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At least 1,153 records · Page 64Linked to original sources
PubMed1999

Evaluating clinical outcome and staff morale in a rehabilitation team for people with serious mental health problems.

Tameside and Glossop rehabilitation team (in England) have developed a progressive and targeted service for people with serious mental health problems through the systematic implementation of research-based evidence in practice and service configuration. This study was undertaken to provide a method of auditing the clinical outcome of the service and monitoring staff morale in a manner which could be integrated in the day to day delivery of services, and which could inform future service developments. Changes in the functioning of the total population of rehabilitation team clients were assessed over a 1-year period by Health of the Nation Outcome Scales (HoNOS) ratings at 6-monthly intervals. Factors causing stress and stress levels among all staff were assessed using the Mental Health Stress Questionnaire. The findings give clear indications of areas of the service which needed improving or changing, and identify ways in which the ongoing process of data collection might be refined.

Benchmarking↗
PubMed2003

Actualizing Gadow's moral framework for nursing through research.

The purpose of this paper is to describe how Sally Gadow's perspectives on existential advocacy as the moral framework for the nurse-patient relationship were synthesized with a general theory of motivation, self-determination theory (SDT), to inform the design of a study in which the influence of interpersonal care on the process of tobacco dependence treatment was explored. Consistent with the tenets of existential advocacy, participants who perceived their care providers as interpersonally sensitive and bringing more of their whole selves to the care encounter reported more autonomous motivation and felt competence for stopping smoking. The integration of existential advocacy with SDT, which led to the empirical work in which Gadow's ideas were actualized and her model supported, is described. Study findings are discussed in light of Gadow's philosophical views, and implications for nursing highlighted.

Humans↗
PubMed2001

[Borderline questions in sustaining life-prolonging life. Moral theological viewpoint].

The subject-matter of the main topic of this contribution focuses on the question concerning the criteria for the renunciation of therapy or for the decision to desist from treatment. The normative basis is the recognition of the principle that no one can be medically treated against his or her expressed will. Age in itself is not a morally justified argument to refuse medical treatment such as dialysis, organ transplants or the application of expensive medication. A therapy is to be rejected and also an already begun therapy is to be discontinued when this will neither cure nor ease the illness.

Ethics, Medical↗
PubMed1999

A basic concept in the clinical ethics of managed care: physicians and institutions as economically disciplined moral co-fiduciaries of populations of patients.

Managed care employs two business tools of managed practice that raise important ethical issues: paying physicians in ways that impose conflicts of interest on them; and regulating physicians' clinical judgment, decision making, and behavior. The literature on the clinical ethics of managed care has begun to develop rapidly in the past several years. Professional organizations of physicians have made important contributions to this literature. The statements on ethical issues in managed care of four such organizations are considered here, the American Medical Association, the American College of Physicians, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics. Three themes common to these statements are identified and critically assessed: the primacy of meeting the medical needs of each individual patient; disclosure of conflicts of interest in how physicians are paid; and opposition to gag orders. The paper concludes with an argument for a basic concept in the clinical ethics of managed care: physicians and institutions as economically disciplined moral co-fiduciaries of populations of patients.

Beneficence↗
PubMed1999

Coming home to Hume: a sociobiological foundation for a concept of 'health' and morality.

Assessing the normative status of concepts of health and disease involves one in questions regarding the relationship between fact and value. Some have argued that Christopher Boorse's conception of health and disease lacks such a valuational element because it cannot account for types of harms which, while disvalued, do not have evolutionarily dysfunctional consequences. I take Boorse's account and incorporate some Humean-like sociobiological assumptions in order to respond to this challenge. The possession of moral sentiments, I argue, offers an evolutionary advantage (thus falling within Boorse's definition of normal functional abilities). However, this does not amount to emotivism: on the contrary, these sentiments can be the basis of a value system. This value structure introduces the concept of sympathizing with a fellow being's suffering as the basis of a normative dimension to disease. For example, it holds the disvalue of disease to lie in the fact that disease involves suffering and functional limitations. The naturalistic Humean type of account presented here thus jumps the normative-descriptive divide. When Boorse's account is extended to include social sentiments and behaviors, a conception of health emerges which is broader than Boorse's or Kass's, but narrower than the WHO's.

Bioethics↗
PubMed2001

Moral absolutism and ectopic pregnancy.

If one accepts a version of absolutism that excludes the intentional killing of any innocent human person from conception to natural death, ectopic pregnancy poses vexing difficulties. Given that the embryonic life almost certainly will die anyway, how can one retain one's moral principle and yet adequately respond to a situation that gravely threatens the life of the mother and her future fertility? The four options of treatment most often discussed in the literature are non-intervention, salpingectomy (removal of tube with embryo), salpingostomy (removal of embryo alone), and use of methotrexate (MXT). In this essay, I review these four options and introduce a fifth (the milking technique). In order to assess these options in terms of the absolutism mentioned, it will also be necessary to discuss various accounts of the intention/foresight distinction. I conclude that salpingectomy, salpingostomy, and the milking technique are compatible with absolutist presuppositions, but not the use of methotrexate.

Abortion, Therapeutic↗
PubMed2002

Trust, moral responsibility, the self, and well-ordered societies: the importance of basic philosophical concepts for clinical ethics.

Although the work of clinical ethics is intensely practical, it employs and presumes philosophical concepts from the central branches of philosophy, including metaphysics, epistemology, ethics, and political philosophy. This essay introduces this issue in the Journal on clinical ethics by considering how the papers and book reviews included in it illuminate four such concepts: trust, moral responsibility, the self and well-ordered societies.

Ego↗
PubMed2002

Moral and social complexities of AIDS in Africa.

In this article, the main complexities of understanding and curbing the HIV/AIDS pandemic in (South) Africa, are discussed. These are: 1. Poverty as niche or social context of the pandemic, 2. Denial, lack of leadership and the politicization of the public discourse on AIDS, 3. Problems related to accomplishing behavior changes under conditions of deprivation and illiteracy, 4. Women's vulnerability, and 5. The disenchantment of intimacy brought about by the pandemic. In each case, some solutions are suggested, although the notion of complexity does not allow for definitive solutions. Concluding remarks deal with the possible philosophical and moral sense that we might make of the pandemic.

Acquired Immunodeficiency Syndrome↗
PubMed1997

A longitudinal study of adolescents' attitudes about assistance in the development of moral values.

A questionnaire-based study of 2,863 adolescents (ages 12 to 22 years), with data collected over 15 years, measured the extent to which informants believed that elementary, secondary, and college-age young people should receive guidance on moral issues from the family, school, clergy, peers, and/or the individual himself or herself. Averaging the ratings of all respondents over the first three categories yielded an overall authority score of 1.85, where a score of 2.00 represented a belief in moderate influence. Results showed a minimal difference in the ratings between genders, among different age groups, and across the different calendar years of questionnaire administration. Much more substantial differences existed among the actual influences investigated and across the ages of those to whom the influence was to be directed.

Adolescent↗
PubMedDate not supplied

Sexual morality of Christianity.

After discussing the origin of religion, functions of religion, and the construction of meaning by religion, the author focuses on the connection between religion and anxiety. The permanent anxiety in religion is determined by guilt feelings that arise for example from the violation of norms in the area of sexuality. In a religion at enmity with sexuality, such as Christianity, the satisfaction of sexual desires is considered bad and sinful; the permanent production of anxiety and a guilty conscience are the result of it. Christian sexual suppression leads to the propagation of asceticism as the taming of corrupt sensuality that only religious virtuosi can maintain. One result of asceticism is celibacy, although passages from the Bible demand monogamy for bishops without prohibiting celibacy. In Catholicism, celibacy institutionalizes the enmity with sexuality and causes a permanent depreciation of real sexuality in favor of one projected onto the mother church and the Virgin Mary. A further consequence of asceticism is the reduction of sexuality to reproduction. In the section about the factual consequences of Christian sexual morality, the author connects sexual instinctual gratification with religious affiliation on the basis of an analysis of the sexual behavior of Germans. The weekly frequency rate of sexual intercourse amounts to 3.1 with male and female nondenominationals, 2.6 with Protestants, and 2.3 with Catholics; 39% of nondenominational men, 20% of Protestant men, and 12% of Catholic men in Germany use condoms. The connection of religion and aggression is empirically significant as well. The religiously most active men feel more inclined to use aggression to reach sexual goals than religiously indifferent ones.

Adult↗
PubMedDate not supplied

The suffering stranger: medical anthropology and international morality.

Addressing global inequities has come to define a domain of activist medical anthropology called social justice studies. In a recent flagship volume, Dying for Growth: Global Inequality and the Health of the Poor, contributors describe the effect of global economic trends and neoliberal policies on the destitute and disadvantaged. In their advocacy, they use the voices and stories of the poor to explain the impact of structural adjustments. This paper uses Dying for Growth as an example through which to comment on the wider scholarly trend of using the local to validate global claims. The term "suffering stranger" describes those iconic figures whose experiences are presented in truncated first-hand accounts of suffering in order to validate broader theoretical aims. I argue that the suffering stranger masks the real absence of the voices of the poor and their suffering on the world stage. There is no international public sphere within which these voices might be heard; rather, there is a set of claims about justice and human rights. These claims, however, are themselves rooted in cultural values and are inextricably woven into global capital. I argue that, in using the voices of suffering to further a theoretical agenda, social justice activists assume the existence of a public, international domain within which those voices might be heard and that, in so doing, they further integrate the poor into destructive economic systems. Alongside the work of documenting health inequities, a truly effective activism may require assessing and critiquing existing claims of international morality.

Anthropology, Cultural↗
PubMedDate not supplied

Sexuality, AIDS, and the lures of modernity: reflexivity and morality among young people in rural Tanzania.

An understanding of young people's perceptions of AIDS and their sexuality is an essential precondition for the effective planning of AIDS campaigns in sub-Saharan Africa. In examining how young Luo men and women in Tanzania describe their sexual behavior, I show that cultural conceptions of sexuality gender, and trust have an important impact on their actions. I also show that these conceptions have been rendered ambiguous by globalization, modernity, and by AIDS campaigns themselves. The values that are imparted to young people from family or peers often conflict with the preventive advice provided by both governmental and non-governmental organizations. However, by critically reflecting upon the ambiguities and inconsistencies in their lives, the young Luo have proven to be self-conscious actors and moral subjects who are actively involved in the process of social change. In the concluding section I suggest how elements of self-critique and self-reflection, as well as the often differing perspectives and dilemmas experienced by young men and women, can be taken into account in order to make future educational campaigns more effective.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Collective moral imagination: making decisions for persons with dementia.

Much debate concerning 'precedent autonomy'--that is, the authority of former, competent selves to govern the welfare of later. non-competent selves--has assumed a radical discontinuity between selves, and has overlooked the 'bridging' role of intimate proxy decision-makers. I consider a recent proposal by Lynn et al. (1999) that presents a provocative alternative, foregrounding an imagined dialogue between the formerly competent patient and her/his trusted others. I consider what standards must be met for such dialogues to have moral force, appealing to narrative and feminist ethics. I then critique the dualistic construction of selves implicit in much of the advance directive literature, noting the continuities of dependence, character, and body, as well as the social dimension of the construction of selves.

Decision Making↗
PubMedDate not supplied

Love, lifestyles and the risk of AIDS: the moral worlds of young people in Bobo-Dioulasso, Burkina Faso.

The HIV epidemic has had a profound impact on people's everyday life in most African societies. A large proportion of all new HIV infections involves young people between 15 and 25 years. The objective of this paper is to explore local moral worlds of young people in Bobo-Dioulasso, Burkina Faso, and discuss how the HIVS epidemic affects their reflections on their everyday life and their perceptions of sexual relationships. Based on anthropological fieldwork, including focus-group discussions, in-depth interviews and participant observation, a total of 57 young people between 15 and 25 years were followed over a 3-month period. Using the notion of 'lifestyle', the paper shows how structural factors of unemployment and poverty paired with global discourse on AIDS present the young people with frustrations and quandaries in relation to their hopes and images of love, faithfulness and modern living. The data shows that the HIV epidemic contributes to and accelerates their feeling of living in a risk society and of being at risk. In order to cope with these uncertainties and contingencies, local discourses of trust and fidelity become extremely important and to most young people HIV prevention is synonymous with finding a faithful partner and/or using condoms.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Addiction and disability: moral and policy issues.

This article discusses the conceptual, ethical, and policy issues raised by the legal classification of drug addiction as an impairment, and of some nonusing drug addicts as people with disabilities. It focuses on the questions of (1) what moral judgments, if any, underlie the classification of addiction as an impairment; (2) whether it makes sense to apportion the burdens of drug addiction between chemical, biological, social, political, and other causes; (3) how considerations of distributive justice may compel or constrain measures to ease the burdens of drug addiction; and (4) whether it is justifiable to deny the current users of illegal substances legal protections available to the current users of legal substances.

Attitude to Health↗
PubMedDate not supplied

Fetal alcohol syndrome: the origins of a moral panic.

Since its discovery almost 30 years ago, the fetal alcohol syndrome (FAS) has been characterized in the USA, as a major threat to public health. In part because FAS resonated with broader social concerns in the 1970s and 1980s about alcohol's deleterious effect on American society and about a perceived increase in child abuse and neglect, it quickly achieved prominence as a social problem. In this paper, we demonstrate that, as concern about this social problem escalated beyond the level warranted by the existing evidence, FAS took on the status of a moral panic. Through examples taken from both the biomedical literature and the media about drinking during pregnancy, we illustrate the evolution of this development, and we describe its implications, particularly how it has contributed to a vapid public policy response.

Female↗
PubMed2004

Genetic medicine: the balance between science and morality.

This article explores the relationship between science and morality with respect to the major changes that genetic knowledge has induced in medicine, as well as in many other spheres of our lives. The following themes are treated: (i) the influence of genetic knowledge on the concepts of normalcy and diversity with respect to health; (ii) the influence of genetic knowledge on the concept of responsibility; (iii) the reciprocal influence of pre-existing biases and genetic knowledge; (iv) the influence of genetic knowledge on the concept of community; and (v) the influence of genetic knowledge on autonomy and trust in the patient-doctor relationship. The article does not wish to be prescriptive, but rather to raise open questions. The key philosophical question is to what extent human beings benefit from predictions about the future. The role attributed to genetics is largely overestimated. Genetic knowledge can be perceived as enhancing the control that individuals have on their lives, or as paralyzing the decision process of an individual who may feel predestined to a serious disease. In the case of breast and ovarian cancer, the probabilistic nature of genetics is especially relevant, given the relatively low penetrance of BRCA mutations. "Future things: not our domain. But in this today which unravels in front of us, what shall we do?" (Sophocles, Antigones).

Breast Neoplasms↗
PubMed1975

A retesting and modification of the Philadelphia Geriatric Center Morale Scale.

The inter-item structuring of the questions in the Philadelphia Geriatric Center Morale Scale was analyzed for sample members of two studies being conducted by the Dept. of Social Gerontological Research of The Hebrew Rehabilitation Center for Aged (Boston) in an attempt to understand better the several components of the PGC battery first reported by Lawton. PGC items were subjected to principal component and Varimax factor analyses for both the original 22 items and also a reduced 17-item battery. In addition, using more recent findings of Lawton, further structural tests were performed in order to obtain the best possible configuration of items for the several reliable scale components found. The results of these cross SAMPLE ANALYSES INDICATE AN OVER-ALL LEVEL OF RELIABILITY FOR THREE OF THE ORIGINAL PGC components; and at the same time, indices of greater length and reliability resulted when these three PGC components were slightly restructured.

Aged↗