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PubMed2000

'All the services were excellent. It is when the human element comes in that things go wrong': dissatisfaction with hospital care in the last year of life.

Patient satisfaction surveys are seen as an important way of obtaining 'user views' of health service provision. However, there is a growing body of research and theoretical literature that questions the validity of the concept of 'patient satisfaction' and hence the use of this type of survey. A postbereavement survey of people who registered a random sample of cancer deaths in an inner London health authority was undertaken in 1996/7. The survey questionnaire (VOICES) included 14 open-ended questions which asked respondents to add any comments they felt were relevant about the care of the deceased. This paper uses these data to examine the causes of dissatisfaction with hospital-based care. Of the 229 informants responding to the questionnaire, 138 included some written comment about care in hospital. At least one negative comment was made by 59% (82) of those making any comment. Of these, 55% (44) rated the care given by doctors as 'excellent' or 'good' and 63% (50) rated that given by nurses as 'excellent' or 'good'. Qualitative analysis of responses to open questions suggest that expressions of dissatisfaction arise from a sense of being 'devalued', 'dehumanized' or 'disempowered' and from situations in which the 'rules' governing the expected health professional-patient relationships were broken. As such, the causes of dissatisfaction for this particular group of patients are similar to the causes of dissatisfaction with health care in general reported elsewhere. The palliative care approach emphasizes patient- and family-centred care and aims to promote physical and psychosocial well-being. The study findings suggest that adoption of the palliative care approach could reduce the experience of dissatisfaction for many service users, not only those whose deaths are anticipated.

Dehumanization↗
PubMed2003

People with cognitive disabilities: the Argument from Marginal Cases and social work ethics.

A primary argument used by animal rights advocates to engage the public in questioning our maltreatment of animals is the Argument from Marginal Cases (AMC). It is important that social workers are aware of this argument, because it has the potential to diminish our consideration of people with severe cognitive disabilities. This article provides a brief overview of the argument, followed by a description of the means by which people with cognitive disabilities have been denigrated over the past century through animalistic rhetoric and negative comparisons with animals. The "animalization" of marginalized groups of all types has often served to reinforce and justify dehumanizing treatment of group members. Questions related to the logic of the AMC are raised, and the importance of the argument for the social work community is discussed.

Animal Rights↗
PubMed1995

The ethics of surrogacy: women's reproductive labour.

The aim of this article is to establish whether there is anything intrinsically immoral about surrogacy arrangements from the perspective of the surrogate mother herself. Specific attention is paid to the claim that surrogacy is similar to prostitution in that it reduces women's reproductive labour to a form of alienated and/or dehumanized labour.

Contracts↗
PubMed2002

Electroshock: a crime against the spirit.

Since its introduction in 1938, electroshock (electroconvulsive treatment, ECT) has been to its proponents a blessing and to its critics a curse. The author, himself an insulin coma-electroshock survivor, sides with the critics arguing that ECT is inherently harmful and dehumanizing. To support his views, he cites findings and comments from the professional literature in four areas: brain damage, memory loss, death, and brainwashing. The author also presents seven reasons for the continuing use of ECT, including profitability, value as a reinforcer of the biological model of mental illness, the absence of informed consent, the procedure's function as a "treatment of next resort," government and media support, and the public's failure to hold psychiatrists accountable for their conduct. The author concludes the article with his poem "Aftermath."

Brain Damage, Chronic↗
PubMed1993

The physician as perpetrator of abuse.

Although the exploitation and abuse of patients is forbidden by every code of medical ethics, physicians are in a power position vis-a-vis their patients, and this power may be misused. The spectrum of abusive physician behaviors includes doctors functioning as agents of control, exploiting physicianly perogatives, acting out personal problems in the medical setting, allowing subversion of their judgment, deliberately delivering suboptimal care, dehumanizing care, and sexually exploiting patients. Guidelines for the treatment of patients with such prior experiences are offered.

Adolescent↗
PubMed1979

Centerfold. An essay on excitement.

A woman who poses for soft-core pornography reports that she has never felt she belonged to her body, that she is and wants only to be an erotic product manufactured by a team of specialists for the use of a viewing audience of males, that since age 5 she has been a nude dancer, and that she has no other material existence except in this form. She is, then, a fetish. Her success illustrates the hypothesis that erotic daydreams in pronography represent fantasies of revenge in which the consumer imagines he is degrading--dehumanizing--women.

Adult↗
PubMed1984

Some problems associated with war experience in men of the Vietnam generation.

A national sample of men who were of military age during the Vietnam War (n = 1,342) was interviewed six to 15 years after veterans in the sample had left the service. Our findings showed that violent experiences in war were associated with a variety of behavioral and emotional problems. When preservice background factors were statistically controlled, combat exposure showed an association with arrests and convictions (generally for nonviolent offenses), with drinking, and with symptoms of traumatic stress. Participants in atrocities reported more stress symptoms and greater use of heroin and marijuana than did other veterans. Veterans who experienced no combat and did not take part in atrocities, however, did not differ appreciably from nonveterans. Not all men who experienced combat or took part in atrocities reported personal difficulties; almost three fourths of heavy-combat veterans were not arrested after the service. Tape recorded responses of the ten blacks and 18 whites who took part in atrocities suggested that soldiers' emotional responses may have been determined by their ability or inability to dehumanize the victims. Future research would benefit from a closer coordination of clinical and epidemiologic approaches.

Affective Symptoms↗
PubMed2003

Continuous support for women during childbirth.

BACKGROUND: Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour. OBJECTIVES: Primary: to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003). SELECTION CRITERIA: All published and unpublished randomized controlled trials comparing continuous support during labour with usual care. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. MAIN RESULTS: Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available. REVIEWER'S CONCLUSIONS: All women should have support throughout labour and birth.

Delivery, Obstetric↗
PubMed1995

Viktor Emil von Gebsattel on the doctor-patient relationship.

This article provides a summary overview of the ideas on medical anthropology and anthropological medicine of the German philosopher-psychiatrist Viktor Emil von Gebsattel (1883-1974), and discusses in more detail his views on the doctor-patient relationship. It is argued that Von Gebsattel's warning against a dehumanization of medicine when the "person" of both patient and physician are not explicitly present in their relationship remains valid notwithstanding the modern emphasis on respect for patient (and provider) autonomy.

Anthropology↗
PubMedDate not supplied

Psychiatric commitment and involuntary hospitalization: an ethical perspective.

As a psychiatrist, I have focused in this paper on the medical model view of commitment. Directed against the medical model is the civil liberties position, mostly put forward by attorneys, which values autonomy over beneficence and sees psychiatric decision-making as biased, imprecise, and too paternalistic. Like the moral principles they champion, neither of these positions is "wrong." The tension between them is inevitable and sometimes beneficial. The conflict is inevitable because the proponents differ in their missions and how they think. Attorneys (and philosophers) think in terms of the general case, of classes of situations, whereas psychiatrists focus on individuals as unique. Chodoff has also pointed out that the medical model is a utilitarian one, i.e. the morality of an act is determined by, on balance, whether it increases the good for the individual or society. The civil liberties position, on the other hand, is a deontological one, i.e. the end does not justify the means; some moral principles must be considered even if they do not lead to maximally good outcomes. This conflict between positions can be ultimately beneficial, if we recognize that each is fighting for a good. As a society, we should expect psychiatrists and other mental health professionals to try their utmost to treat the mentally ill, and attorneys to protect their rights. When we view it as such a moral dilemma, "we are confronted not with melodrama, a contest of right against wrong, but rather with tragedy, a conflict of one right--to be at physical liberty--against another right--to be free dehumanizing disease."

Beneficence↗
PubMed1982

[Surgery within the scope of technical perfection and humanitarianism].

The symptoms of the strained relationship between technology and humanity in modern medicine are excessive expectations with regard to achievement, protest on the part of patients against alleged dehumanization, and protest by doctors against dissonance between the tasks of the medical profession and science. - These symptoms require of the surgeon, as a representative of medical progress, that he intensively cultivate the trust-relationship with his patients and a readiness to accept the technical controls of medical research.

Altruism↗
PubMedDate not supplied

Decision analysis in surgical education.

Surgical education can no longer be considered adequate if limited to description of surgical diseases and methods of management. Due to the growth in numbers of surgical diagnostic and therapeutic procedures, the surgeon of the future will find it increasingly necessary to understand the principles by which algorithms are constructed and by which individualized decisions should be made. Several systematic approaches for assisting clinical decision makers have been developed. Decision analysis is particularly appealing because it is flexible and readily adapted to a wide range of clinical situations. It explicitly guides the decision maker in determining the crucial variables in a clinical decision, and permits both objective data and personal preferences to play a part in decision making. Because it provides for personal estimates and preferences, decision analysis is not dehumanizing, even though it is quantitative, explicit, and mathematically rigorous. Topics for a series of seminars or case conferences are suggested. Decision analysis should be part of the intellectual preparation of every clinician.

Decision Support Techniques↗
PubMed2003

Ethical and social issues in the care of the newborn.

Ethical and social issues are based upon a system of moral values that serve the best interests of the society in a humane and compassionate manner. The ethical decisions should be based upon the well-enunciated principles of beneficence, non-maleficence, parental autonomy, correct medical facts and justice. In view of our economic constraints, we should follow the philosophy of utilatarian ethics based on the concept of "value for money" and focus our resources and efforts for the care of salvageable babies. Nevertheless, we should try to ensure equitable development of health care of neonates at all levels, and NICU facilities should be developed in the country in a phased manner. In order to ensure justice and cost-effectiveness, the narrow principles of "best interest" of the child should be replaced by the concept of global beneficence to the family, society and the state. Neonatologists are often faced with a large number of ethical issues and dilemmas in the care of critically sick newborn babies and they should be resolved jointly by taking nurses, sub-speciality colleagues and family members into confidence. The technology should not be allowed to further dehumanize medicine and we must establish rapport and provide emotional support to the family members by showing our concern, sympathy and compassion in the care of their critically sick and extremely preterm babies. It is desirable that all the medical and nursing schools in the country should initiate regular education programs in the field of behavioural sciences, communication techniques and medical ethics for the benefit of graduate and postgraduate medical and nursing students.

Ethics, Medical↗
PubMed2005

Textual abuse: Faulkner's Benjy.

William Faulkner's The Sound and the Fury has become a classic in literary history. Since its publication in 1929, it has sustained critical interest worldwide. Over time, analyses of this work have reflected shifting cultural perspectives of the inscribed human dynamics such as gender, race and sexuality. This paper contends that a similar critical development cannot be detected around the reception of the character of the "idiot," Benjy. Faulknerian scholarship, regardless of its place in time or trend, persists in conflating the dehumanized images of Benjy with the lived experience of disability, thus perpetuating oppressive disability prejudice and limiting the richness of the character's metaphoric potential. Acknowledging this critical lacuna, historicizing and theorizing Benjy's character from a disability perspective could lead to a deeper understanding of human experience.

Consciousness↗
PubMed2005

The role of moral disengagement in the execution process.

The present study tested the proposition that disengagement of moral self-sanctions enables prison personnel to carry out the death penalty. Three subgroups of personnel in penitentiaries located in three Southern states were assessed in terms of eight mechanisms of moral disengagement. The personnel included the execution teams that carry out the executions; the support teams that provide solace and emotional support to the families of the victims and the condemned inmate; and prison guards who have no involvement in the execution process. The executioners exhibited the highest level of moral, social, and economic justifications, disavowal of personal responsibility, and dehumanization. The support teams that provide the more humane services disavowed moral disengagement, as did the noninvolved guards but to a lesser degree than the support teams.

Adaptation, Psychological↗
PubMed1988

The norms and values held by three groups of nurses concerning psychosocial nursing practice.

Research findings indicate that nurses often fail to provide patients with supportive psychosocial nursing care. The reasons for this and the norms and values on which nursing practice is predicated are unknown. The norms and values of three similar groups of nurses concerning psychosocial nursing care were inferred from observation and analysis of the nurses' interactions with each other, with other hospital personnel and with patients. Each group was observed for 5-7 weeks while working on one of three selected medical floors in the same hospital. Each group of nurses had norms and values which were discernable in typical behavior patterns, characteristics, explicit and implicit expectations, orientations, beliefs and attitudes. Two head nurses greatly influenced selection and enforcement of their groups' norms and values. The third group had not developed work-oriented norms and values. Nurses did not usually collaborate with other health-care professionals in the interests of their patients. The head nurses performed this function for each group. All nurses demonstrated knowledge of psychosocial nursing concepts but patient care was usually limited to physical nursing care, giving medications and meeting patients' verbally expressed requests for assistance. Nurses did not respond to or seem to notice patients' non-verbal or incoherent distress. They referred patients who exhibited disruptive behavior to other health professionals without delay. Patients who did not require physical nursing care had little opportunity for interaction with nurses. All three groups had work schedules which facilitated the typical style of nurse-patient interaction on each unit. These interactions were: cool, efficient and rushed on one unit; casual, warm and somewhat superficial on the second unit; brusque and business-like on the third unit. Nurses used social/moral assessment of patients which was facilitated by nurses telling each other anecdotes concerning patients. These anecdotes facilitated one group's typical humane, and two groups' typical dehumanizing nurse-patient interactions. The researcher concluded that group dynamics require consideration when planning nursing care delivery systems and that nurses need to develop pragmatic, supportive, psychosocial nursing interventions.

Adult↗
PubMed1990

Models, muddles and medicine.

The current prevalent attitude of disapprobation towards the medical model, held by nurse practitioners and educationalists alike, stems from a desire to denounce diagnostic reductionism and proselytize holistic care. It is argued, that the medical model encourages the perception that the patient is "essentially and only their medical diagnosis," and to relate to patients 'as if' they are kidney, a broken leg, a gall stone, or an ulcer, is to dehumanize the person. In order to overcome this predilection, the patient must be seen as a 'whole person' and not simply as some extraneous part of their dysfunctional anatomy. But this all too pervasive tendency, to reduce patients to nothing more than their medical diagnosis, is surely not the responsibility of the medical model? On the contrary, it is the responsibility of the individual medical or nurse practitioner who, on formulating a medical diagnosis, proceeds to convert the patient into an object and from there on regards the patient as "essentially and only their diagnosis of illness."

Holistic Health↗
PubMedDate not supplied

Breastfeeding. Toward resolution of the unsatisfying birth experience.

The act of birth and the way that it is managed have great meaning for many women. What may appear to professionals as a routine or unremarkable delivery may be perceived by the mother as humiliating, mutilating, or dehumanizing. If the mother has an extremely negative perception of her birth experience, she will suffer a loss of self esteem, and it is more likely that she will have difficulty taking on the maternal role. A successful brestfeeding experience builds up a mothers' confidence and self esteem and facilitates acquisition of the maternal role. The problem with relying upon breastfeeding to determine or establish maternal identity is that failure or untimely termination may occur for a variety of reasons. Anticipatory guidance and emotional support are the primary approaches to be used in helping a mother to nurse her baby for as long as she wants.

Adaptation, Psychological↗