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A moral emergency and a medical problem: negotiating the control of venereal disease--the Saskatchewan Venereal Disease Protection Act, 1946.

The author examines Saskatchewan legislation that regulated venereal disease. Although venereal disease legislation was introduced in Saskatchewan in 1919, the centrepiece of this article is The Venereal Disease Prevention Act, 1946. In an attempt to understand the nuances of and underlying rationale for these laws, the author situates the legislation within its social context. The author demonstrates that the trends and contradictions apparent in society's approach to the regulation of venereal disease were reflected in the legislation. The concept of a continuum is used to illustrate the coexistence of two approaches to the control of venereal disease. On one side of the continuum, venereal disease was a moral problem and a taboo subject. Force was the key to controlling venereal disease; involuntary examinations and intrusions into people's personal lives were the solution. On the other side of the continuum, venereal disease was a medical problem. If approached rationally and openly, control of venereal disease was possible; through education and social acceptance of venereal disease as just another illness, people would voluntarily come forward for treatment. The approaches represented at the extreme ends of the continuum did not exist in isolation; these views existed simultaneously, producing contradictory and colourful rhetoric.

Coercion↗

Moral objections to suicide: Can they counteract suicidality in patients with cluster B psychopathology?

OBJECTIVE: Patients with cluster B personality disorder (CBPD) are particularly prone to suicidal behavior, yet possible protective mechanisms are not often studied. The present study investigated a possible protective role of moral objections to suicide (MOS) against suicidal behavior in patients with CBPD and current depression. The effect of MOS was then examined in relation to other mechanisms affecting suicide risk including trait aggressivity and the presence of effective coping strategies. METHOD: 147 depressed patients with comorbid CBPD (DSM-III-R) were compared with 210 depressed patients without CBPD in terms of their history of suicide attempts and clinical and demographic characteristics. The relationship of MOS to suicide attempt was examined by logistic regression controlling for demographic and clinical differences between the groups as well as presence of comorbid CBPD. Data were collected from 1990 to 2003. RESULTS: Subjects with comorbid CBPD had fewer MOS and reported more previous suicide attempts. In logistic regression, fewer MOS/religious beliefs, lower coping potential, and higher aggression level were associated with suicide attempt. A CBPD diagnosis did not affect the relationship between MOS and suicide attempts. CONCLUSIONS: The results of this study suggest that the presence of MOS/religious beliefs may have a protective effect against suicidal behavior in depressed patients with comorbid CBPD and may be a target for therapeutic intervention.

Adaptation, Psychological↗

Children as research subjects: moral disputes, regulatory guidance, and recent court decisions.

The millennium has ushered in a new era of oversight for pediatric research, with renewed moral and legal attention to the upper thresholds of potential harms to which children may be exposed in studies. Watershed events discussed include: First, the deaths of two research subjects, allegedly due to insufficient oversight by the investigators and their institutional review boards. Second, the courts expressed concerns about research policies for incompetent persons or children in two cases, T.D. v. N.Y. and Grimes v. Kennedy Krieger Institute, and reinforcement of the principle that the best interest standard must be used for incompetent persons even in research. Third, the Best Pharmaceutical for Children Act and the Pediatric Rule created incentives as well as uncertainty among Institutional Review Boards and researchers about conducting pediatric studies. Fourth, the Office of Human Research Protection signaled the start of more rigorous oversight with its public rebuke and suspension of a National Institute of Child Health and Human Development pediatric obesity study. Failure to clarify the meaning of the pediatric regulations has sometimes misled generally risk-averse institutions and dedicated investigators about what is permissible.

Biomedical Research↗

Moral dilemmas in nursing research.

This paper addresses the important issue of moral dilemmas which can arise in nursing research. It argues that with the increase in nursing research, emphasis must be placed upon a greater understanding of ethical principles and codes of research for the protection of human subjects from possible exploitation. Two such dangers are identified as breach of confidentiality and not securing informed consent. These areas are used to illustrate possible dilemmas, together with discussion of relevant measures to avoid such exploitation.

Codes of Ethics↗

Stability and change in adolescents' positive attitudes toward guidance in moral development.

A total of 1,913 junior high school and college students tested between 1978 and 1988 responded to a 15-item questionnaire on the extent and type of influence they thought desirable in developing moral judgment in elementary, secondary, and college students. The average response across subjects, year of administration, and age of individuals for whom the item was being tapped was highest for the influence of the individual him/herself (2.52 on a 3-point scale), but also relatively high for the three institutions tapped: family (2.17), school (1.85), and clergy (1.45). Peers' influence was rated at 1.84. Differences on the other dimensions (year of questionnaire, sex, and age of subject) were rarely substantial, and while yielding some significant differences, did not show clear, strong patterns.

Adolescent↗

[The moral significance of religion for bioethics].

Religion is concerned with problems of health, medicine, and disease. Conversely, concepts of health and disease reflect values that are often influenced by religious postulates. Thus, the complex ways in which religion refers to and describes health, medicine, and disease help to explain its many-sided relationship to bioethics. This article examines the manner in which religion, as a descriptive and empirical entity, and also a normative and conceptual one, has moral meaning for bioethics and can enrich it. An analysis is also made of how a particularly complex problem in bioethics--whether the medical technology available for prolonging life should be used--could be approached from the standpoint of different religious traditions.

Bioethics↗

Ecclesiogenic neuroses and psychoses in adolescence. On the complicated detachment problems of adolescents from rigorously moralizing, Christian-religious movements.

In the child and adolescent psychiatric department of Bern University Clinic, between 1982 and 1986 42 adolescent male and female patients were admitted for in-patient treatment. 9 of them (21.4%) came from Christian-religious sects. This was all the more surprising as the proportion of marginal Christian-religious groups in the population was 1.4% in the population census in the canton Bern in December 1980. This noticeably over-proportional accumulation was taken as a reason for carrying out an analysis of the case histories. It was shown that the patients from the circles of Christian sects became either obsessive-compulsive neurotically, anorectically or psychotically ill in puberty and that a very strictly moralizing upbringing by the parents was present which led to an aggravation of the relation conflict with the parents in the detachment and separation-process in puberty. By means of three case reports the problem of ecclesiogenic neuroses and ecclesiogenic psychoses in adolescence was gone into and the conclusion was made that the religious conflicts must be given increased attention in the therapeutic dealings with the patients concerned with the inclusion of members of the family and also persons of reference outside the family.

Adolescent↗

The moral failure of the patriarchy.

The present health care system operates within a larger structure that now has to be openly acknowledged as patriarchal: Caring is viewed as women's work, which is not valued and which is considered less important than the work of men. The moral failure of this worldview is evident in such health care crises as care of the homelessness and those with AIDS, and dramatic rises in rates of infant mortality among the poor. This failure demands a health care revolution--a revolution in the sense that society must give up that which no longer works.

Attitude to Health↗

Nurses' responses to moral dilemmas.

Using six typical dilemma situations a study testing the morality and reasons for the reactions of subjects was conducted and the responses investigated.

Ethics, Nursing↗

Preparing students to be moral agents in clinical nursing practice. Report of a national study.

Various types of teaching and learning strategies can be effectively employed to assist students' professional development in ethical decision-making skills. To be prepared to act as a moral agent in clinical practice, a terminal goal upon completion of the baccalaureate program is the student's ability to develop and consistently use a systematic approach/framework when confronted by an ethical dilemma. Eleven skill steps not necessarily exclusive or in sequence were outlined as selected activities that can be considered for the ethical decision process. Specific ethical issues that are germane and applicable to many patient care situations were investigated and identified as frequently occurring in clinical practice. Course work about these issues prior to completion of their nursing programs may be beneficial in preparing students with basic knowledge and skill about them as they enter or return to clinical practice.

Attitude of Health Personnel↗

[Moral judgment and prediction of criminality. Comparative study of delinquents and non-delinquents].

A group of imprisoned criminals was compared to two groups of not-criminals with regard to five modes of judgment (profile of judgment) measured by Baruk's Tsedek test. The delinquents use more self-interest judgment, social judgment and absence of judgment that the whole of the not-delinquents (significantly different). They more often use the mode of moral judgment than the not-delinquents of the control group (general population) but less often than the not-delinquents of the comparative group (subjects of high educational level and religious for more than half of them). From the profile of judgment obtained for each group, a formula of prediction of tendency to crime was elaborated. It makes it possible to classify with rather good reliability the persons tested in the category of criminals or not-criminals.

Adolescent↗

Using Tom and Huck to develop moral reasoning in adolescents: a strategy for the classroom.

The first part of this article examines some theoretical arguments for teaching moral education in the classroom. This discussion is followed by an investigation into how the use of fiction might enhance this process. Finally, a specific strategy using Mark Twain's novel, The Adventures of Huckleberry Finn, is offered as an example of how this might be done.

Adolescent↗

A comparative moral approach to suicide--a Jewish perspective.

Suicide is a statistically significant cause of death, constituting an alarming public health problem. Many countries, therefore, have acknowledged the necessity to create special centers for the prevention of suicide. There is a moral conflict between the principle of autonomy and the value of life in the case of suicide. This can be resolved in several ways: 1) autonomy should be considered as a categorical imperative and as an absolute principle, hence overriding even the value of life; 2) suicide should be regarded, prima facie, as a noncompetent decision, thus being in no conflict with the principle of autonomy; 3) the value of life nullifies the principle of autonomy; thus, when free will is used for the destruction of life, it should be entirely relinquished. Judaism endorses the last interpretation of the relationship between free will and destruction of life. It strictly forbids suicide, based on theological considerations, regarding such an act as one of the gravest of sins. The educational impact of such a philosophy may favorably contribute to the efforts devoted to the prevention of suicide. By contrast, those attributing absolute importance to the principle of autonomy may have contributed to the increasing rate of suicide in the Western world. It was already stated by a contemporary philosopher that the degree of rationality of the suicide act depends on the degree of the philosophy guiding the person's deliberations.

Attitude↗

Bioethical issues and the moral matrix of U.S. health care.

Solutions to ethical-moral issues will be influenced by the growth of medical technology, by the escalating cost of medical care, and by the involvement of public entities in health care delivery. The major areas of concern that will be affected by these factors are care of the dying, genetics, euthanasia, sterilization, behavior control, reproductive interventions, abortion, informed consent, and distributive justice.

Abortion, Legal↗

[An analysis of moral judgments in impression formation (author's transl)].

This experiment was designed to test the assumption of additive information integration in moral judgment. 35 subjects gave punishment ratings for descriptions that varied in kind of offence, information about previous conviction and personality characteristics. The data, analysed by Anova, show regular deviations from additivity.

Analysis of Variance↗

Moral narcissism.

Narcissism, to which so many theoretical works have ben devoted during these last few years in France, has been the object of very few clinical studies. An earlier work (1963) on the phallic-narcissistic position led me to define more accurately a state observed in the clinic and first described by Reich. I should now like to give a more solid contour to another clinical impression, to verify its validity in individual experience and, if possible, to attribute a structure to it. We shall now take up the matter of moral narcissism.

Adolescent↗