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PubMed1981

[Dynamics of the remission of acute schizophrenic episodes during psychopharmacologic treatment].

The process of formation of therapeutic remission in patients with acute schizophrenic episodes was studied. Two types of the therapeutic regression, i.e. the critical and the lytic ones (both having a harmonious and a dysharmonious variants) are specified. It is shown that the process of the therapeutic remission formation in the harmonious variant of the lytic regression passes through a regular sequence of stages (stages of polymorph disturbances, structural organization of the objective manifestations of the psychosis, reduction, destruction, and transformation of the syndrome and the disturbances at the neurotic level). The integrated picture is formed at each stage of psychopathological disturbances having peculiarities associated with the level of the patient's conscience and self-conscience. The direction of the experiences, as regards the values and the sense, regularly changes. At each stage respective ways of psychological defence are realized.

Acute Disease↗
PubMed1984

Ethical dilemmas and nursing.

Professional responsibilities, tradition, and personal conscience along with legal, philosophical, and religious convictions dictate nursing interventions. Inevitably, these factors embrace life-sustaining therapies; however, in view of complications, prognosis, pain and suffering, and their own views of quality of life, some patients express wishes inconsistent with life-sustaining measures. In other situations, the health care provider as well as the patient may view heroic efforts as more debilitating than resortative. Resolving the conflict while preserving the patient's best interests requires a confrontation with the status of "do-not resuscitate" policies within th e nurse's institution, informed consent, refusal, and competency as the necessary underpinnings for the development of an ethical and legal posture within the profession, with which to approach significant decisions regarding life-sustaining therapies. Literally every hour of every day nurses are immediately and directly involved with resolving ethical dilemmas based upon judgements and interpretations of oral or written orders, patient and family wishes, professional training, and an infinite number of other factors. When clear policies or orders are lacking, the nurse is left with the burden of making a life or death decision. It is imperative that professional nurses assess the administrative, legal, and ethical ramifications of their actions in terms of ethical codes of practice, patients' rights, institutional and personal liability, civil and criminal laws, and private conscience. An understanding of these issues, passive and active euthansia, state and national trends, and uniform legislation can assist in resolutions of the no-code dilemma. Nursing as a profession must strive to develop sound and consistent guidelines and rationale for the scope of practice in ethical dilemmas.

Conflict, Psychological↗
PubMed1995

[Secondary effects of the treatment of hypermicrofilaremic loiasis using ivermectin].

In the last ten years ivermectin appeared an efficient and safe alternative to diethylcarbamazine which is known to induce severe adverse reactions in loiasis, including encephalitis. After these results, large scale ivermectin treatments against onchocerciasis were carried out in Central Africa where loiasis is also endemic; and seven cases of severe reaction were reported in Cameroon since 1991, during these mass ivermectin treatments. In order to study adverse reactions in patients harbouring high load of Loa loa microfilariae (mf), we realized careful hospital based treatment in 112 patients with more than 3,000 mf/ml (ml) blood. Patients received once 200 micrograms ivermectin per kilogram at day 0 (D0). Clinical examination was made daily during the four following days (D1 to D4). Blood and urine samples were analysed before treatment and at D1 and D3. Lumbar puncture was made at D1 for 39 patients with more than 10,000 mf/ml; at D3 for the 49 following patients without consideration for the level of parasitaemia, and at D0 and D3 for ten voluntary patients. For analysis the patients were distributed in 3 groups according to initial parasitaemia: the first group included 50% out of the patients, those whose parasitaemia was fewer than 15,000 mf/ml blood; the second group included 25% patients whose parasitaemia was between 15,000 and 30,000 mf/ml; the third group included the last 25% patients whose parasitaemia was higher than 30,000 mf per ml blood. Adverse reactions were observed in 71% out of the patients. Symptoms described were fever, pruritus, headache, arthralgia. Most symptoms appeared 24 to 36 hours after treatment. Temperature increased significantly in group 3. Microfilaraemia decreased by 85% in the 3 groups during the 4 days following treatment. C-reactive-protein increased dramatically after treatment in all patients (p < 10(-4)). Some patients presented blood in urine in three groups but haematuria reached 35% of patients in group 3. Proteinuria is noted among 33% of all patients but 20% in group 1 and 2 versus 70% in group 3. Loa loa mf were observed in urine of half the patients, but in low amounts (< 10 mf per 50 ml urine). In cerebro-spinal fluid (CSF), some mf appeared at D1 or D3 in people heavily infected with Loa loa, reaching 80% of the patients of group 3. LP made at D0 in ten patients with parasitaemia higher than 30,000 mf/ml blood confirmed that CSF was naturally microfilaria free before treatment. One patient presented severe troubles with fever, asthenia and conscience troubles beginning at D3, reactive coma at D4, renal impairment with transitory anuria; progressive improvement in 2 weeks and complete recovery at D22; he presented 102 mf/ml CSF at D6. The study confirmed that ivermectin treatment is generally well tolerated. Among people with high Loa loa parasitaemia the symptoms after treatment are frequent but mild. However severe cases with conscience troubles are possible, and may occur in about 1% of subjects with more than 3,000 mf/ml blood. Severity of adverse reactions was linked to level of parasitaemia before treatment. The critical parasitaemia level which could lead to expect serious adverse effects seems to be 30,000 ml/ml blood. These informations should induce carefulness to carry out large scale treatments against filariosis in endemic areas of Loa loa.

Adult↗
PubMed1996

[The ethics of psychoanalytic technique].

The ethic of psychoanalytic technique which goes back to Freud and emphasizes the importance of anonymity, abstinence, neutrality and the central role of interpretation is subjected to a critical examination. The author traces the changes that have taken place since Freud and proposes a new ethic of psychoanalytic technique. Proceeding from the theory of object relations, Treurniet stresses the symmetrical relationship between analyst and analysand permitting both to assume a "meta-position" in order to reflect on the analysis material. The author further suggests that, beyond the projections of the analysand, the analyst should be open to his own subjectivity, as this openness is the key to the essential feature of analytic procedure, the enactment of countertransference. Finally, Treurniet reformulates his advocacy of a non-intrusive, affirmative attitude on the part of the analyst, a spontaneous willingness to "fall into the analysand's trap", an ability to oscillate between acting-out and introspection, to live out countertransference involuntarily and finally to incorporate the non-ideal into his conscience. These rules of technique must be controlled not only by the conscience and the countertransference of the analyst, but also--apart from intervision and consultation with collegues--by the analysand himself, whose opinion of the analytic situation the analyst should ask for.

Countertransference↗
PubMed1991

Living systems are tonically inhibited, autonomous optimizers, and disinhibition coupled to variability generation is their major organizing principle: inhibitory command-control at levels of membrane, genome, metabolism, brain, and society.

It is proposed that the major organizing principle in living systems is disinhibition coupled to variability generation. Facile traverse of adaptive functional ranges is made possible by activities of inhibitory (attenuating and/or time-delaying) influences. These maintain barriers to physicochemical perturbations, so that interactions between the external environment and living systems produce transient local changes (signals) that are transduced by a variety of devices at hand to release activities within them. Coupling exists between the driving force (forcing function) and the generation of variability (information-processing capacity) among subunits of particular systems, i.e., there is expansible capacity for processing information in relation to demand. Metaphorically, metabolically generated energy is used to wind the biological springs. Hierarchical nesting of inhibitory command-control is discussed at levels of membrane, metabolism, genomic expression, brain function, and internalization of societal prohibitions (conscience).

Animals↗
PubMedDate not supplied

Why physician-assisted suicide perpetuates the idolatory of medicine.

Adequate response to physician-assisted suicide and euthanasia depends on fundamental philosophical and theological issues, including the character of an appropriate philosophically and theologically anchored anthropology, where the central element of traditional Christian anthropology is that humans are created to worship God. As I will argue, Christian morality and moral epistemology must be nested within and understood through this background Christian anthropology. As a result, I will argue that physician-assisted suicide and euthanasia can only be one-sidedly and inadequately appreciated through rational appeal to central values, such as "human dignity" and "self determination", or through "sola scriptura" biblical interpretation, or individual judgments of conscience. Adequately addressing physician-assisted suicide and euthanasia will depend on a more fundamental spiritual-therapeutic approach. This cluster of moral, epistemological, anthropological, and bioethical claims will be explored by drawing on the texts of St. Basil the Great, St. Maximos the Confessor, and St. Isaac the Syrian. Their reflections on medicine, the human good, and its relationship to worship, spiritual therapy, and God will be used as a basis to indicate a broader philosophical perspective, which will be needed to avoid a one-sided, incomplete approach to the challenges of physician-assisted suicide and euthanasia. Medical morality, I argue, is best understood within categories that transcend the right, the good, the just, and the virtuous; namely, the holy.

Bioethics↗
PubMed2005

Dispensing with liberty: conscientious refusal and the "morning-after pill".

Citing grounds of conscience, pharmacists are increasingly refusing to fill prescriptions for emergency contraception, or the "morning-after pill." Whether correctly or not, these pharmacists believe that emergency contraception either constitutes the destruction of post-conception human life, or poses a significant risk of such destruction. We argue that the liberty of conscientious refusal grounds a strong moral claim, one that cannot be defeated solely by consideration of the interests of those seeking medication. We examine, and find lacking, five arguments for requiring pharmacists to fill prescriptions. However, we argue that in their professional context, pharmacists benefit from liberty restrictions on those seeking medication. What would otherwise amount to very strong claims can be defeated if they rest on some prior restriction of the liberty of others. We conclude that the issue of what policy should require pharmacists to do must be settled by way of a theory of second best. Asking "What is second best?" rather than "What is best?" offers a way to navigate the liberty restrictions that may be fixed obstacles to optimality.

Attitude of Health Personnel↗
PubMed2006

Tube feedings and persistent vegetative state patients: ordinary or extraordinary means?

This article looks at the late John Paul II's allocution on artificial nutrition and hydration (ANH) and the implications his statement will have on the ordinary-extraordinary care distinction. The purpose of this article is threefold: first, to examine the medical condition of a persistent vegetative state (PVS); second, to examine and analyze the Catholic Church's tradition on the ordinary-extraordinary means distinction; and third, to analyze the ethics behind the pope's recent allocution in regards to PVS patients as a matter of conscience. Rather than providing clarification, I argue that the papal allocution has raised many difficult questions. People in situations where decisions must be made about withdrawal or continued ANH are in need of guidance. Moreover, additional analysis is needed to determine whether the papal allocution is in conflict with the traditional Catholic medical ethics understanding of the ordinary-extraordinary care distinction.

Catholicism↗
PubMed1997

In the world but not of it: managing the conflict between Christian and institution.

Christian physicians, nurses and other health care workers must manage a daily conflict of conscience between their Christian faith and predominantly secular health care institutions. This essay examines various efforts for managing these conflicts: a turn towards social justice or a seeking of holiness. Seeking social justice, however, is theologically empty. Traditionally, the Christian requirement that we be "in this world but not of it" requires a journey along a narrow path to holiness. Christian medical morality must, therefore, be understood within this light. However, just as there cannot be generic health care, but rather health care for a particular person's needs and problems there cannot be generic holiness, but only a holiness grounded in worshiping God rightly. In so worshiping the Christian will be assisted in negotiating the inescapable and perilous vocation of being in the world but not of it.

Catholicism↗
PubMed2000

Defense mechanisms and morality: a link between isolation and moralization.

The relationship between morality and perceptual defense mechanisms was studied. Three new scales were constructed to measure different aspects of morality: moralism (the tendency to evaluate everything in terms of right and wrong), conscience (strength of feelings of right and wrong) and reparation (inclination to repair the damage one has caused). Perceptual defense mechanisms were measured with Kragh's Defense Mechanism Test (DMT). Three hypotheses about relationships between morality and defense mechanisms, derived from psychoanalytical literature, were tested on 54 male University students. Results show positive correlations between the defense mechanism isolation of affect and moralism, and between identification with the aggressor and reparation. Total amount of perceptual defense correlated positively with moralism. It is argued that the psychological study of morality should take unconscious processes into consideration.

Adult↗
PubMed1993

Doing what the patient orders: maintaining integrity in the doctor-patient relationship.

No profession has undergone as much scrutiny in the past several decades as that of medicine. Indeed, one might well argue that no profession has ever undergone so much change in so short a time. An essential part of this change has been the growing insistence that competent, adult patients have the right to decide about the course of their own medical treatment. However, the familiar and widely accepted principle of patient self-determination entails a corollary that has received little attention in the growing literature on the ethics of physician-patient relations: if patients are to direct the course of their own medical treatment, then physicians are at least sometimes to be guided in their actions on behalf of patients by values that are not, and may even be incompatible with, their own values. Unless it is supposed that it would be best if physicians were simply to accommodate any and all patient requests, a possibility I consider and reject in this paper, there are bound to be numerous instances of legitimate moral conflict between the preferences of physicians and patients. In this paper, I examine the implications of this sort of moral conflict from the standpoint of the integrity of the physician....I have also considered the common practice of patient referral from the standpoint of physician integrity, and asked whether a physician who refuses to treat a patient as a matter of conscience can consistently refer the patient to another physician for the same treatment....

Altruism↗
PubMed1994

Consequences for patients of health care professionals' conscientious actions: the ban on abortions in South Australia.

The legitimacy of the refusal of South Australian nurses to care for second trimester abortion patients on grounds of conscience is examined as a test case for a theory of permissible limits on the autonomy of health care professionals. In cases of health care professional (HCP) conscientious refusal, it is argued that a balance be struck between the HCPs' claims to autonomous action and the consequences to them of having their autonomous action restricted, and the entitlement of patients to care and the consequences for them of being refused such care. Conscientious action that results in the disruption or termination of health care services, however, is always impermissible on two grounds. Firstly, because it is at this point that the action '... invades a patient's autonomy, puts a patient at serious risk ... [and] treats a patient unjustly' (1) Secondly, because the consequences of such refusals turn them into political acts--acts of civil disobedience. It is arguable that in order for acts of civil disobedience to be legitimate, certain obligations are required of the dissenter by the community. It is concluded that the actions of the South Australian nurses, which have over the last few years both terminated and disrupted second trimester services, are morally impermissible.

Abortion, Legal↗
PubMed2004

Meeting ethical challenges in acute care work as narrated by enrolled nurses.

Five enrolled nurses (ENs) were interviewed as part of a comprehensive investigation into the narratives of registered nurses, ENs and patients about their experiences in an acute care ward. The ward opened in 1997 and provides patient care for a period of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The ENs were interviewed concerning their experience of being in ethically difficult care situations and of acute care work. The method of phenomenological-hermeneutic interpretation inspired by the French philosopher Paul Ricoeur was used. The most prominent feature was the focus on relationships, as expressed in concern for society's and administrators' responsibility for health care and the care of older people. Other themes focus on how nurse managers respond to the ENs' work as well as their relationships with fellow ENs, in both work situations and shared social and sports activities. Their reflections seem to show an expectation of care as expressed in their lived experiences and their desire for a particular level and quality of care for their own family members. A lack of time could lead to a bad conscience over the 'little bit extra' being omitted. This lack of time could also lead to tiredness and even burnout, but the system did not allow for more time.

Acute Disease↗
PubMed2005

Meeting ethical challenges in acute nursing care as narrated by registered nurses.

Five registered nurses were interviewed as part of a comprehensive investigation by five researchers into the narratives of five enrolled nurses (study 1, published in Nursing Ethics 2004), five registered nurses (study 2) and 10 patients (study 3) describing their experiences in an acute care ward at one university hospital in Sweden. The project was developed at the Centre for Nursing Science at Orebro University Hospital. The ward in question was opened in 1997 and provides care for a period of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The registered nurses were interviewed concerning their experience of being in ethically difficult care situations in their work. Interpretation of the theme 'ethical problems' was left to the interviewees to reflect upon. A phenomenological hermeneutic method (inspired by the French philosopher Paul Ricoeur) was used in all three studies. The most prominent feature revealed was the enormous responsibility present. When discussing their responsibility, their working environment and their own reactions such as stress and conscience, the registered nurses focused on the patients and the possible negative consequences for them, and showed what was at stake for the patients themselves. The nurses demonstrated both directly and indirectly what they consider to be good nursing practices. They therefore demand very high standards of themselves in their interactions with their patients. They create demands on themselves that they believe to be identical to those expected by patients.

Acute Disease↗
PubMed1977

Personality correlates of the Mosher Guilt Scales.

Examined the relationship between sex guilt, hostility guilt, and morality-conscience guilt, and more traditional concepts in personality, to extend the construct validational work of the Mosher Guilt Scales. This was achieved by correlating the scores of the three guilt subscales with the 15 manifest needs of the Edwards Personal Preference Schedule. The results indicate that while there was some overlap between the guilt scores and the manifest needs, the association was usually a function of theoretically consistent relationships rather than duality of constructs. These findings, and the literature review of the Mosher Guilt Scales, are interpreted as supporting the continued use of the three guilt subscales as well as suggesting that guilt is a personality variable of considerable theoretical significance.

Conscience↗
PubMed2004

Temperament and developmental pathways to conduct problems.

This article reviews research linking a number of temperamental vulnerabilities to the development of severe conduct problems in children. Also reviewed are 2 areas of research that focus on important developmental processes that could mediate the relation between temperament and conduct problems. These processes are the development of emotional regulatory abilities and the development of the affective components of conscience. Both of these processes have been associated with certain temperamental vulnerabilities, and they can both place a child at risk for the development of conduct problems. Importantly, these 2 processes may designate children who develop conduct problems through distinct causal pathways and, as a result, could help to explain some of the subtypes of antisocial youth reported in past research.

Adaptation, Psychological↗
PubMed2004

Abandon the dead donor rule or change the definition of death?

Research by Siminoff and colleagues reveals that many lay people in Ohio classify legally living persons in irreversible coma or persistent vegetative state (PVS) as dead that additional respondents, although classifying such patients as living, would be willing to procure organs from them. This paper analyzes possible implications of these findings for public policy. A majority would procure organs from those in irreversible coma or in PVS. Two strategies for legitimizing such procurement are suggested. One strategy would be to make exceptions to the dead donor rule permitting procurement from those in PVS or at least those who are in irreversible coma while continuing to classify them as living. Another strategy would be to further amend the definition of death to classify one or both groups as deceased, thus permitting procurement without violation of the dead donor rule. Permitting exceptions to the dead donor rule would require substantial changes in law--such as authorizing procuring surgeons to end the lives of patients by means of organ procurement--and would weaken societal prohibitions on killing. The paper suggests that it would be easier and less controversial to further amend the definition of death to classify those in irreversible coma and PVS as dead. Incorporation of a conscience clause to permit those whose religious or philosophical convictions support whole-brain or cardiac-based death pronouncement would avoid violating their beliefs while causing no more than minimal social problems. The paper questions whether those who would support an exception to the dead donor rule in these cases and those who would support a further amendment to the definition of death could reach agreement to adopt a public policy permitting organ procurement of those in irreversible coma or PVS when proper consent is obtained.

Brain Damage, Chronic↗
PubMedDate not supplied

Ethical and juridical foundations of conscientious objection for health care workers.

In front of the evolution of medicine and biotechnology, health care workers are called upon to take part within new biomedical practices, that may overcome the limit of acceptability, as it is perceived by their moral conscience. Issues as abortion, euthanasia, assisted suicide, artificial fertilisation, experimentation on human embryos and prescription of contraceptives and abortifacients call into play the right to conscientious objection of health care personnel, and in some cases, perhaps of physicians and pharmacists too. This recall--already present in many codes of professional conduct and medical ethics--sounds today as a necessity, which asks for a serious deepening of the content, the applicability and the new hypothesis of conscientious objection, in the light of bioethics and law. In particular, the self-determination and often exasperated autonomy of the patient within these practices makes a new principle of professional integrity arise, to protect the physician's conscientious convictions, if the request of the patient or society seem to violate some fundamental human values.

Bioethical Issues↗