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PubMed2002

[Induced abortion--a doctor's point of view].

Traditionally, the medical community has sided against abortion. However, over the past century there has been a change in this stance. This paper will explore the position of the physician and the medical community in regards to abortion. From the physician's perspective, is there not a conflict between performing an abortion and the physician's duty to save life? Does the physician not feel some hypocrisy in working to save some fetuses and aborting others? The issue of abortion can also lead to the question of what the physician's obligations are; is he or she obligated to the woman and her best interests or to the principle of upholding life? Another discussion will be devoted to abortion in Israel and the factors affecting the decision making process of the "Abortion Committees". Members of these committees weigh issues that are not expressed forthrightly in the law, such as the social situation of the pregnant woman under consideration. Furthermore, the physician's outlook and even conscience can sway his or her decision in some cases. A review committee set up by the Ministry of Health found that in many cases in which abortion was permitted, there was no legal back up for the decision. That is to say, in some cases there was found to be no correlation between the decision and the legal guidelines set out. In light of this, the committee made a number of recommendations. One of these recommendations was that in cases that permission for an abortion was granted based on a reasonable concern for the welfare of the mother or fetus, this decision should be based on medical evidence that there was in fact danger to the mother or fetus.

Abortion, Induced↗
PubMedDate not supplied

[Silent cerebral infarct in patients with sickle cell anemia].

INTRODUCTION: Ictus is a complication in patients with Sickle Cell Anemia (SCA), in these is of importance the precocious diagnosis of Silent Cerebral Infarcts (SCI). OBJECTIVE: To determine the incidence of ICS in patients with SCA without neurological symptoms but with images in Cerebral Magnetic Resonance (RMC). PATIENTS: A total of 18 patients (13 males, 5 females) with ages between 5 and 24 years (11.5 4,9), without history of neurological alterations, taken care at the Instituto Hematol gico de Occidente Banco de Sangre, Estado Zulia Venezuela. Methods. A clinical history was made to each patient in addition to detailed physical and neurological examinations that included the state of mind, conscience, language, sensitivity, cranial pairs, muscular force, reflexes, cerebella tests, neck and march. Later, RMC studies were carried out. RESULTS: It was found that 2/18 (11,1%) patients without neurological manifestations showed alterations in the RMC and they were diagnosed as ICS. The findings by images showed asymmetry of lateral ventricles and one of them showed gliosis as well. CONCLUSION: 11,1% of the all the studied cases (2/18) showed SCI, for what is suggested to carry out neurological evaluation and images, once a year, and to offer opportune therapies, for their impact in the function neurocognitive

Adolescent↗
PubMed2002

The doctor's defense.

The paper takes as its point of departure a relatively recent case which attracted publicity in Britain, concerning a doctor charged with (but acquitted of) the murder of his terminally ill patient, and critically examines the criminal law of England and Wales relating to homicide in the context of medical practice. While similar issues obviously arise in many other countries, no comparative study is attempted in the paper. However, the arguments which have been presented are of more than local interest. From an analysis of this case and others, it appears that there is in common law something which can be called the doctor s defense. It holds that a doctor may, when caring for a patient who is suffering great pain, lawfully administer pain-killing drugs, despite the fact that, as the doctor well knows, one certain or highly probable consequence will be to shorten the patient s life. Current justifications for this defense are either incoherent or too weak. Some require that different conceptions of intention be deployed, depending on whether the agent is a doctor or not. Others rely on the philosophically controversial doctrine of double effect. Still others invoke an implausible notion of minimal causation. All these justifications apply readily enough to morally and factually easy cases, but fail in hard cases where the need for some justification is most pressing. These justifications seem incapable of providing adequate guidance to prosecutors or trial judges. Absent principled and transparent justification, the English criminal justice system exhibits different outcomes on what appear to be broadly similar facts. It is disturbing that the law is uncertain and incapable of giving adequate guidance. A doctor, compelled by conscience to intervene to end a person s life, should certainly be ready and willing to face rigorous legal scrutiny, but the law applied should not be arbitrary and random, nor should the outcome turn solely or chiefly on prosecutorial discretion or the predilections of the trial judge. The hope is to find a better rationale for the doctor s defense through an analysis of professional ethics and the concept of a recourse role.

Criminal Law↗
PubMed2002

[Phenomenology and psychosomatics].

By dividing the field of the human, the psyche-soma dualism ended in sectorizing diseases into organic illnesses, and psychic illnesses. Eventually, however, the so-called 'psychosomatic disorders' that, apparently, had broken up such a pattern have been converted to a new corpus pineale just as Descartes would have done. The body is reduced to a mere instrument of psyche, and the subject is reduced to a mere onlooker of illness he or she tries to remove one way or the other. Conversely, phenomenology understands that, first of all, the body is 'the body I am' (Leib): the body is the place for communicating with other people, and the place for performing exchanges with things. It is through the body that the world affects us, and it is by means of the body that we display all our meaning onto the world. In everyday life people are just unaware of their bodies. Whenever anxiety busts out, however, the body makes a massive comeback, giving expression to the complex dialectics of the speaking subject through his or her body. Anxiety pertains to a pre-category order of the body, to the unfathomable depth reason is unable to pierce. At the bottom line of a great majority of psychosomatic disorders there lies an intersubjective anxiety conveying a conflict between the loss of an object and the obstacles thus hindering the personal growth. Reason, as a reflexive conscience is unable to solve the conflict -reason is not even aware of conflict, reason does not even perceive any likely relationship among disorders and such or such situations. The body, as an 'operating intentionality' (Merleau-Ponty), as a pre-reflexive access to the world, as a pathos life experience (Lang), will erupt and see to it that conflict is solved, and conflict-linked anxiety are transformed. Body and its great reason -- as Nietzsche would have said, 1883 -- solves everything its way.

Humans↗
PubMed2002

Prince of Lyallpur.

Prince Masud Khan was a leader of psychoanalytical movement in its halcyon days. His name is given by many in the profession in the same breath as Freud, Klein and Winnicot. Despite his aristocratic background, handsome and charismatic personality and distinguished achievements as an academic and clinician, to the English he remained a Pakistani and nobody knows him in Pakistan. This article is an attempt to examine Prince Masud's work, personality and some of the issues behind his absence from our collective conscience.

History, 20th Century↗
PubMed2002

Wrongful death claims. Harriton v Stephens. [2002] NSWSC 461. Edwards v Blomeley. [2002] NSWSC 460. Waller v James [2002] NSWSC 462.

Studdert J in all three cases went to great length to summarise the global judicial position of "wrongful life" claims. He did not, however, examine in great length how or whether "wrongful life" claims or "wrongful birth" claims are reconcilable with tort and common law principles. Although the cases identify the difficulty in assessing and quantifying damages, they do not directly address the strict legal principles which apply in the assessment of damages. The main conclusion of the three judgments was that no duty of care is owed to the plaintiff in these circumstances and, even if a duty could be established, the impossibility of quantifying damages and public policy considerations warrant the rejection of such a claim: "thus conscience does make cowards of us all." The significance of the decisions cannot be understand. The decisions deny recognition of "wrongful life" claims in circumstances where a disabled person has incurred injuries en ventre sa mere (in the mother's womb) as a result of infections contracted by a plaintiff's mother or genetic material passed on by a plaintiff's parents. Some countries have now legislated for the abolition of "wrongful life and birth" suits. In January 2002 the French legislature passed a Bill overturning the "wrongful life" decision of the Cour de Cassation in Perruche (17 November 2000). As the issue now falls for ultimate determination by the French Senate, the French pro-life movement continues to lobby for the prohibition of "wrongful birth" suits as well. Furthermore, eight States in the United States have prohibited either one or both actions and the State of Michigan prohibited both actions in 2001. It is likely that all three cases will be appealed. The appeal in Harriton will re-examine the viability of a "wrongful life" claim in Australia whereas the cases of Edwards and Waller still need to determine the "wrongful birth" claims brought by the plaintiffs' parents. It is likely that the latter two cases will not be determined until the High Court has considered the Queensland "wrongful birth" case of Melchior v Cattanach, expected to be late in 2002.

Abnormalities, Multiple↗
PubMed2002

Euthanasia: why it doesn't matter (much) what the doctor thinks and why there is no suggestion that doctors should have a duty to kill.

A major reason that The Netherlands has taken a different approach to the rest of the world on such a fundamental moral issue is that the courts and legislature in that country have accorded the interests of doctors a cardinal role in the euthanasia debate. This article argues that the interests of doctors are of only incidental and peripheral relevance in relation to the moral status of euthanasia. The moral status of euthanasia has little to do with the preparedness of doctors to administer the lethal injection or their general attitude towards the practice. Euthanasia is principally about the interests of the patient and the impact that the practice may have on the community in general, not preserving the conscience or improving the working life of doctors.

Attitude to Death↗
PubMed2003

Don't trust your gut.

Making high-stakes business decisions has always been hard. But in recent decades, it's become tougher than ever. The choices facing managers and the data requiring analysis have multiplied even as the time for analyzing them has shrunk. One simple decision-making tool, human intuition, seems to offer a reliable alternative to painstaking fact gathering and analysis. Encouraged by scientific research on intuition, top managers feel increasingly confident that, when faced with complicated choices, they can just trust their gut. The trust in intuition is understandable. But it's also dangerous. Intuition has its place in decision making--you should not ignore your instincts any more than you should ignore your conscience--but anyone who thinks that intuition is a substitute for reason is indulging in a romantic delusion. Detached from rigorous analysis, intuition is a fickle and undependable guide. And while some have argued that intuition becomes more valuable in highly complex and changeable environments, the opposite is actually true. The more options you have to evaluate, the more data you have to weigh, and the more unprecedented the challenges you face, the less you should rely on instinct and the more on reason and analysis. So how do you analyze more in less time? The answer may lie in technology. Powerful new decision-support tools can help executives quickly sort through vast numbers of alternatives and pick the best ones. When combined with the experience, insight, and analytical skills of a good management team, these tools offer companies a way to make consistently sound and rational choices even in the face of bewildering complexity--a capability that intuition will never match.

Administrative Personnel↗
PubMed2003

[Type-A aortic dissection without chest pain in a patient with Clostridium fallax infection].

We describe the case of a 64-year-old patient admitted to our hospital because of syncope and suspicion of cardiac tamponade. At admission he had temporary alteration of conscience with clinical evidence of sepsis without chest pain. There was a mild pericardial effusion in absence of clinical and echocardiographic signs of cardiac tamponade. About 36 hours later we found evidence of an aortic dissection and in the blood culture an isolation of Clostridium fallax that we consider the probable cause of this lesion.

Aortic Dissection↗
PubMed2003

The killing of psychiatric patients in Nazi Germany between 1939-1945.

Between 1939 and 1945, 180,000 psychiatric patients were killed in Nazi Germany. This paper opens with a brief discussion of the reasons for addressing this issue today; it is followed by the details of the so-called euthanasia program that entailed killing of patients by gas in special hospitals in the years 1939-1941, and in psychiatric hospitals in the years 1942-1945. In this latter period, patients were killed with lethal injections and through the introduction of a starvation diet. The fate of the Jewish patients and forced laborers, as well as the experiments conducted on the patients, are mentioned. Finally, some thoughts are presented to answer the question of why this could have happened. To me, the giving up of individual responsibility in an authoritarian system leads to the loss of the individual conscience and soul, including those of a psychiatrist.

Euthanasia↗
PubMed1956

Normal psychological changes in adolescence.

It behooves physicians to be aware that adolescents are different people, that they have a vast capacity for change, that they often exhibit the sickest kind of behavior, which may be very frightening to us and to them. Physicians have to be able to wait and not become panicked by the turbulences, confusions, and contradictions that mark the adolescent's behavior; to keep in mind at all times that much of what is going on is relatively normal behavior in the drive toward maturation and adulthood; that the adolescent has to cope with his sexual drive which is continually frustrated, that he has to cope with the problems of emancipation from parental authority, that he has to cope with an aggressive drive to achieve and to dominate.Parents, too, have to be understanding and ready to render unselfish support, for they continue to be the source of strength and security, and even the source of healthy restrictions. Adults must be aware that the adolescent struggles with his conscience and its dictates, and we should look upon cliques, groups and clubs as a healthy assistance in the preservation of standards, ethics, and mores.

Adaptation, Psychological↗
PubMed1956

Delinquency.

Not all behavior problems develop into juvenile delinquency nor do all juvenile delinquents become adult criminals. Environment is not in itself the only determining factor in the development of delinquency; rather, environment may offer the opportunity for acting out conflicts in an antisocial way. Conflicts are dealt with by antisocial behavior patterns rather than through various neurotic defense mechanisms. There appears to be a defect in conscience. Parental roles are extremely important in helping the growing child develop those positive aspects of his personality which lead to adult maturity and adult happiness. Included in parental factors are the relationships of both parents to the child, not just in what is conscious and deliberate in the relationship, but in what also can occur unconsciously or without awareness in the relationship.

Adult↗
PubMed1992

[The re-enchantment of medicine].

This is the speech delivered by Bernardino Piñera MD, a catholic bishop, at the time of his incorporation as an Honorary Member of the Chilean Academy of Medicine. Medicine, health, and life, suffering and death are endowed with marvelous elements of reenchantment; turn pain into well-being, anxiety into serenity, fear into confidence; give sense to life and death, live and make men feel their human dignity. Many a patient miss the times when the doctor was a friend who knew him, not through biochemical or imaging diagnosis but through intimate conversation; when he was familiar with his character, his family and environment; when he could die in peace at home, surrounded by his family and thinking of God according to his religious beliefs. A profound change in medical conscience is needed, a philosophical and cultural change, allowing "high touch" to dominate and use "high tech". Let us transform the words sick or patient into "sick man" or "suffering man". Let us think of death as a culminating moment of life on earth, not as a failure of Medicine, but as the joyful acceptance of human destiny.

Philosophy, Medical↗
PubMed1992

Mast cells sensitive to v-H-ras transformation are hyperinducible for interleukin 3 expression and have lost tumor-suppressor activity.

Subcloning of interleukin 3 (IL-3)-dependent PB-3c mastocyte cells revealed two populations, of which only one is sensitive to oncogenic transformation by v-H-ras. The corresponding tumors produce IL-3 and grow in vitro in the absence of exogenous IL-3 [Nair, A.P.K., Diamantis, I.D., Conscience, J.F., Kindler, V., Hofer, P. & Moroni, Ch. (1989). Mol. Cell. Biol., 9, 1183-1190]. In the present investigation, IL-3 gene regulation was compared in ras transformable (rT) and ras nontransformable (rNT) lines. We report that upon expression of v-H-ras rT clones but not rNT clones express low levels of IL-3 mRNA as detected by reverse polymerase chain reaction. Treatment with ionomycin, a calcium ionophore, induced high levels of IL-3 expression only in ras-expressing rT clones. Somatic cell fusion between the rNT clone 20 and the IL-3-expressing mastocytoma line V2D1 led to down-regulation of IL-3 expression and to the requirement for exogenous IL-3 for in vitro growth and tumor suppression. In contrast, rT clone 15 lacked tumor-suppressor activity and failed to down-regulate IL-3 expression in somatic hybrids which grew in vitro without added IL-3. Our results indicate that IL-3 gene expression is a critical determinant for the generation of v-H-ras-induced mast cell tumors and show that disturbances in IL-3 gene regulation can be detected already at the premalignant level in v-H-ras transformation-sensitive cells.

Animals↗
PubMed1992

[Ethics in psychiatry].

In psychiatry there are two major problem areas where ethical questions are of greatest importance. On one hand these are problems arising from commitment to an institution, e.g. forced hospitalisation and forced treatment. Swiss civil law requires in articles 397a to f that such patients may appeal to a judicial court. When this court is a commission comprised of an attorney and of psychiatric and psychotherapeutic specialists, it is of greatest importance that the patient himself be heard by the attorney and not just by a member of the commission and that this attorney also takes into account statements of relatives, as an incompetent patient may say things that are inconsistent with actual facts. As existing or planned hospitalization laws apply mainly to acutely ill patients who are dangerous to themselves or to others, the treatment of chronically ill psychiatric patients cannot be guaranteed. Thus conflicts of conscience arise, since physicians are required to provide medical aid; therefore if such aid is not given or if it is refused, a physician can be sued for inflicting heavy injury. Hence there is an urgent need for judicial measures that guarantee also the treatment of the chronically ill who, like all patients, have a right to be treated. A second problem area is represented by the ethical commissions that decide which scientific investigations may be performed on psychiatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Commitment of Persons with Psychiatric Disorders↗
PubMed1992

[Snow-white in danger. Women, socialization and health. Some messages, by means of allegory].

This is the modern-day allegory of Snow White, the most beautiful woman in the kingdom. Because of her beauty she is banished from the castle. The seven dwarfs who befriend her welcome her into their cottage. Little by little, they begin to impose their demands on her. They try to coerce her into submitting to life's little demands in order to attain beauty, health and happiness. Diet categorizes the foods filled with nasty calories that Snow White must learn to do without. Fitness outlines her spare time exercise regimen to keep her slim and trim. Mr. Clean provides her with specific household cleaning tips. Job tips advise her how to get a job outside the home to maintain her financial autonomy. Pills provide her with a way to assure a smooth transition between work and the household chores. Oh! And we almost forgot Baby. Who will care for Baby? Snow White of course--since she is the only woman in the house. Finally, to assure perfect co-ordination of all these tasks, Excel sends her off to take a time management course. Snow white responds enthusiastically to all the expectations. As anticipated, she loses weight. She then becomes exhausted and collapses and is transformed into Burnt-Out Beauty. She remains in a deep sleep for 100 days and nights. The dwarfs place her in a glass box in a forest clearing where she is discovered by Prince Conscience. He opens the glass box, kisses her lightly on the forehead, and immediately disappears. Snow White awakens and remembers the events preceding her deep sleep.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1992

Linguistic production, process of meaning and the interactive pattern in avoiding anxiety.

The aim of this study is to work out a theoretical model that would at once be able to tackle the connection between emotions, thoughts, language and actions, since man has constant contact with others during his life, and to recognize the single basic concepts deriving from anxiety and desire. Our main concern is to follow the outcomes of anxiety, in order to understand how it is avoided, by which mental and emotional forms and ways of behaviour. Hence one can find the result of this process in interaction with others. In this perspective the process of meaning is autonomous, and neutrality is not only interpreted as a therapeutic directive, but as a fundamental aim of the therapy, related to controlling the anxiety and emotions which fill the field of conscience during interaction with the other.

Anxiety↗