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At least 91 records · Page 5Linked to original sources
PubMed1992

Requirements or incentives by government for the use of long-acting contraceptives. Board of Trustees, American Medical Association.

Following the approval of the long-acting contraceptive levonorgestrel (the Norplant Contraceptive System) for use by women, government officials have required or proposed uses of levonorgestrel that are problematic. One court ordered a woman convicted of child abuse to use levonorgestrel as a condition of her probation; legislators have proposed that women on welfare be paid to use levonorgestrel. Court-ordered use of long-acting contraceptives because of child abuse raises serious questions about a person's fundamental rights to refuse medical treatment, to be free of cruel and unusual punishment, and to procreate. The state's compelling interest in protecting children from abuse may be served by less intrusive means than imposing contraception on parents who have committed child abuse. If government benefits were based on the use of long-acting contraceptives, individuals would have to assume a potentially serious health risk before receiving their benefits. Government benefits should not be made contingent on the acceptance of a health risk.

Adult↗
PubMed1989

Enforcing patient preferences. Linking payment for medical care to informed consent.

The legal and ethical doctrine of informed consent is well accepted in modern medicine. Nonetheless, medical interventions sometimes take place in the absence of informed consent, particularly in the case of life-sustaining medical procedures. These procedures ordinarily are reimbursed by third-party payers. This article proposes as a strategy to ensure greater attention to patient preferences in medical decision making that financial reimbursement for each medical service be linked to a requirement of valid patient (or surrogate) consent to the service involved. Utilization review bodies could monitor informed consent in the same way that other aspects of necessity, appropriateness, and quality are now monitored.

Consent Forms↗
PubMed1987

Attitudes of persons at risk for Huntington disease toward predictive testing.

Attitudes of 69 persons at risk for Huntington disease (HD) were obtained by means of semistructured interviews and questionnaires. About 79% of the individuals said that they would use a presymptomatic predictive test if it were available. All believed that the test should be made available even though there was no cure for HD. Nearly 2/3 of subjects would use the test for prenatal diagnosis, and of these 71% would terminate a pregnancy if the fetus was found to carry the HD gene. Most subjects believed that pretest counseling should be mandatory and many said that testing should be withheld from persons who were psychologically unstable or were threatening self-harm. The data suggest that about 2-6% of persons at risk for HD may have severe psychiatric or suicidal responses to a positive outcome of predictive testing. This underscores the need for adequate pretest counseling and the availability of professional and community resources to deal with the impact of predictive testing on individuals and their relatives.

Adult↗
PubMed1991

Primary prevention of cancer. The case for comprehensive school health education.

Comprehensive school health education plays an important role in the primary prevention of cancer because so many of the health habits relating to cancer and other diseases have their onset early in life. A comprehensive health education program should begin early in life. Such education must be multifactorial from kindergarten through high school, should involve annual health screening, must be assessed annually, and is most effective when coordinated by a full-time health education teacher. Those concerned about the many problems of health behavior in our society should insist that such programs become mandatory in every state in this nation.

Adolescent↗
PubMed1991

AIDS, a social dilemma: detection of seropositives.

At present, we can observe an evolution in ideas about the detection of HIV seropositivity through a qualitative analysis of specialised literature on the ethical aspects of AIDS. In the case of this disease, systematic screening of the population does not correspond to epidemiological criteria: it is wasteful, troublesome and costly. Whether it is voluntary, and therefore biased, or compulsory, and therefore controversial, systematic screening seems an unlikely option. This situation has prompted many versions of target-group screening, which correspond to two options: systematic screening of known risk-groups, discriminatory, confidential and anonymous; target-group screening linked to particular circumstances: recognised as necessary by blood-donors and well-accepted by pregnant mothers. This method can be institutionalised and applied in the armed forces and in prisons,.... Lastly, we consider measures taken by different countries and organisations.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Ethical problems raised by anti-HIV vaccination.

At present questions are being asked world-wide about the risk of the AIDS epidemic. The discovery of an anti-HIV vaccine has become an urgent priority, but it also raises a number of sensitive questions. Ethical problems in this field are particularly delicate, since the perspectives of individual health and public health do not seem to coincide. Our research team conducted a review of more than 400 articles on the ethical problems raised by AIDS. We concentrated particularly on the ethical and legal issues raised by research on anti-HIV vaccine. These problems fall into three main categories: therapeutic assays, which must be controlled by a strict agreement defined by international norms; manufacture of the future vaccine, raising legal difficulties which must be faced and solved now; distribution of the vaccine to the population, which should be conducted on a general basis, i.e. it should be offered to all individuals and not only to risk groups.

Animal Experimentation↗
PubMedDate not supplied

Teaching humanistic and psychosocial aspects of care: current practices and attitudes.

OBJECTIVE: To assess current practices and attitudes toward teaching humanistic and psychosocial aspects of care in internal medicine residency programs. DESIGN AND PARTICIPANTS: Survey questionnaires were sent to residency directors at all 434 internal medicine residency programs accredited in 1985-1986. Response rate for two mailings was 71%. MEASUREMENTS AND MAIN RESULTS: 78% OF RESIDENCY DIRECTORS and 70% of department chairpersons had high or moderately high levels of commitment to teaching humanistic/psychosocial aspects of care, but only 44% of responding programs offered mandatory training, and only 18% offered elective training in these areas. Obstacles to expanded teaching of the humanistic/psychosocial aspects rated high or moderately high by residency directors included insufficient curriculum time (51%), lack of trained faculty (44%), and pressures to reduce both training costs (40%) and patient-care costs (37%). CONCLUSIONS: Most of the training that does occur in the humanistic/psychosocial aspects of care probably happens informally via mentoring and role modeling. Appeals to expand teaching in these areas raise questions regarding what to include in medical training and the proper scope of internal medicine. Sustainable change will depend on the politics of resource distribution and the influence of general internal medicine and primary care on traditional training.

Clinical Competence↗