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PubMed1990

Creating a caring environment: moral obligations in the role of dean.

Mayeroff (1971) states "from a loose stringing together of ideas a tight fabric emerges; ideas intertwine and tend to reinforce each other, making for a mutual deepening of meaning and gain in precision". The fabric throughout this discussion is nursing. Commitment, compassion, confidence, competence, and conscience represent the ideas that, when uniquely and beautifully woven together, create the aesthetic experience of caring in nursing. The dean of a caring-based nursing program is morally obligated to foster an environment that reflects a commitment to caring.

Empathy↗
PubMed1990

[Medical, moral, ethical and legal problems in modern obstetrics].

This paper addresses the problems which have arisen in connection with the improved intensive care of neonates and the possibility of prenatal diagnosis and therapy. Medical problems consist of difficulties in determining the indications. Ethical problems result from the right of decision of the pregnant woman, of her family and of the society beyond the normal physician-patient relationship and there are expert and legal questions, too. A more public evaluation of the patient material may lead to solution of the problems. Ethical and legal principles can be derived from these basic considerations. No new morals and ethics must evolve even if damage to the fetus or malformations can now be recognized antenatally instead of only postnatally as before. Malformations incompatible with life are indications for termination if the pregnant woman so desires. Every other type of malformation is something which the pregnant woman, her family and society must come to terms with. Prenatal medicine is able to soften the consequent burdens for the family and society.

Abortion, Spontaneous↗
PubMedDate not supplied

[Moral specificity of the work of stomatologists].

The ethical problems in the work of the stomatologists are presented by the author in three aspects: has the stomatologist sufficiently good will? has he/she sufficient knowledge and skill? has he/she sufficient possibilities, that is sufficient time to give to the patient, adequate equipment and adequate remuneration. The author believes that the first factor is in the greatest degree dependent on the stomatologist, while the second factor is less dependent, and the third is least (in the national health service system). This means that the responsibility of the stomatologist is greatest in the first case, only half as great in the second case, and least or nearly none in the third case. Attention is called to the shortcomings in the university education of the stomatologists, and lack of continuous postgraduate training. Stress is laid also on inadequate technical equipment and overworking of the dentists. The specific moral problems of various stomatological specialities are mentioned.

Clinical Competence↗
PubMed1986

[Motor activity of the mouth and mouth therapy in cerebral palsy. Preliminary results in the treatment of neuromuscular disorders of the mouth in children with cerebral palsy using the Castillo-Morales concept].

56 patients suffering from connatal cerebral palsy were treated with removable orthodontic appliances possessing stimulation areas according to Castillo-Morales. The intention was to improve the well-known orofacial dysfunctions of these patients. The evaluation of a standard treatment schedule leads to the following statements: The tongue and lip control can be improved in many patients, as well as the chewing and swallowing pattern, the speech and the problem of saliva running out of the mouth. The resting-position of the tongue is normalized in some of the cases. The habit of an open mouth can hardly ever be improved. In a small number of patients some parameters of orofacial function worsened during treatment; in most of these cases, however, a general improvement of orofacial function justified further treatment with palatal plates.

Cerebral Palsy↗
PubMed1983

[Moral and ethical aspects of surgery in the octogenarian].

Through the evolution of medicine, its recent progress, in particular, in the geriatric surgery, new ethical problems arise. It is the surgeon's task to study these problems and, bearing in mind the moral and medical factors, to suggest lines of conduct. On examining the results of this surgery, it is noticeable that one cannot speak of therapeutic eagerness. On the contrary, not to resort to surgery could be assimilated with non-assistance of a person in need. Through its subjectiveness, the notion of quality of life that can be ascertained after surgery, is difficult to describe. It is for the surgeon to see that his own value judgment is not given priority. In this respect, the relation patient-surgeon is most important. The results of geriatric surgery must be critically studied, without forgetting the traditional criteria of duration of life modulated with the supplementary notion of mortality due to the senescence pathology. The scientific study of the results involve post mortem verifications, which are ethically considered as quite normal. The medical body is conscious of the fact that many of the medical progress and in particular those obtained in geriatric surgery, create economical problems. Nevertheless, our task is to push the progress of medicine as far as possible in spite of the economical pressure which it represents. Should the economists and politicians feel these costs are exaggerated, it is they who should inform the population. But, doctors have also the right to say that these economical measures are not justified, and this in relation with the objective results of the type presented today.

Aged↗
PubMed1993

Drug and alcohol testing in the workplace: moral, ethical and legal issues.

The proponents of drug and alcohol testing advance several safety and productivity arguments in support of their position. It is asserted that persons who test positively for drug and alcohol at the workplace experience higher levels of absenteeism and use sick leave to a much greater extent than non-users. Moreover, it is claimed that they have levels of productivity from 10 to 60 per cent lower than persons who do not test positively for drugs or alcohol. Perhaps the greatest argument advanced by those in favour of testing, however, is the safety element. Persons who abuse drugs or who consume alcohol to excess are involved in significantly more accidents than those who test negatively. In other words, proponents take the position that persons who test positively for the presence of drugs or alcohol form a category of individuals and that being in this category is grounds for labelling them as problematic employees. Moreover, so the reasoning goes, the only way to find out if an employee is a member of the category of drug or alcohol users is to test. Opponents of alcohol testing feel that the goal of ensuring a drug- and alcohol-free workplace is reached at too high a social cost and that the testing process constitutes an unwarranted invasion of the privacy of the individual. The provision of urine for analysis is a search, which, if conducted without consent or reason, would constitute an assault. Some opponents to testing feel that the real motivation for testing is controlling employee behaviour. Enterprises impose behavioural constraints on employees that may extend to off-duty times. Moreover, it is advanced that the testing process itself is humiliating to many people. In order to obtain a sample for testing, the person being tested must urinate in the presence of an attendant or supervisor. Often, medical standards are not used. Another moral issue is the implication of discrimination as a result of drug or alcohol testing. Perhaps the greatest concern is the systemic discrimination against disabled persons, persons with acquired immunodeficiency syndrome (AIDS), visible minorities and pregnant women that testing may engender. Again, different countries have addressed the discrimination issue in varying ways. Finally, opponents to drug and alcohol testing question the need to test. It is asserted that all testing shows is that, at some point in time, the person being tested ingested the screened substance.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗
PubMed1994

Filial piety, authoritarian moralism, and cognitive conservatism in Chinese societies.

In the present study, I examined the role of Confucian filial piety in relation to parental attitudes, the function of personality, and social cognition, using data assembled from 11 samples of adults and students in Hong Kong and Taiwan. Results showed that (a) filial attitudes tend to be moderately associated with parental attitudes and child training that emphasize obedience and indebtedness to one's parents, impulse control, and proper conduct; (b) people endorsing traditional filial and/or child-training attitudes tend to be poorer in verbal fluency, to adopt a passive, uncritical, and uncreative orientation toward learning, to hold fatalistic, superstitious, and stereotypic beliefs, and to be authoritarian, dogmatic, and conformist; and (c) parents' attitudes rooted in filial piety tend to result in high rigidity and low cognitive complexity in their children. The results support the contention that filial piety underlies both authoritarian moralism and cognitive conservatism.

Adolescent↗
PubMed1993

Healing the self. The moral meaning of relationships in rehabilitation.

Ethical issues in rehabilitation include both clinical dilemmas and broader philosophic issues about the goals of rehabilitation and the nature of the provider-patient relationship. Two philosophic issues are explored in this paper. One involves the social conceptions of the human good that necessarily underlie rehabilitative care and provide its ethical context. The second is the way in which the clinical reality of rehabilitation challenges the ideals of autonomy and individualism central to mainstream bioethics. This paper argues that only with a moral vocabulary of relationships and transformative healing, rather than with a vocabulary of individualistic autonomy, can rehabilitation convincingly express its social goals and professional mission in an era of scarce resources.

Ethics, Professional↗
PubMed1995

[Ethical problems with the current French practice in therapeutic abortions. Part 3: resolving moral dilemmas in fetal medicine].

OBJECTIVE: Based on the information acquired in the first two parts of this study and the data in the literature, to propose ethic codifications for solving moral dilemmas concerning fetal medicine. METHODS: Identification of situations where the object of the conflict is ethics: general methodology propositions for making individual decisions. RESULTS: In all cases a rigorous method is required, based on three main elements: a complete and well documented medical file; the opinion of the couple after appropriate participative communication; case by case collegial discussion. CONCLUSION: The methodology proposed underscores the roles played by health carers: obtain a medical file as complete as possible with prime emphasis on the infant; establish active communication with the parents giving greater value to their free examination of the situation; collegial discussion in order to be pertinent social partners.

Abortion, Therapeutic↗
PubMed1995

Lessons from history: Horace Wells and the moral features of clinical contexts.

Horace Wells first used nitrous oxide for anesthetic purposes in December 1844. Although his life ended tragically in 1848--and before he received official recognition for his work--Wells' significance in the history of anesthesiology is now firmly established. One hundred fifty yr later, the story of his discovery may also be seen as having significance in terms of ethical issues in health care, particularly as regards clinical decision making. Wells' story provides an example of how the moral dimensions of actions taken in the health care setting can be understood only in the context of the individual, clinical, institutional, and political arenas in which they occur. Resolving ethical conflicts and dilemmas thus requires clinicians to pay attention to such factors as personal, professional, institutional, and broader social, political, and economic considerations that influence what one believes to be "best" in given circumstances.

Anesthesiology↗
PubMed1995

[Psychological and moral problems in physician-patient relations in carcinoma].

In this article the basic moral and psychological problems a doctor encounters in his professional relationship with a cancer patient are being discussed. That relationship should be mature one, humanistic and sincere. Unfortunately, in the reality it is most frequently an emotionally immature to a certain degree even insincere and thus deprived of its humanistic attributes. The reasons for such a situation are partly concealed in the very psychological problems a doctor might have, which is closely linked to his unconscious motivation for selecting this particular profession as his or her walk of life. The aformentioned problems must be seen in the light of a wide-spread fallacy that the patient need to be preserved from knowing the truth of their doomed state. However, in the same time, there is doctrinary attitude that instructs doctors to reveal all the details describing the situation realistically to the patient but in sincere, thoughtful, warm, humanistic way that can instill some hope to the patient's view on his illness. The mechanisms of phychological defense patients uses when faced to the truth are also being analysed, as well as all therapeutic preventive measures that should have to be taken in addvesing the same issue.

Communication↗
PubMed1998

[Psychological, moral-ethic and deontologic aspects of relaparotomy].

Analysis of the results of relaparotomy in 208 patients is presented. Psychological, moral, ethic and deontologic aspects of repeated laparotomy have been studied. In indications for relaparotomy the choice of the surgeon is advisable to make as a collective decision, on individual basis, after careful analysis of the causes of postoperative complications and with regard for the wish of the surgeon who performed the first operation. In 137 patients of 208 relaparotomy was carried out by the surgeon by whom the first operation was performed, with the assistance of more experienced surgeons. Lethality made up 35% (48 patients died after the operation). 60 patients were reoperated by the other surgeons with the assistance of the surgeon who had carried out primary operation. In 11 cases relaporotomy was carried out without participation of the surgeon who had performed the initial laparotomy. 24 (33.8%) patients died after relaparotomy performed by the other surgeons. "Radical" relaparotomies were carried out in 141 patients, in 94 (66.7%) of them being performed by the surgeon who had done the initial operation and in 47 (33.3%)--by the other surgeons. 25 (17.7%) patients died after "radical" relaparotomies and after "palliative"--47 (70.1%) patients. Total lethality after relaparotomy made up 34.6%.

Adolescent↗
PubMed1994

Modifying autonomy--a concept grounded in nurses' experiences of moral decision-making in psychiatric practice.

Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autonomy' and its dimensions, such as being aware of the patient's vulnerability, caring for and caring about the patient, were identified. The findings in this study make clear the need for further research into the experiential aspect of ethical decision-making in psychiatric practice.

Beneficence↗