entrepreneurial model is becoming an increasingly popular career choice for nurses. Marx's theoretical formulations were selected as a framework for examining various aspects of the entrepreneurial model of consultation in nursing. Areas addressed include the growing alienation of nurses from their work in institutional settings, entrepreneurial practice as an escape from alienation, and the inherently conservative nature of entrepreneurial consultant practice.
It is now 6 years since Salvage's (1988) analysis of the position of nursing within the professionalization process; this was written in the light of the aspirations of Project 2000. Recently there have been several significant policy statements from the United Kingdom Central Council which appear to be pursuing professional status despite Salvage's contention that nursing's leaders know 'that full professional status for nursing cannot be achieved'. Elements of these statements are discussed in relation to the professionalization thesis. Using the examples of nurse prescribing and managerialism, it is argued that the deprofessionalization thesis is more appropriate to nursing since the ideals of autonomy, authority and status are being eroded in the new managerialist post-Griffiths National Health Service culture. A positive deprofessionalization notion is put forward which highlights and re-emphasizes the caring role through the new occupational strategy of Assessment of Prior Experiential Learning (APEL).