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PubMed1991

Informed consent.

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Informed Consent↗
PubMed1993

Neonatal extracorporeal membrane oxygenation (ECMO): clinical trials and the ethics of evidence.

Neonatal extracorporeal membrane oxygenation (ECMO), a technology for the treatment of respiratory failure in newborns, is used as a case study to examine statistical and ethical aspects of clinical trials and to illustrate a proposed 'ethics of evidence', an approach to medical uncertainty within the context of contemporary biomedical ethics. Discussion includes the twofold aim of the ethics of evidence: to clarify the role of uncertainty and scientific evidence in medical decision-making, and to call attention to the need to confront the irreducible nature of uncertainty.

Clinical Trials as Topic↗
PubMed2000

The morality of coercion.

The author congratulates Dr Brian Hurwitz, who recently reported the successful "intimidation" of an elderly competent widow into accepting badly needed therapy for a huge ulcerated carcinoma. He reports approvingly of the Israeli Patients' Rights Law, enacted in 1996, which demands detailed informed consent from competent patients before permitting treatment. But the law also provides an escape clause which permits coercing a competent patient into accepting life-saving therapy if an ethics committee feels that if treatment is imposed the patient will give his/her consent retroactively. He suggests this approach as an appropriate middle road between overbearing paternalism and untrammelled autonomy.

Aged↗
PubMedDate not supplied

A Prisoner's Dilemma model of the evolution of paternal care.

The heavy energetic demands of gestation, lactation and rearing of offspring mean that studies of paternal care in primates usually focus on female reproductive effort. Here it is shown that both male and female reproductive effort must be considered in order to understand how paternal care evolved. This is done using the Prisoner's Dilemma, best known as a model of reciprocal altruism. It is found that the relative cost of reproduction for males and females is crucially important in determining co-operative and competitive strategies. In particular, when male reproductive costs are less than female reproductive costs, males co-operate with females even when females do not reciprocate. This surprising behaviour, termed non-reciprocal altruism, is comparable with male investment in a female and her offspring.

Altruism↗
PubMed2000

Commentary & analysis: the Draft Act Governing Hospitalization of the Mentally Ill: its genesis and its legacy.

As a follow-up to the preceding article first published in the February 1953 issue, Paul Appelbaum, M.D., offers a commentary and analysis on the revised Draft Act Governing Hospitalization of the Mentally Ill. He includes its psychiatric context in the five-year period between 1951 and 1955 and later developments related to involuntary commitment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1979

Informed consent: special problems for psychiatry.

There is a growing demand for more patient autonomy in the doctor-patient relationship, and legal reformers believe that an expanded dodctrine of informed consent is the key to change. Informed consent is meant to force the doctor to give the patient the knowledge that will make his an equal bargaining partner. However, most evidence demonstrates that the majority of patients do not comprehend or retain medical information. Further, the legal doctrine of informed consent has never been coherently worked out. Informed consent in psychiatry is particularly complicated, because of the constitutional implications of right-to-refuse-treatment litigation and because patients may be incompetent to give informed consent as a result of their illness. One of the special problems for psychiatry is that complex consent requirements have been mandated by those who oppose certain somatic therapies. The author discusses the implications of these legal developments. He lists the kinds of informed-consent and refusal-to-consent situatons psychiatrists face and comments briefly on the most troublesome.

Ethics, Medical↗
PubMed1991

The medical captivity of religion and health.

Uses actual hospital-based experiences to draw attention to and illustrate how modern chaplaincy may fall into forms of paternalism and iatrogenesis. Notes particularly how high tech iatrogenesis and high touch chaplaincy may interact in counterproductive ways. Opines that the church once again needs a revisioning of health which is based on theological notions of the church as sustaining community and as a school for empowerment.

Attitude of Health Personnel↗
PubMedDate not supplied

Becoming an involved father of an infant.

UNLABELLED: DATA OBJECTIVE: To describe the experience of fatherhood in the early months after the birth of an infant through a metasynthesis of relevant qualitative studies. DATA SOURCES: Cinahl, PsychInfo, MEDLINE, and Social Work Abstracts electronic databases from 1990 through 2001 were searched using the terms qualitative, fathers, fatherhood, infants, father-infant relationship, and postpartum. STUDY SELECTION: Ten published articles, representing seven qualitative studies, focusing on the experiences of fathers of healthy infants were reviewed. Only studies published from 1990 through 2001 were selected to reflect more recent representations of fatherhood. DATA EXTRACTION AND SYNTHESIS: Using Noblit and Hare's metasynthesis approach, each study was carefully read, and key metaphors from each study were compared and translated by applying each of the metaphors to all the other studies. The study translations were synthesized into a whole, and the synthesis refined, leading to a description of the experience of being the father of an infant. CONCLUSIONS: The metasynthesis revealed that fathers of infants experienced four phases, represented by the following characteristics: (a) entering with expectations and intentions, (b) confronting reality, (c) creating one's role of involved father, and (d) reaping rewards. Contextual factors that influenced the father-infant relationship were identified. Implications for theory development, research, and clinical practice are discussed.

Adult↗
PubMedDate not supplied

Meeting the challenge of new fatherhood during the early weeks.

OBJECTIVE: To explore new/subsequent Australian fathers' perspectives on the experiences, processes, and life changes in the early weeks of fatherhood. DESIGN: Interpretive study using in-depth interviews and grounded theory analysis techniques, based on a symbolic interactionist framework. SETTING: Participants were recruited from the postnatal wards of a major public hospital, early discharge program, and early childhood centers in southeast Queensland, Australia. PARTICIPANTS: Eighteen first-time/subsequent fathers interviewed 6 to 12 weeks after the birth. RESULTS: Although rewarding, fathers found new or expanding fatherhood to be a significant challenge and time of change. Major themes included making a commitment, taking responsibility, negotiating responsibilities, developing and maintaining relationships, maintaining family integrity, balancing activities, and perceiving the self as father. Work had a major impact on fathers' ability to participate with their family and newborn. To manage, fathers sought to balance the demands of work and home, deal with stressors, manage their time, develop routines, and reprioritize. Fathers developed a sense of themselves as fathers over time, building confidence and deriving satisfaction from their fathering role. CONCLUSIONS: A range of competing factors affected fathers' ability to participate in the home with their newborn in the early weeks after birth.

Adult↗
PubMed2004

Couples' relationships and breastfeeding: is there an association?

One hundred fifty-three Brazilian families with 4-month-old infants--51 cases (breastfeeding had ceased) and 102 controls (breastfeeding maintained)--were recruited to verify if a problematic couple relationship is associated with early breastfeeding termination. The relationships of the 118 cohabiting couples were assessed by clinical interviews and the Global Assessment of Relational Functioning and Beavers-Timberlawn scales, examining marital and parental functions, parents' satisfaction with the quality of care each partner provided to their infants, mothers' opinions of paternal breastfeeding support, and interviewers' assessments of paternal breastfeeding support and involvement in the infants' care. The quality of a couple relationship was not associated with the interruption of breastfeeding before 4 months postpartum. However, a good couple relationship was associated with more paternal breastfeeding support (P < .01) and involvement in the infant's care (P < .0001).

Adult↗
PubMed2004

Family characteristics associated with duration of breastfeeding during early infancy among primiparas.

This investigation examined the association of relationship characteristics and parental gender roles with duration of breastfeeding among primiparous women during the early postpartum period. An ethnically diverse group of urban middle-class women (n = 115) who initiated breastfeeding were individually surveyed by telephone along with their male partners. Results of the Cox regression analyses confirmed earlier findings reported in the literature. Reporting higher relationship distress was predictive of early breastfeeding cessation at a marginal level of significance. However, levels of maternal responsibility for household tasks and infant care were highly significant predictors of breastfeeding cessation but in opposite directions. These results suggest that the effects of paternal gender roles on breastfeeding success may vary depending on the area of involvement. Findings have implications for further research examining breastfeeding duration, gender roles, and relationship quality and for clinical practice that facilitates adaptive roles and relationships among new parents.

Adult↗
PubMed2005

Variation in the psychosocial determinants of the intention to prescribe hormone therapy prior to the release of the Women's Health Initiative trial: a survey of general practitioners and gynaecologists in France and Quebec.

BACKGROUND: Theory-based approaches are advocated to improve our understanding of prescription behaviour. This study is an application of the theory of planned behaviour (TPB) with additional variables. It was designed to assess which variables were associated with the intention to prescribe hormone therapy (HT). In addition, variations in the measures across medical specialities (GPs and gynaecologists) and across countries (France and Quebec) were investigated. METHODS: A survey among 2,000 doctors from France and 1,044 doctors from Quebec was conducted. Data were collected by means of a self-administered questionnaire. A clinical vignette was used to elicit doctors' opinions. The following TPB variables were assessed: attitude, subjective norm, perceived behavioural control, attitudinal beliefs, normative beliefs and power of control beliefs. Additional variables (role belief, moral norm and practice pattern-related factors) were also assessed. A stepwise logistic regression was used to assess which variables were associated with the intention to prescribe HT. GPs and gynaecologists were compared to each other within countries and the two countries were compared within the specialties. RESULTS: Overall, 1,085 doctors from France returned their questionnaire and 516 doctors from Quebec (response rate = 54% and 49%, respectively). In the overall regression model, power of control beliefs, moral norm and role belief were significantly associated with intention (all at p < 0.0001). The models by specialty and country were: for GPs in Quebec, power of control beliefs (p < 0.0001), moral norm (p < 0.01) and cytology and hormonal dosage (both at p < 0.05); for GPs in France, power of control beliefs and role belief (both at p < 0.0001) and perception of behavioural control (p < 0.05) and cessation of menses (p < 0.01); for gynaecologists in Quebec, moral norm and power of control beliefs (both at p = 0.01); and for gynaecologists in France, power of control beliefs (p < 0.0001), and moral norm, role belief and lipid profile (all at p < 0.05). CONCLUSION: In both countries, compared with GPs, intention to prescribe HT was higher for gynaecologists. Psychosocial determinants of doctors' intention to prescribe HT varied according to the specialty and the country thus, suggesting an influence of contextual factors on these determinants.

Adult↗