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PubMed1993

Medical ethics in times of war and insurrection: rights and duties.

In this paper I shall take the Geneva Conventions and Additional Protocols as my point of departure and link these with the International Declaration of Human Rights as a statement of faith and of aspirations.... The second part of my paper will focus on medical morality with brief reference to various languages of moral discourse and to differences in conceptual logic which underpin debates on duties and rights with particular reference to the circumstances of conflict. While acknowledging the value of talking of rights as primary I shall also suggest that the shift away from discourse on duties and obligations as primary undermines the likelihood of super-erogatory moral action. I shall conclude by emphasizing the centrality of acceptance by the State and the military of their duty to the injured and to medical personnel caring for them, if man's inhumanity to man, particularly evident during times of war, is to be kept out of our concern for each other as human beings even when nations are pitted against each other in the ongoing, but hopefully not eternal, struggle for material and ideological power.

Altruism↗
PubMed1994

The technical conditions for an open architecture.

The development of Open Systems Architecture and the extensive networked interconnection of Health and Hospital Information Systems (HIS) offer great opportunities for improved care, but simultaneously these facilities pose a great danger to the overall security of the information held. The Geneva University Hospital which has built up it centralized informatics system over the last twenty years must now bring about the conditions for a migration towards open system, for although during the last ten years there have been declarations of intent, this architecture is still a long way from final implementation. Like others, the DIOGENE system (the Geneva HIS) has had to face difficult choices especially due to its own successful situation at the end of the eighties. This paper gives a brief explanation of the technical conditions needed in order to fully migrate towards an open system. The first choices towards obtaining optimum communication standards, operating systems and database management systems were the easiest. The real difficulties occurred when deciding on the choice for management tools in this open environment.

Computer Communication Networks↗
PubMed2005

Pain as a human right: the 2004 Global Day Against Pain.

On October 11, 2004, the International Association for the Study of Pain (IASP), the World Health Organization (WHO), and the European Federation of IASP Chapters (EFIC) held a Global Day against Pain campaign to promote pain relief as a human right. International leaders in pain management and public health participated in the full day program that took place in Geneva Switzerland and was simultaneously broadcast around the world through the Word Wide Web. The declaration and statements that were released and announced, and selected contents of the program are summarized in this report.

Chronic Disease↗
PubMed1994

WHO at country level--a little impact, no strategy.

The acid test of WHO's effect on the world's health is its impact at country level. Unless it has an impact there, all of its declarations, its debates at the World Health Assembly, its conferences, its pamphlets, its political manouvering in Geneva and the regions, all of these come to nothing. Working as it does through national governments, WHO insists that it has no role in directly managing or delivering health care. Judging WHO's impact in individual countries is therefore difficult--its approaches are largely indirect, and initiatives may take years to bear fruit. But from the meagre resources that WHO makes available at country level it is clear why its country operations are criticised as the weakest link in an already weak chain of influence from its headquarters in Geneva to the people in its member states. Poorly funded, undertrained, and with no clear strategy to follow, its staff at country level stand little chance of making an impact.

Global Health↗
PubMedDate not supplied

Old dogs or new tricks: chemical warfare at the millennium.

There were about 50,000 deaths from chemical agents in the First World War and 7,000 deaths in the Kurdish population of Iraq from mustard gas and nerve agents. Signatories to the 1925 Geneva Protocol forswore first use of chemical warfare, but were allowed to maintain stockpiles, and there were no sanctions against use. The Chemical Weapons Convention (CWC), which entered into force in 1997, establishes timetables for declaration of current and past CW activity and destruction of stocks. The Convention allows inspection of suspect sites. The Organisation for the Prohibition of Chemical Weapons has been established to give effect to the CWC, which, as of June 1999, has 125 States Parties. Progress in reporting and destroying CW agents is described. It is essential that participation in the CWC becomes universal, but until this is the case monitoring by other agencies will be needed.

Chemical Warfare↗
PubMed1997

[Health status, health behavior and attitudes of young Geneva adults].

This study was aimed at assessing the health status, health-related life-styles and health concerns among young urban adults, 41% of them university students. Two mailed surveys were conducted in Geneva (Switzerland), in 1992 among 1007 persons and in 1993 among 1424 persons. Participation rates were over 80%. Study participants were aged 18-45 (mean age 31 years in 1993). For most health status dimensions, men declared to be healthier than women. Mental health-related concerns were frequent, especially among university students. Prevalence of health-related life-styles were: smoking 39%, drinking-and-driving at least once in past year 18%, always wear a seat belt 35%, had several sexual partners in past year but did not always use condoms 11%, exercise each week 46%. The more educated persons had healthier life styles, for all aspects except for unprotected sex with several sexual partners. These results are worrying and call for more active prevention strategies, directed at mental health problems, use of seat belts, drinking-and-driving, smoking and sexually transmitted diseases.

Adolescent↗
PubMed2003

Patients' rights, quality of life, and health care system performance.

The purpose of this paper is to promote the development of a social contract between patient and clinician that permits patients to state how they want to live as they survive rather than what they are willing to lose to extend their survival. To do this, patients must have sufficient leverage to affect the nature of the care they receive. This leverage, it is proposed, can be achieved by first making a 'Declaration of Patients' Rights Relative to Their Quality of Life' and then evaluating the extent to which the patient's providers comply with this rights statement. The paper also reviews The World Health Report 2000 [Health Systems: Improving Performance Geneva: WHO, 2000] as an example of an alternative approach to defining a health care social contract and evaluating a health system's performance. Also discussed, were steps that could be taken to facilitate the integration of the patients' rights statement into medical practice and health care systems performance.

Bioethics↗
PubMed1999

Tender love and transference: unpublished letters of C. G. Jung and Sabina Spielrein.

The author dissents from the widely accepted interpretation that the relationship between Sabina Spielrein and Carl Jung in the years 1904-1910 included sexual intercourse and constituted an ethical breach of the doctor-patient boundary in the course of a treatment. Spielrein declared that her treatment ended with her discharge from the Burghölzli hospital as Jung's patient in 1904-1905. Jung maintained he 'prolonged the relationship' in order to prevent a relapse and also referred to it as a friendship. Materials published in 1994 (letters, drafts, diaries, hospital chart) and unpublished letters recently found by the author in the Claparède archive in Geneva shed new light on previously published documents and interpretations by Carotenuto that have dominated the secondary literature since 1980. The new materials provide a more nuanced view of the Spielrein-Jung relationship and point to the function of non-erotic love in the therapeutic relationship. A new look at the Freud-Jung correspondence about the Spielrein-Jung relationship shows that Jung's perception that a sex scandal was initiated by Spielrein resulted from Jung's misreading of rumors concerning another woman; the episode had no ill effect on the relationship between Freud and Jung.

Correspondence as Topic↗
PubMedDate not supplied

[Current standards for body height and weight of Swiss children and adolescents 4 to 19 1/2 years old (Geneva 1972)].

New tables have recently been published containing (1) the usual percentiles of body weight and stature in each of the successive 6 months age groups, (2) two different age independent estimates of weight percentiles related to height, and (3) 50%, 80%, and 95% contours for the bivariate joint distribution of height and weight in each age group. All of the tables and charts are given for boys and girls separately. In view of the randomness of the sampling and the characteristic heterogeneity of the population concerned, these new normal limits may be declared valid not only for the entire Swiss area, but even for adjacent regions.

Adolescent↗
PubMed2003

Present practice and development of minimally invasive techniques, imaging and training in European urology: results of a survey of the European Society of Uro-Technology (ESUT).

OBJECTIVES: The European Society of Urological Technology (ESUT) conducted a survey in order to assess and record the current trend between European urologists with regard to the application of new technologies in BPH, stone disease and imaging and to identify differences amongst urologists. MATERIAL AND METHODS: A total of 854 certified urologists and residents coming from European countries answered the ESUT survey during the XVIth Annual EAU Meeting in Geneva in 2001. The respondents were classified according to the geographical origin (Eastern, Southern and Northern Europe), year of certification (before 1980, and every 5 years hereafter) and power of the department in beds (less than 25, 26-50, and more than 50) in order to identify any differences in the replies mainly due to economical reasons, national or hospital policy and personal attitudes. RESULTS: According to the replies, in Eastern Europe more procedures related to BPH and stones are performed comparing to Northern and Southern Europe (165.8 versus 77.1 and 100.6/month/department, respectively). However, the Northern European urologists have access to every type of lithotriptor and most of the different minimally invasive treatments for BPH in a higher percentage, followed by the Southern and the Eastern European urologists. The most widespread intracorporeal lithotriptor is the pneumatic and the most common alternative minimally invasive BPH treatment is electrovaporization (80.7% and 45.6%, respectively). Holmium laser is the most frequent choice (40.1%) when the surveyed urologists were asked to choose which of the minimally invasive techniques would like to have access to. In total 79.4% (54.1% alone and 25.3% in collaboration with the radiologists) of the respondents perform the ultrasound studies while the remaining 20.6% declare that only the radiologists do the studies. Of the surveyed urologists, 92.8%, 89.6% and 94.9% are interested in hands-on courses, simulators and live surgery, respectively. CONCLUSIONS: The data obtained from the 854 surveyed European urologists and residents can be used as a tool to highlight the disparity between European countries and to advance training of European urologists.

Cohort Studies↗