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On masochistic enthralment a contribution to the study of moral masochism.

Freud rested his final understanding of moral masochism (the masochistic character) upon the concept of the death-instinct. Those analysts who have been unable to accept this concept have continued to define and enrich the understanding of the masochistic character. Out of their work has emerged the picture of a character structured in three discernible layers: an upper one of "nobility in adversity": a middle one of hate toward the mother; and the deepest one of primary union with the mother to which a later return is made. An abbreviated account of an analysis is given to exemplify this structure. An understanding of the relation between the deepest layers is essential to a comprehension of the total structure. Out of a primary maternal union accompanied by experiences of omnipotence and grandiosity emerges an ambivalent relationship to the omnipotent mother characterized primarily by hate. The relationship to the mother is one of masochistic enthralment. The lost omnipotence is then recaptured by a union mystica (primary identification) with the hating and hated mother now internalized as an aggressive self-ideal in which phallic characteristics become prominent. The unio mystica may be momentary and orgasmic as in the masochistic perversion or more or less enduring and characterological as in the masochistic character to which it contributes traits of haughtiness and disdain.

Character↗

Moral dilemmas experienced by nurse practitioners.

This article details the moral dilemmas experienced by NPs in their primary care practices. From the practitioners' stories emerged strong personal and professional values that guided and shaped the resolutions to the dilemmas. The dilemmas themselves and the values of the NPs offer insight into the role of the nurse in advanced practice. Implications based on these findings for clinical practice and NP education are also discussed.

Conflict, Psychological↗

[Morals, logic and ethics in reproductive medicine].

Human reproduction has always been a matter of philosophical interrogations and controversies. This situation has been reinforced by the technical evolution which has occurred during the past years. Both hopes and concerns have been raised at the same time. Two recent advancements deserve consideration and are given as demonstrative examples: intracytoplasmic injection of spermatozoon, preimplantatory diagnosis. Their consequences are very important for both the medical and the philosophical approach. One of the questions which arises at this occasion is to determine if research on pre embryos is legitimate or not. This evolution has provoked some reluctancy and several criticisms concerning the future of the children obtained by such techniques: the risk of slippery slope, possibly leading to a form of eugenics, and the fundamental and philosophical problem of the status of the embryo. However, behind these discussions a deeper and heavier controversial matter may be discovered; it deals with the role and the responsibilities of the governmental power. An opposition does exist between two different perceptions: on the one hand, the concept of a powerful governmental body, responsible for the respect of a statutory law, grounded on a sort of universal ethical rule, to be followed by all, a concept which bears the risk of totalitarianism; on the other hand, the concept of a law with a limited responsibility to protect public order, allowing a normal social life. Amongst the numerous responsibilities of the governmental power, one is often neglected, everywhere; its concerns the protection of the female life and health. Some examples are given. However the most frightening risk, much more dangerous than the frequently alleged risk of biological eugenics, is what can be called "economical eugenics". Again some examples are given, in all the systems of social protection. Submitted to ethical rules imposed by political and legal powers, and to the influence of economical forces, what will be the role and the responsibilities of the practitioner? Unfortunately the answer may be obvious: the only way is leading to a relinquishment of medical responsibility. Far away from the dialogue which was the rule of the "dual relationship" between the patient and the practitioner, away too from the more complicated situation of today, characterized by the intervention of "third parties", the evolution, probably unavoidable, appears to be towards the withdrawal of the psychological, moral, human and humanistic involvement of the practitioner, leading him or her to a technical role.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethics, Medical↗

Depression and moral masochism.

Depression and moral masochism are inseparable, and originate in a particular climate of lived experience in which one or both parents suffer from a masochistic-depressive disposition. Developmentally, there has been a deficit in the child's experience of shared pleasure, and of being a source of enjoyment to the parent. Instead, the child experiences himself or herself as a source of pain and feels responsible for the parent's dysphoric, anhedonic state. This is not simply a fantasy construction of the child, as parental reproachfulness is characteristically encountered. The child makes reparative efforts, but they generally do not succeed. Central psychological capacities are compromised under these conditions, particularly a sense of personal efficacy and of natural entitlement. The evolution of initiative, autonomy, and individuation are also significantly affected. The aggression, both conscious and unconscious, which is generated by these early conditions creates intrapsychic conflict which further inhibits the development of these essential psychological functions. Some therapeutic recommendations are proposed based on these considerations.

Aggression↗

Are nursing's 'extraordinary' moral standards realistic?

This paper discusses a hypothetical situation, taken from the author's book Nursing Ethics: a principle-based approach, in which a nurse feels pressured into working beyond his official span of duty. The nurse experiences a conflict between a number of obligations; to patients and clients, to his family and to himself. To which should he give greatest weight? Steven Edwards suggests the nurse's decision is a moral one, based on personal standards held by the nurse.

Ethics, Nursing↗

Diagnosis: poor morale. A wellness program.

A pilot wellness program was designed to develop self-managed emotional responses, optimism, self-empowerment skills and improved interpersonal interactions. The pilot program revealed unexpected differences between nursing division members as well as evidence supporting the original diagnosis-poor morale contributes to anxiety, powerlessness and ineffective coping skills.

Holistic Health↗

Managed care: is it moral?. Interview by Cheryl Slagle King.

The expansion of managed care has raised a number of ethical and moral issues in the evolving health care marketplace. Health care providers have been highly concerned about the dominant shift from quality to cost in the health care marketplace. As a nation, a fundamental challenge we face is determining what comprehensive health care system can be implemented, enabling us to maximize dollars spent on health care while simultaneously improving quality and access. A parallel to the Hitlerian era is used to dramatically illustrate the importance of remembering lessons learned from the past.

Ethics, Nursing↗

A new wellness center concept: integration of the physical therapy and the morale, welfare, and recreation departments.

This case study describes the implementation of a wellness center based on the integration of a Navy outpatient physical therapy department and a morale, welfare, and recreation cardiovascular center. The logistics and services provided are discussed. The productivity of the physical therapy department based on the monthly number of patient treatments is assessed. A statistically significant increase in patient visits of 38% above the previous year was noted. The newly established cardiovascular center averaged 1,500 client visits monthly. This unique collaboration appears to hold promise as an effective wellness center concept.

Cardiovascular Diseases↗

Investing or discounting self: are moral decisions shaped by conditions in the workplace?

Modern socioeconomic trends contribute to the complexity and diversity of ethical issues encountered in clinical nursing practice. Despite growing interest in ethical decision making among nurses, little is known about the contextual influences. The article describes an exploratory study of how nurses make ethical decisions and what factors hindered or helped them to act on their moral choices. Two central constructs were identified: investing and discounting self. The article explains essential subprocesses of these constructs within the context of clinical nursing practice.

Adult↗

The social, moral, ethical, legal and political implications of today's biological technologies: an Indian point of view.

The last 50 years have seen an increasing emphasis on ethical, moral, social, legal, political and economic implications of science for reasons that are discussed in this article. Biotechnology has been no exception to this trend. Areas of biotechnology where the above implications have been important, are briefly described. Ethical and related issues in today's biology-based technologies are discussed with special reference to India. Examples of technological exploitation within a country, or of one country by another, using modern biology-based technologies are given. The possible implications of one new and emerging biology-based technology are discussed. It is concluded that a well-informed and knowledgeable society is the only assured insurance against possible misuse of biology-based technologies of today and tomorrow, including their use for the exploitation of people. The recent decision of the Prime Minister of India to set up a National Knowledge Commission is mentioned in this context.

Biotechnology↗

Moral dilemmas in clinical cancer experimentation.

An examination of certain moral tensions that have developed in clinical cancer experimentation is offered. It is argued that the individual partner must be addressed in his singular unique position, rather than as a potential for the future good.

Antineoplastic Agents↗

Moral responsibilities of trustees: some first thoughts.

The role of a trustee is unclear to most people, including many trustees. The author proposes a view of trustees as persons who have public responsibility for private or independent provision of a public good. This is a moral definition of trusteeship; without trusteeship a pluralist society would be in trouble. The author argues that trustees should be constrained by fiduciary duties, the common good, an interpretative responsibility, and some procedural norms.

Ethics, Institutional↗

Kinetic analysis of the general modifier mechanism of Botts and Morales involving a suicide substrate.

Suicide substrates are widely used in enzymology for studying enzyme mechanisms and designing potential drugs. The presence of a reversible modifier decreases or increases the rate of substrate-induced inactivation, with evident physiological and experimental consequences. To date, only the action of a competitive or uncompetitive inhibitor of an enzyme system involving suicide substrate has been reported. In this paper, we analyse the kinetics of enzyme-catalysed reactions which evolve in accordance with the general modifier mechanisms of Botts and Morales in which enzyme inactivation is induced by suicide substrate. Rapid equilibrium of all of the reversible reaction steps involved is assumed and the time course equations for the residual enzyme activity, the inactive enzyme forms and the reaction product are derived. Partition ratios giving the relative weight of the product and inactive enzyme concentrations, and the relative contribution to the product formation of each of the unmodified and modified catalytic routes, are studied. New indices pointing to the conditions under which the modifier acts as inhibitor or as activator are suggested. The goodness of the analytical solutions is tested by comparison with the simulated curves obtained by numerical integration. An experimental design and kinetic data analysis to evaluate the kinetic parameters from the time progress curves of the product are proposed. From these results, those corresponding to several reaction mechanisms involving both a suicide substrate and a modifier, and which can be regarded as particular cases of the general case analysed here, can be directly and easily derived.

Animals↗

Things ain't what they used to be! Demography, mental cohorts, morality and values in post-war Australia.

This is the "presidential address to the Ninth Biennial Conference of the Australian Population Association, Brisbane, 30 September 1998.... I propose to look back 50 or so years, at a period of demographic change in Australia that I have found intensely interesting, and that it is hard to imagine will be rivalled in extent or profoundness over the next half century." Aspects considered include morality and values--demographic evidence of change; broad changes in nuptiality and fertility; the sexual revolution; contraception; and life cycle changes.

Australia↗

Euthanasia in Greece: moral and ethical dilemmas.

Euthanasia as a concept and a practice has led to enormous debate in Greece, as well as in other countries. In this study, we examined the views of the public and of professionals on the issue of euthanasia. A self-administered questionnaire of 28 items was completed by 417 subjects, and provided information about attitudes towards the moral and ethical problems of euthanasia. Psychiatric speculations which arose during the approach of this issue were seen in the majority of the responses (88.3%). Psychodynamic unconscious processes reinforced and violated mechanisms and motives in favour of, or against euthanasia. Of the respondents, 44.3% were against life extension with mechanical devices. Putative main risk factors for suicidal ideation and the desire for death were: pain 66.2%, despair 60.2%, depression 59.7%, and psychopathology 38.6%. This study thus revealed that apart from pain, psychosocial factors play a key role in leading people to ask for euthanasia. On the other hand, the knowledge of the public and professionals regarding this issue is not sufficient, and thus discussion of euthanasia by Medical Societies is needed and necessary.

Adult↗

The moral high ground: reflections on ethical dilemmas in unethical circumstances.

In this paper we reflect on the challenges of maintaining traditional ethical standards in social health research with asylum seeker detainees. Researchers in this context who begin from a clear advocacy position can face various dilemmas in the research process. The need to demonstrate particular research outcomes that support an advocacy position has the potential to compromise the veracity of the research endeavor. We review the potential benefits and risks to researchers and asylum seekers in this area, and argue that such research must be faithful to the realities encountered, so that rigour is not compromised by the interests of advocacy and a researcher's own moral imperatives.

Australia↗