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PubMedDate not supplied

Mother-child conflict in the toddler years: lessons in emotion, morality, and relationships.

Sixty-three mother-toddler dyads took part in a 6-month prospective study that examined how differences in the frequency and nature of early mother-toddler conflict related to individual differences in children's subsequent socioemotional development. When the children were 30 months, mothers and children participated in a series of laboratory tasks and in a 1.5-hr unstructured home observation. All episodes of verbal conflict between mothers and their children were identified from these sessions, transcribed, and coded for certain elements (e.g., strategy, discussion of emotion, and resolution). At 36 months, children participated in measures of emotional understanding, social competence, and early conscience development. Mothers' use of justification, resolution, and mitigation in conflict at 30 months predicted high levels of socioemotional development at age 3. These findings suggest that conflict may be an important context for children's socioemotional development.

Child, Preschool↗
PubMed1990

The efficiency of a questionnaire in detecting heavy drinkers.

The suitability of the nine-question Malmö modified Michigan Alcoholism Screening Test (Mm-MAST) was tested on 133 40-year-old men and 140 45-year-old men attending a voluntary population health screening in a typically week-end-drinking society. With a cut-off level of two 'yes' answers 29% of the middle-aged male population has been reported to give a positive result in this questionnaire. In our study alcoholics were excluded. The amount and type of alcohol consumed per week was asked. The subjects were divided into three groups: (1) social drinkers (0 or 1 'yes' answer), (2) suspect abusers (two 'yes' answers), and (3) abusers (three or more 'yes' answers or drinking at least 280 g absolute alcohol per week). Group 2 reported drinking more than group 1, but according to biological markers they belonged better to group 1 than group 3. With the originally recommended cut-off level of two 'yes' answers 50.8% of 40-year-old men and 36.5% of 45-year-old men in our study proved positive. With the three 'yes' answer criterion the corresponding percentages were 28.5 and 24.0. Forty- and 45-year-old men in group 2 gave many positive answers in the question concerning week-end drinking and avoidance of alcohol for a time, as did 40-year-old men in the question concerning bad conscience after drinking. Beer and spirits were the most popular beverage combination and week-end drinking was the commonest drinking habit. The number of positive answers correlated well with the announced amount of alcohol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Obsessive-compulsive behaviour in children and adolescents: a cross-sectional Australian study.

OBJECTIVE: To examine the reliability of the survey form of the Leyton Obsessional Inventory-Child Version (LOI-CV), ascertain the prevalence of self-reported obsessive-compulsive behaviour together with age and sex differences and identify the most common obsessive-compulsive behaviours and their associated level of interference. METHODOLOGY: The survey form of the LOI-CV was administered to a large sample of children and adolescents attending regular schools. Participants were aged between 8 and 16 years (n = 1602). RESULTS: We found the survey instrument to have adequate internal consistency and test-retest reliability. There was an age-related decline in self-reported obsessive-compulsive behaviour and girls reported a higher level of obsessive-compulsive behaviour than boys. The most common obsessive-compulsive behaviours included: repeated thoughts or words, having trouble making decisions, having to do certain things and doing things in the exact manner and having a bad conscience. For the most part, these behaviours were associated with low levels of interference. However, for a significant minority of youth (5 to 14%), these behaviours did cause problems and significantly interfered with their lives. CONCLUSIONS: Although many obsessive-compulsive behaviours are part of normal development, they may still be problematic for some children and adolescents.

Adolescent↗
PubMed1979

Child rearing and children's prosocial initiations toward victims of distress.

Maternal rearing behavior was examined in relation to children's reparation for transgressions and altruism as bystanders to distress in others. The children were 1 1/2-2 1/2 years old. Mothers were trained in techniques of observing. They recorded their child's reactions and their own behaviors in everyday encounters with expressions of distress in others (sorrow, discomfort, pain). Distress was also simulated by mothers and investigators. Mothers' empathic caregiving was rated during home visits. Mothers' affectively delivered explanations regarding the distresses their children had caused to others were associated with children's reparations for transgressions. Such explanations were also associated with children's altruism when they were bystanders to another's distress. Empathic caregiving by mothers was positively associated with children's reparation and altruism. Findings are discussed in relation to theories of altruism, conscience, and child rearing.

Altruism↗
PubMed1986

The Bartling case. Protecting patients from harm while respecting their wishes.

The recent legal decision in the Bartling case affirmed that competent patients may refuse life-sustaining treatment, even if they are not terminal or comatose and even if physicians object because of ethics or conscience. However, clinicians may be concerned that patient refusal of treatment is not truly informed. Physicians have an obligation to benefit patients as well as to respect patients' wishes. They may fulfill both obligations by determining whether further medical treatment is indicated, identifying reversible conditions that may impair patient decision making, and checking that the patient's decision is informed.

Aged↗
PubMed2005

Administrative and research policies required to bring cellular therapies from the research laboratory to the patient's bedside.

The research process is a balance between the inherent risks of new discoveries and the risks of research participant safety. Conflicts of interest, inherent to the research process, as well as those introduced by emerging cellular therapies, have the potential to compromise safety. The relationship of trust between the researcher and the clinical trial participant facilitates objective decision making, in the best interest of both parties. In the setup of each clinical trial, investigators incorporate ethical, political, legal, financial, and regulatory considerations as protocols are established. Responsibility to abide by these decisions ensures a systematic process and safeguards participants in this process. The integrity of the research process is strengthened by identifying potential conflicting issues with the guiding principles established in the protocols, which may threaten the objectivity of involved parties and jeopardize safety of the participants. The rapid pace and changing paradigms of new discoveries in cellular therapies exaggerate existing conflicts and introduce new ones. Ethical issues raised by emerging cellular therapies include the division of opinions regarding the use of embryonic and fetal tissue to develop stem cell lines for research, the individual versus professional conscience of a researcher, overselling of outcomes as a result of the researcher's desire to be the first to discover a cellular therapy, and therapeutic misconception resulting from a participant's desire for a miracle cure. The basic ethical issue of whether stem cells should be utilized as a cellular therapy raises heated debates because some believe that it is not acceptable to use fetal material as a source of research material for future cures and others feel equally as strong that inaction is unethical because it results in needless suffering and death owing to the absence of this research. Political issues include the divergent position statements of presidential administrations on cellular therapy, variations in individual state laws, and states becoming involved in research funding, such as California's Proposition 71. Legal concerns include expanding private litigation with diversity of lawsuits, expanding lists of defendants, and the use of class-action lawsuits in research cases. Ownership issues also arise in terms of intellectual property, patents, and ownership of stem cells collected from minors, as in umbilical cord blood donations. Situations that challenge the regulatory processes established to ensure participant safety include differences in reporting requirements for private- and public-funded research and the lack of adequate funding and resources to implement and support the institutional review board (IRB) process. Financial considerations influence the development of clinical protocols, because funding is often limited. Financial incentives, personal investment in companies funding research activities, and fundraising pressures may present potential conflicts. In addition, the increasing role of emerging biotechnology start-up companies and pharmaceutical companies in clinical research introduces additional financial considerations. Administrative policies are needed to address these possible conflicts and ensure research participant safety as cellular therapies progress from the research laboratories to the patient's bedside. Administrative policies to ensure minimum standards of quality for emerging products before human clinical trials, policies to enforce consistent reporting requirements for private and public cellular research, policies to minimize financial conflicts of interest, policies to strengthen implementation of the existing IRB process and to structure into the process a consistent, systematic review of these identified conflicts, and policies to limit private litigation will help to preserve the objectivity of the review process and ultimately increase participant safety.

Cell- and Tissue-Based Therapy↗
PubMed1998

Guilt proneness and expressed emotion in relatives of patients with schizophrenia or related psychoses.

OBJECTIVE: Knowledge of what predicts relatives' expressed emotion (EE) may contribute to improved family work in schizophrenia. In the present study we examined guilt proneness as a determinant of EE components. METHOD: In a Norwegian sample of 46 recently hospitalized patients (schizophrenia or schizophreniform disorder) and 69 relatives, relatives' expressed emotion was assessed by means of the Camberwell Family Interview, and guilt proneness by means of the Revised Mosher Guilt Inventory. (RMGI). RESULTS: Confirmatory multiple regression analyses showed that hostility-guilt (RMGI) was negatively related to high levels of criticism and hostility and, for men, positively related to emotional overinvolvement. There was a strong positive relationship between relatives' guilty conscience (RMGI) and emotional overinvolvement if the patient had a diagnosis of schizophrenia. CONCLUSIONS: Our analyses indicate that relatives' guilt proneness may be a determinant of their criticism, hostility and emotional overinvolvement towards a schizophrenic family member. This personality trait should be taken into account in family work which aims at modifying relatives' expressed emotion.

Adolescent↗
PubMed2006

Paths to and from poverty in late 19th century novels.

Late 19th century novels provide graphic descriptions of working and living conditions and their impact on population health, in particular the detrimental effects of hunger, poor housing, environmental conditions, hazardous work and poor pay, smoking and alcohol and crime, but also the transformative possibilities of social and political action. The popularity of these novels helped raise the collective conscience of citizens and illuminated the direction for 20th century welfare reforms. Yet many of these problems remain and the pathways to and from poverty are still recognisable today. Although novels are now less central in conveying social information, re-reading these novels enables us to understand how social and economic circumstances were understood at the time and what led to social and political change.

Female↗
PubMed1995

Enhancing humanistic skills: an experiential approach to learning about ethical issues in health care.

An outstanding feature of the study of nursing ethics is that it raises questions concerning moral virtue, conscience, consistency and character. A considerable section of the literature is devoted to ideas of how best to teach ethics to health professionals. It has been shown that when faced with ethical dilemmas nurses tended to rely on intuition and instinct to resolve them, with little systematic analysis to help the process. Nurses who have been in practice for a number of years may experience particular difficulties in resolving ethical dilemmas, for although they may be able easily to identify ethical problems they may feel powerless to behave appropriately through lack of theoretical background and/or confidence in participating in informed debate. An educational programme was designed to meet the needs of mature registered nurses who were undertaking a post-qualification part-time honours degree in nursing studies. A variety of teaching methods were employed in teaching the nurses. These included discussion, student-led seminars, structured debate and role play. A session which dealt with sudden death and organ donation is described in some detail. Because the topic involved communication between professionals and patients and/or relatives and was linked with ethics, role play was used to explore the dynamics in these areas. The participants were invited to act out the situation as they felt it might occur. Role play highlighted the stress and shock attached to such an experience. Before working through the dynamics of a situation the nurses were conscious of being part of decision-making 'in the cold' and 'in isolation'. As a result of the experiential learning they felt more able to reflect analytically and to participate in discussions in an informed and articulate way.

Delivery of Health Care↗
PubMed2000

Why some Jehovah's Witnesses accept blood and conscientiously reject official Watchtower Society blood policy.

In their responses to Dr Osamu Muramoto (hereafter Muramoto) Watchtower Society (hereafter WTS) spokesmen David Malyon and Donald Ridley (hereafter Malyon and Ridley), deny many of the criticisms levelled against the WTS by Muramoto. In this paper I argue as a Jehovah's Witness (hereafter JW) and on behalf of the members of AJWRB that there is no biblical basis for the WTS's partial ban on blood and that this dissenting theological view should be made clear to all JW patients who reject blood on religious grounds. Such patients should be guaranteed confidentiality should they accept whole blood or components that are banned by the WTS. I argue against Malyon's and Ridley's claim that WTS policy allows freedom of conscience to individual JWs and that it is non-coercive and non-punitive in dealing with conscientious dissent and I challenge the notion that there is monolithic support of the WTS blood policy among those who identify themselves as JWs and carry the WTS "advance directive".

Blood Transfusion↗
PubMed1977

False belief and the refusal of medical treatment.

May a doctor treat a patient, despite that patient's refusal, when in his professional opinion treatment is necessary? This is the dilemma which must from time to time confront most physicians. An examination of the validity of such a refusal is provided by the present authors who use the case history of a patient refusing treatment, for cancer as well as for a fractured hip, to evaluate the grounds for intervention in such circumstances. In such a situation the patient is said to have a 'false belief' and it is the doctor's duty to try to change that belief in the patient's interest. The false belief is considered here in terms of the liberty principle, the patient's mental competence and on what is called the 'harm principle' (harm to other individuals or to society). Finally the concept of paternalism is examined. The authors conclude that the doctor must attempt to change a false belief, and if this fails he must examine the patient's mental competence to make the decision to refuse treatment. But in the last analysis the doctor may be under an obligation to respect the patient's refusal. Readers might like to look at (or read again) the papers on 'Liberty' and 'Conscience' published in this Journal under the heading Analysis.

Attitude to Health↗
PubMed1979

Law and medical ethics.

Summarising the interrelationship between law and medical ethics, I would say that in cases which do not touch the patient's body or integrity, such as professional secrecy, statutory law may take precedence over rules of medical ethics. But in cases where the human subject becomes a victim because of domestic statutory laws which are in contradiction with medical ethics, the medical practitioners should insist on adhering to their professional standards in such a way that the legislators will have to adapt their legislations to the laws of humanity and public conscience. Legislators, as well as medical practitioners, should not forget that the term 'being' is preceded and qualified by 'human'.

Abortion, Legal↗
PubMed1982

Ethics in psychiatry--the patient's freedom and bondage.

Ethics is defined as the realm of the 'ought', the realm of conscience which postulates that Man has the freedom to carry out what he judges to be morally right. By such acts he realizes his freedom of making himself into a truer, more authentic person than he was before. A libertarian psychotherapy, based on this ethic, is outlined. Medical science (as all science) belongs to the realm of the 'is' and postulates that the phenomena which it studies follow a necessary course. It is therefore deterministic. In psychiatry, allowance is made for a neurological determinism in cases in which personal freedom has been diminished or abolished by mental illness, but the determinisms of behaviour therapy and of psycho-analysis are rejected by the author.

Ethics, Medical↗
PubMed2001

The euthanasia debate.

Debates about the moral dilemmas of euthanasia date back to ancient times. Many of the historical arguments used for and against the practice remain valid today. Indeed, any form of discussion on the subject often provokes emotive responses, both from members of the medical profession and the general public. For this reason alone, the issue will continue to be debated at all levels of society. There are, however, other factors that ensure euthanasia will remain a subject of major controversy within medical, legal and governmental bodies. Firstly, the act of euthanasia itself is illegal, yet in its passive form occurs on a daily basis in many of our hospitals (1). Secondly, medical advances have made it possible to artificially prolong the life of an increasing number of patients far beyond what was possible only a few years ago. Furthermore, we must all contend with the reality that financial constraints are an important consideration in modern health care provision. Finally, there is an ethical difficulty in interpreting the concept of a patient's right, or autonomy, versus the rights and duty of a doctor. Before attempting to answer the questions posed by these issues, it is important to have some accurate definitions of both euthanasia and of the concept of morality. According to the House of Lords Select Committee on Medical Ethics, the precise definition of euthanasia is "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering" (2). The term can be further divided into voluntary and involuntary euthanasia. The former is said to occur if a competent patient makes an informed request for a life terminating event and the latter can be used if a patient does not give informed and specific consent for such treatment. It is the occurrence of involuntary euthanasia which forms one of the main arguments against legalisation. This is discussed in greater detail below. Euthanasia is frequently separated into active and passive forms. A number of authors consider these terms to be misleading and unhelpful. They are, however, used in the literature and in discussion and consequently should be understood. Active euthanasia takes place if deliberate steps are taken to end a patient's life; this would include administration of potassium containing compounds to induce cardiac arrest, a practice that is illegal in this country. Passive euthanasia is the withholding of treatments necessary for the continuance of life. Whether the administration of increasingly necessary, albeit toxic doses of opioid analgesia is regarded as active or passive euthanasia is a matter of moral interpretation, but in order to pacify doctors' consciences, it is usually regarded as a passive measure. Many people, therefore, regard it as an acceptable facet of good professional practice.

Ethics, Medical↗
PubMed2006

Dismembering the ethical physician.

Physicians may experience ethical distress when they are caught in difficult clinical situations that demand ethical decision making, particularly when their preferred action may contravene the expectations of patients and established authorities. When principled and competent doctors succumb to patient wishes or establishment guidelines and participate in actions they perceive to be ethically inappropriate, or agree to refrain from interventions they believe to be in the best interests of patients, individual professional integrity may be diminished, and ethical reliability is potentially compromised. In a climate of ever-proliferating ethical quandaries, it is essential for the medical community, health institutions, and governing bodies to pursue a judicious tension between the indispensable regulation of physicians necessary to maintain professional standards and preserve public safety, and the support for "freedom of conscience" that principled physicians require to practise medicine in keeping with their personal ethical orientation.

Attitude of Health Personnel↗
PubMedDate not supplied

Genealogical information and the structure of rural Latin-American populations: reality and fantasy.

Genetic data organized in the form of genealogies can provide much information regarding the history and genetic structure of human populations. A large proportion of the population of Latin America is organized in small rural semi-isolated communities, with little immigration, and until the last 50-100 years, little emigration. These communities have a strong sense of their genealogical history, and this "genealogical conscience' is a frequent leitmotif in modern Latin-American literature. In this communication, we compare the characteristics of fictitious genealogies described in two masterpieces of Latin-American literature, García Márquez' Cien Años de Soledad (A Hundred Years of Solitude), and Verissimo's O Tempo e o Vento (Time and the Wind), with one existing well-studied population in Argentina, Aicuña. All three populations exhibit a number of common characteristics, such as histories of long periods of civil war, and large pedigrees with complex paths of inheritance resulting in complex patterns of inbreeding. Genetic themes common to all three are: (1) the use of genealogical records to substantiate the property of the land or the political power of a kinship; (2) the genealogical registry of biological descendants, independent of their legal or marital status in the clan; (3) the existence of pedigrees of the aristocratic branches in the same kindreds, which illustrate the legal principle of primogeniture; (4) the value of last names as indicators of kinships and the extent of genetic isolation, and (5) the awareness of the deleterious consequences of consanguinity.

Argentina↗
PubMed1994

The biblical view of the kidney.

The biblical view of the kidney differs radically from the modern perception. For example, there is no reference in the Bible to the fact that the kidneys make urine. The kidneys were viewed as the seat of conscience and of ethical feelings and yearnings, and the source of mortality and ethical activity. The kidneys were believed to be associated with the innermost parts of the personality. There are references to God examining the ethical nature of man through the kidneys or punishing man by injuring the kidneys. The fat around the kidneys was considered to be of special value for sacrifice and may have symbolized luxury or opulence. Much of the biblical understanding of the anatomy of the kidneys and the anatomic relationships between the kidneys, perirenal fat and the liver appears to be derived from observations made in domestic animals.

Bible↗
PubMed1994

Countertransference in factitious disorder.

In the treatment of patients with factitious disorder it is important to realize that at various levels of their experience these patients are more intimate with death than with life. This requires a particular awareness of resistance mechanisms to countertransference as well as of the importance of clinical procedures, in particular with regard to superego analysis. A requirement for establishing a psychotherapeutic alliance with patients suffering from factitious disorder is a high degree of 'therapeutic eros', hope and trust in one's own capabilities. The emphasis on a 'biophile attitude' does, however, involve the danger that the destructive potential, fantasies of death or killing, but above all feelings of guilt and shame are euphemistically interpreted and played down. A supportive superego analysis is viewed by the patient as playing down her or his 'terror of conscience' and a sense of being left alone. The therapist can be of greater help to the patient by focusing on his or her need and by escorting him or her. This requires that the therapist accept the feelings of relentlessness and hopelessness experienced by the patients in her- or himself. By relinquishing the denial of death-directed tendencies, the therapist is able to establish normality, reality and structure, and is thus in a position to exert a stabilizing effect, initially on her- or himself, but frequently also on the patient, for whom new horizons open.

Adult↗