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PubMed2004

Why are community treatment orders controversial?

The use of community treatment orders and other forms of mandatory outpatient treatment has been controversial. The debate on the appropriateness of compulsory treatment in the community addresses a volatile mix of clinical, social policy, legal, and philosophical issues. This paper describes the major sources of contention, outlines the position of the protagonists, and where possible, attempts to answer some of the questions raised and identify common ground.

Antipsychotic Agents↗
PubMed1993

The child abuse reporting laws: an ethical dilemma for professionals.

A central issue in the development of family law and child protection in this country has been the right of the state to intervene in family life. The reporting laws, which were developed in the 1960s, made it mandatory for any citizen, including professionals, to report child abuse (physical and sexual) to the authorities. These laws have fundamentally altered the relationship between the clinician and families in need of help and have resulted in a dramatic increase in the number of cases assessed and treated by child welfare agencies. Because of the emphasis on case-finding, the limited resources have been stretched to the point where families with serious problems of child abuse do not get the services they require. Apparently, at least 60% of all reports turn out to be unfounded. Other criticisms of the current system include ineffective intervention, over-intervention and ignoring parents' rights. The legalization and bureaucratization of the child protection process has profoundly affected the relationship between troubled families and social workers who now must "investigate" them as well as help them. This role conflict is exacerbated even further in cases of alleged child sexual abuse, where social workers are often expected to inform the police of the allegations. The authors argue that the reporting laws have been useful in that society is aware of the problem, and they suggest that it may be more beneficial now to dispose of them.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1992

Community health and ethical theory: implications for holistic nursing.

A conceptual shift from Enlightenment philosophies to communitarian virtues is discussed. Epidemics and preventing disease spread are used as a basis for discussing the major bioethical concepts beneficence, justice, respect for autonomy, and Moskop's principle of restrictive measures. The addition of the concept of community and communitarian virtues to the ethical analysis is discussed. Holistic nurses are challenged to develop and employ morally sound rationale for ethical decisions.

Beneficence↗
PubMed2002

A shot in the arm for the military: consent to immunisation against biological warfare agents.

The risk to Britain's Armed Forces from Biological Warfare (BW) is low but without protection their use would be devastating. Available protective measures include immunisation. The Government owes a legal duty of care to Servicemen to provide protection against a range of hazards, including those of BW. The State also owes Servicemen a duty of care to allow free and informed consent or free and informed refusal to medical procedures, including immunisation. However, refusal by key personnel to accept BW immunisation could degrade operational capability. Resolution between these two, potentially conflicting, duties of care may be controversial. To override a soldier's expressed interests would rank society's needs higher than those of the individual. Yet there are circumstances, such as exposure of Servicemen to BW used by an aggressor, where this would be ethically acceptable. The State's interests, combined with the best interests of the Servicemen, provide adequate ethical argument for both occupational immunisation (where it is an entry criterion for the Armed Forces) and mandatory immunisation (where disciplinary action may be taken against the non-compliant). Historically, both approaches have been used for public health immunisations and the legal framework already exists for both.

Biological Warfare↗
PubMed1995

Mass childhood immunization: some ethical doubts for primary health care workers.

The mass childhood immunization programme has traditionally been viewed as a safe and effective preventative measure by health promoters, primary health care professionals and governments. This consensus has meant that immunization has rarely been viewed as ethically problematic. A number of recent changes in the context of the delivery of health care, particularly the emphasis on consumerism and the effect of the marketization of services, makes timely an examination of ethical, social and political issues. This article examines four main grounds for problematizing the mass childhood immunization programme. These are: clinical research evidence about the safety and efficacy of vaccines; the masking of wider social and political determinants of ill health; the contradictory strictures about collective and individual rights in relation to immunization; and the uniqueness of childhood immunization as a physical intrusion into a healthy body. The implications of these ethical issues are discussed in relation to informed consent and the need for a 'greenfield' review that includes the views of dissenting parents, lawyers and moral philosophers, as well as health professionals.

Child↗
PubMed2007

An evaluation of gender differences in the implementation and impact of a comprehensive approach to domestic violence.

The primary goal of society's response to domestic violence is the protection of the victim from further abuse. Recently, the coordinated community response (CCR) has been developed as one example of an approach aimed at reaching this goal. Prior research has generally found support for the model, with male offenders recidivating at lower rates. The current study examines whether a comprehensive, community-based approach is capable of reducing recidivism rates among male and female offenders. Comparisons are made between 70 female and 131 male offenders. Specific attention is given to the intervention process, including differences in service or treatment component completion and recidivism by gender.

Aftercare↗
PubMed2003

Laparoscopic resection of colonic cancer.

Laparoscopic resection of colonic cancer can be regarded as a safe and efficacious procedure. Short-term outcome is better after laparoscopic colectomy than after open colectomy. Long-term results of the first published randomized clinical trial indicate improved cancer related survival following laparoscopic resection of colonic cancer. However, patients included in this single center study were operated on by highly experienced laparoscopic surgeons and included relative small numbers of patients. Results of other large randomized controlled trials have to be awaited before laparoscopic resection can be recommended for colonic cancer. Higher in-hospital costs and a long learning curve hinder rapid implementation of laparoscopic colectomy into general surgical practice. Integration of laparoscopic surgery into surgical training programs is mandatory.

Colectomy↗
PubMed2005

Nurses' work environment perceptions when employed in states with and without mandatory staffing ratios and/or mandatory staffing plans.

Multiple stakeholders have sought regulatory and nonregulatory strategies to address nursing workforce and patient safety concerns. This study examines differences in nurses' work environment perceptions. Approximately 4,000 nurses employed in 10 states provided their perceptions of key characteristics of their work environment using the Individual Workload Perception Scale. Univariate statistics were used to characterize mean values of the nurses' work environment perceptions by state of employment and whether these perceptions changed if employed in states with versus without mandatory staffing ratios and/or mandatory staffing plans. This study provides preliminary evidence that mandatory staffing plan legislation may be linked with the most positive nurse work environment perceptions when compared with implementation of mandatory staffing ratios or no workforce regulation. Based on this preliminary observation, further analysis comparing the relative benefits and costs of workforce regulation may be warranted.

Adult↗
PubMed2006

Trends in drop out, drug free discharge and rates of re-presentation: a retrospective cohort study of drug treatment clients in the North West of England.

BACKGROUND: Governments aim to increase treatment participation by problematic drug users. In the UK this has been achieved by fiscal investment, an expanded workforce, reduced waiting times and coercive measures (usually criminal justice (CJ) led). No assessment of these measures on treatment outcomes has been made. Using established monitoring systems we assessed trends in 'dropped out' and 'discharged drug free' (DDF), since the launch of the national drug strategy, and rates of treatment re-presentation for these cohorts. METHODS: A longitudinal dataset of drug users (1997 to 2004/05, n = 26,415) was used to identify people who dropped out of, and were DDF from, services for years 1998 to 2001/02, and re-presentations of these people in years to 2004/05. Trends in drop out and DDF, baseline comparisons of those DDF and those who dropped out and outcome comparisons for those referred from the CJ system versus other routes of referral were examined using chi square. Logistic regression analyses identified variables predicting drop out versus DDF and subsequent re-presentation versus no re-presentation. RESULTS: The proportion of individuals dropping out has increased from 7.2% in 1998 to 9.6% in 2001/02 (P < 0.001). The proportion DDF has fallen from 5.8% to 3.5% (P < 0.001). Drop out was more likely in later years, by those of younger age and by CJ referrals. The proportion re-presenting to treatment in the following year increased from 27.8% in 1998 to 44.5% in 2001/02 (P < 0.001) for those DDF, and from 22.9% to 48.6% (P < 0.001) for those who dropped out. Older age and prior treatment experience predicted re-presentation. Outcome (drop out or DDF) did not predict re-presentation. CONCLUSION: Increasing numbers in treatment is associated with an increased proportion dropping out and an ever-smaller proportion DDF. Rates of drop out are significantly higher for those coerced into treatment via the CJ system. Rates of re-presentation are similar for those dropping out and those DDF. Encouragingly, those who need to re-engage with treatment, particularly those who drop out, are doing so more quickly. The impact of coercion on treatment outcomes and the appropriateness of aftercare provision require further consideration.

Adolescent↗
PubMed1992

Psychology ethics down under: a survey of student subject pools in Australia.

A survey of the 37 psychology departments offering courses accredited by the Australian Psychological Society yielded a 92% response rate. Sixty-eight percent of departments employed students as research subjects, with larger departments being more likely to do so. Most of these departments drew their student subject pools from introductory courses. Student research participation was strictly voluntary in 57% of these departments, whereas 43% of the departments have failed to comply with normally accepted ethical standards. It is of great concern that institutional ethics committees apparently continue to condone, or fail to act against, unethical research practices. Although these committees have a duty of care to all subjects, the final responsibility for conducting research in an ethical manner lies with the individual researcher.

Australia↗
PubMed1992

Case vignette: to share or not to share.

For years, the notion that researchers should share data freely with fellow scientists has been discussed widely. Some argue that this is especially true when the data are generated in federally funded projects. A recent provision in the reauthorization bill for the National Institutes of Health (NIH) would ensconce this principle in law. NIH grantees would be required, on demand, to furnish their data to other researchers. According to the proposed legislation, research data would have to be preserved and made avilable for 3 years after the completion of a project, and for 5 years following publication of the results in a scientific journal. One objective, according to a congressional aide, would be to make it easier for scientists with dissenting views to obtain and reanalyze data collected with public funds. It would also facilitate publication of alternative analyses. Personal records and patent applications would be exempted, but other data from clinical, behavioral, or epidemiological research focused on the evaluation or efficacy of a drug, medical device, or treatment of any sort would be covered immediately. Is such mandatory sharing of data ethical and appropriate scholarship? Does it raise potential for abuse? Should colleagues be required to provide such access to data, whether or not federal support was used in its collection?

Behavioral Research↗
PubMed2004

Ethics in violence against women research: the sensitive, the dangerous, and the overlooked.

Traditional disciplinary guidelines are inadequate to address some of the ethical dilemmas that emerge when conducting research on violence against women and girls. This article is organized according to the ethical principles of respect for persons, privacy and confidentiality, justice, beneficence, and nonmaleficence. In the article, I describe dilemmas involved in cross-cultural research, research on children, informed consent, voluntariness, coercion, deception, safety, mandated reporting, and dissemination. In the article, I include examples from qualitative and quantitative studies in many nations. I also offer suggestions for researchers and institutional review boards.

Adolescent↗