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PubMed2000

Should it be mandated that an HEC review a physician's decision not to honor a patient's or surrogate's refusal of treatment?

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Advance Directive Adherence↗

PubMed2001

The mandatory health insurance system in Chile: explaining the choice between public and private insurance.

In Chile, dependent workers and retirees are mandated by law to purchase health insurance, and can choose between private and public health insurance. This paper studies the determinants of the choice of health insurance. Earnings are generally considered the key factor in this choice, and we confirm this, but find that other factors are also important. It is particularly interesting to analyze how the individual's characteristics interact with the design of the system to influence choice. Worse health, as signaled by age or sex (e.g., older people or women in reproductive ages), results in adverse selection against the public health insurance system. This is due to the lack of risk adjustment of the public health insurance's premium. Hence, Chile's risk selection problem is, at least in part, due to the design of the Chilean public insurance system.

Adult↗

PubMed2003

Universal compulsory service in medical research.

Despite the prominence of healthcare-related concerns in public debate, the ground remains infertile for the idea of conscripting citizens into medical research. Reluctance to entertain the thought of a system where nearly everyone could be selected for service might reflect uncertainty about what the project would involve. There might also be a fear that the more crucial issue is how to protect research subjects within current, voluntary systems. No doubt reluctance to explore a system of universal service results from the common hope that each of us might avoid research in any capacity besides researcher. A system of full civic participation might, however, avoid many of the usual objections. Ethics regulations, including informed-consent guidelines, could for the most part remain in force. Though the system would compel people to serve, it could remain responsive to principles of autonomy and justice if it centered on broad public education, community representation, and a lottery-type selection process. The system could draw from the largest possible cross-section of society, and offer conscripts the widest possible range of service. In this way, a compulsory system might reconcile the expectations about healthcare with research needs.

Cross-Sectional Studies↗

PubMed2003

Quality assurance and dental hygiene.

Dental hygiene in Canada has experienced significant growth. It has shifted from an emerging occupation to a regulated health profession in several jurisdictions. Many achievements may be attributed to this growth, including self-regulation and a national code of ethics. However, the majority of Canadian dental hygienists are relying on traditional, outdated and ineffective quality assurance mechanisms, such as mandatory continuing education requirements. In the interests of public protection, dental hygiene needs to ensure that the quality assurance activities required from its members are effective, valid and reliable. Quality assurance in health care continues to undergo modifications that better reflect the public's need for competent, ethical, safe and appropriate health care. Dental hygienists and dental hygiene regulatory bodies are challenged to find valid, reliable and effective methods of quality assurance. This paper discusses some of the developments in quality assurance in health care as well as some of the key and significant achievements of dental hygiene in Canada. The use of quality assurance mechanisms currently used in dental hygiene in Canada is also discussed. The paper concludes with a discussion on the potential barriers and issues that the profession may face when attempting to incorporate suitable quality assurance activities into daily dental hygiene practice.

Canada↗

PubMedDate not supplied

Exposing the myths surrounding preventive outpatient commitment for individuals with chronic mental illness.

Using New York's "Kendra's Law" as an illustrative vehicle, this article addresses the principal criticisms lodged by opponents of preventive outpatient commitment. The authors argue that preventive outpatient commitment is a useful adjunct to conditional release or placement in the least restrictive alternative that has neither produced revolutionary change in psychiatric commitment standards nor will be used inappropriately to assert governmental control over mentally ill citizens. The authors contend additionally that preventive outpatient commitment does not violate federal constitutional norms or represent bad policy making. The authors acknowledge, however, that the coercion inherent in outpatient commitment schemes may produce certain undesirable side effects. Thus, they explore an alternative approach currently in development in Australia that promotes community-based treatment for chronically mentally ill persons without judicial intervention.

Australia↗

PubMedDate not supplied

Outpatient civil commitment: a dangerous charade or a component of a comprehensive institution of civil commitment?

This article examines three criticisms frequently directed toward preventive commitment as one form of outpatient commitment. These criticisms contend that preventive commitment (a) abandons the dangerousness criteria for civil commitmnet, (b) promotes unwarranted inpatient commitment of those who do not meet civil commitment criteria, and (c) undermines important individual liberties by diluting the right to refuse treatment. Understanding and evaluating these criticisms requires analysis of the intersection among empirical, conceptual, and justificatory claims. According to the analysis presented here, advocates of preventive commitment can defend a legitimate role for preventive commitment. This analysis applies to preventive commitment as a dispositional alternative within a comprehensive institution of civil commitment involving distinct parens patriae and police power components.

Civil Rights↗

PubMedDate not supplied

Outpatient commitment: the state of empirical research on its outcomes.

This article briefly describes the historical conditions in the origin and development of outpatient commitment that framed the discourse on its merits and the empirical studies on its outcomes. It divides those empirical studies into two sets on the basis of the questions addressed and critically reviews them. The review pays particular attention to the latest studies that were able to randomize subjects to experimental and control conditions and that were able to offer enhanced services. Finally, this article presents issues not addressed by the empirical studies on outpatient commitment but that need to be addressed in order to understand the choice of using the law to force persons with mental illness to comply with treatment and receive services in the community.

Advance Directives↗

PubMed1994

Patterns of consultation among adolescent minors obtaining an abortion.

Interviews with 184 adolescents revealed that all had consulted at least one individual before obtaining an abortion, although one-quarter, primarily the older adolescents, did not consult an adult prior to pregnancy counseling. At both the time of the abortion and one year later, the adolescents perceived their mother and their male partner as the two most important and helpful people in reaching a decision.

Abortion, Induced↗

PubMedDate not supplied