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PubMed1994

A clinician's guide to decision making capacity and ethically sound medical decisions.

Competence, or decision making capacity, refers to a patient's ability to understand a situation and to make a choice in light of that understanding. It requires the physician to disclose adequate information so that the patient is able to understand and choose. The standard for determining competence is that a person is deemed competent to make medical decisions if the person is capable of giving informed consent. The crucial ethical issue is whether the patient understands and appreciates the nature of the treatment, the risks and benefits, the alternatives and the consequences. Although there is no universally accepted test of a patient's capacity to consent to treatment, the "knowledge and understanding" test offers clinicians a simple competence test that can be administered at the bedside. The physician first identifies the information needed for the patient to give informed consent. Then the physician determines the patient's understanding and appreciation of that information by means of five objective questions. Ultimately, talking to the patient is the only way to determine if the patient is capable of making a medical decision. Of particular ethical interest, however, is rehabilitation medicine's efforts to exempt itself, in the early stages of rehabilitation, from the "moral force" of informed consent. Relying on its unique characteristics as a medical specialty, and on the fact that some of its patients have suffered sudden onset of severe impairment, rehabilitation medicine appears poised to espouse the "thank you theory" of medical practice. In addition, physiatrists may have a professional obligation to fully inform patients when potentially beneficial treatment is withheld from them, such as when they are denied access to or terminated from rehabilitation.

Comprehension↗
PubMed1998

Bioethics for clinicians: 17. Conflict of interest in research, education and patient care.

A conflict of interest occurs in a situation in which professional judgement regarding a primary interest, such as research, education or patient care, may be unduly influenced by a secondary interest, such as financial gain or personal prestige. Conflicts of interest exist in every walk of life, including medicine and science. There is nothing inherently unethical in finding oneself in a conflict of interest. Rather, the key questions are whether one recognizes the conflict and how one deals with it. Strategies include disclosing the conflict, establishing a system of review and authorization, and prohibiting the activities that lead to the conflict.

Bioethics↗
PubMed1997

On the threshold of disclosure. The effects of a mass media field experiment.

OBJECTIVE: To assess whether the number of disclosures of child abuse changed as a result of a prevention strategy on a national scale in a West-European country. The child abuse involved child sexual and physical abuse, both ongoing and past. METHODS: In order to assess possible intervention effects, changes in calling the Child Line were measured. For this, a 4 year longitudinal design, starting before the intervention and ending 2 and 1/2 years after it was used (N = 3,117 disclosures). In addition, data were collected from the Dutch Telecom and a newely developed Child Abuse Form (N = 1,227). Finally, two measures were introduced, the disclosure coefficient and the relative disclosure coefficient. RESULTS: Most calls were silent calls, a phenomenon that deserves more attention in disclosure research. Compared to pre-intervention data, the amount of disclosures almost tripled during the intervention and was even further enhanced in the post-intervention and follow-up. In nine out of 10 cases, ongoing abuse was disclosed. Marked differences between child physical abuse and child sexual abuse were observed. CONCLUSION: It is concluded that mass media communication, if well implemented, can positively influence the process of disclosure of ongoing child abuse.

Adolescent↗
PubMed2001

First incest disclosure.

Despite the pivotal importance of disclosure to incest treatment and healing, disclosure has never been studied from the victim's perspective. How do incest victims move from keeping the secret to speaking about their abuse? Nine adult women were asked to talk about the first time they each told about the incest. They often spoke, not of "telling" in the commonly understood sense (i.e. giving information to someone who understands one's meaning), but instead of a time when some form of knowledge of the incest first entered an interaction with another person. Colaizzi's (1978) phenomenological method was used to analyze the interviews. Seven themes emerged: (1) living in the silencing home; (2) I am totally and particularly alone; (3) my mother, the focus of need; (4) incest as burden; (5) the secret must be kept; (6) disclosure: trying to balance above a chasm; and (7) disclosure as loss: no matter what, I still lose. The themes were then integrated into an essential description of first incest disclosure. Implications for nursing practice are explored.

Adolescent↗
PubMed1999

What date/acquaintance rape victims tell others: a study of college student recipients of disclosure.

The authors surveyed 828 college students and found that approximately one third (n = 282) of the respondents reported that one or more women had told them that they had been raped by their dates or acquaintances. The 282 respondents who knew 1 or more victims of date/acquaintance rape reported on a total of 396 victims. The number of victims identified by respondents ranged from 1 to 3 or more (1 = 73%; 2 = 19%, 3 = 5%, > or = 4 = 3%). Reactions to disclosure offered by these respondents were generally supportive of the victim. The respondents' reactions suggested that there is a continuing need to educate students about the incidence and risks associated with date/acquaintance rape and the possibility of disclosure, particularly by friends or dating partners, and brought out some possible helpful and some counterproductive reactions to such disclosures.

Adolescent↗
PubMed1998

Psychodynamic psychotherapy, religious beliefs, and self-disclosure.

The intersection of psychodynamic psychotherapy and religious beliefs may present technical challenges for the psychotherapists; particularly if patients request to know more about the therapist's religious beliefs. Contrary to a recent technical recommendation for therapists to self-disclose personal religious beliefs when asked to do so, I suggest that such a request is complex and requires a thoughtful grounding in psychotherapeutic theory. Disclosing personal beliefs to patients runs the risk of being off-task as well as holding oneself out as an exemplar for the patient. Rather than adopt a formulaic response to requests for information, to deepen the understanding of the patient and the work of therapy, the therapist needs a complex understanding based on a careful diagnostic assessment of the patient, as well as an assessment of the current status of the psychotherapeutic venture. The workings of patients' particular transferences are often evident in requests for personal information and require careful evaluation and consideration. Likewise, countertransference elements may influence the type of response offered by the therapist. Using ethical principles as a guide is different from using them as a rule. The nexus of religious belief, psychosocial context, psychotherapy, and self-disclosure provides a potentially rich source of understanding when explored in the psychotherapeutic situation.

Ethics, Professional↗
PubMed2003

Perspectives of people with psychiatric disabilities on employment disclosure.

The Americans with Disabilities Act (ADA) of 1990 protects people with disabilities from employment discrimination. Under the ADA, employers must accommodate the known disabilities of a qualified employee or applicant. For persons with psychiatric disabilities, which are often invisible, the individual is required to make a conscious decision regarding disclosing their disability to an employer. The decision to disclose is very complex because the person needs to consider the possibility of confronting stigma and negative stereotypes. A qualitative study including a focus group and individual interviews was conducted to gather data from people with psychiatric disabilities/labels regarding employment disclosure. Major findings include the significant impact of disability identity (does the participant think they have a disability), and the importance of appropriate job matching as a disclosure strategy.

Adult↗
PubMed1998

Privacy Act of 1974; addition of routine uses to an existing system of records--HRSA. Notification of an addition of routine uses to an existing system of records.

In accordance with the requirements of the Privacy Act, the Health Resources and Services Administration (HRSA) is publishing a proposal to add three new routine uses for the records in System of Records 09-15-0056, National Vaccine Injury Compensation Program (VICP), BHPr/ HRSA/HHS. HRSA proposes to specify the categories of records in the system, and to expand the list of routine use in record disclosures to include disclosures for research purposes, disclosures to annuity brokers, and disclosures to employees of life insurance companies for the purposes of providing benefits to recipients under the VICP.

Forms and Records Control↗