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PubMed1989

Infertility and bioethical issues of the new reproductive technologies.

The scientific breakthroughs resulting in the delivery of Louise Brown in 1978 have opened the floodgates for an ongoing bioethical discussion about medically assisted reproduction. The majority in our society has accepted in vitro fertilization as an ethically justifiable procedure for infertile couples. The concern persists, however, that new reproductive technology has started us on the course of a slippery slope with potentially dire consequences for the so-created children, the traditional family, and, indeed, for society as a whole. The moral status of the embryo is the central issue in debates about such reproductive developments as the "spare" embryo, embryo freezing, embryo donation, embryo research and micromanipulation. Conflicts of interests between the adult's desire to become a parent and the welfare of the offspring are at the root of moral objections raised against manipulation of human reproduction. Extracorporal conception with the possibility for various gamete donors has also brought the long-practiced procedure of artificial insemination by donor and the potential consequences for the child into the discussion. Surrogate mothering and surrogate gestational mothering force us to redefine the age old dictum mater certa est and can render the child a helpless pawn in parental, emotional, and legal strife. Over the ages, society has through firmly established values exerted control over reproduction and acceptance of the new member in the community. Sex without reproduction was a severe blow to the highly regarded societal belief in parenting as the epitomy of life goals. Reproduction without sex through various technically feasible collaborative means further jolts fundamental traditional values and mandates their re-evaluation. Ethical belief systems are by nature highly charged and fiercely defended. Thus, in a pluralistic society, a consensus on the question "What ought to be done of all that can be done with new reproductive technologies?" is probably unachievable. Heated controversies between interest groups constitute an additional psychological burden complicating the ethical ambiguities for some infertile couples who have to decide about using noncoital conception. The interdisciplinary group report by the ethics committee of the American Fertility Society published in the "Ethical Considerations of the New Reproductive Technologies" constitutes a wide framework of guidelines for rational consideration. It will, one hopes, help to formulate needed regulations because some segments of our society as well as many scientists and physicians in the field believe that not all that potentially can be done ought to be done.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethics, Medical↗
PubMed2005

Core ethical issues of clinical nursing supervision.

Clinical nursing supervision enables supervisees to reflect on ethically difficult caring situations, thereby strengthening their professional identity, integrating nursing theory and practice, and leading to the development of ethical competence. The aim of this study was to develop an understanding of the core ethical issues of clinical nursing supervision, using previous research as well as philosophical analysis of the theories of three moral philosophers: Harald Ofstad, Richard Hare and Carol Gilligan. The ultimate aim of this study was to develop a general model for ethical decision-making and to establish its relevance for clinical nursing supervision. The findings highlight four important values for the development of a basis for ethical decision-making. These values are caring, dignity, responsibility and virtue.

Decision Making↗
PubMed1983

Structural stability of well-being factors across age and gender, and development of scales of well-being unbiased for age and gender.

Well-being, life satisfaction, morale, or affect valence is often used as an outcome in studies of adult life. Many instruments are available, and choice among them is difficult. There is need for information regarding the structure underlying what they measure and, in view of rising interest in adult-span models and investigations, for instruments that are unbiased with respect to age. Analysis of the items in several instruments showed four factors that seem to define the dimensions underlying these measures and that are constant across age (25 and older) and gender. Reliable scales developed on the basis of the factors provide measures that are, for all practical purposes, unbiased with respect to age and gender. Both factors and scales were cross-validated with a second sample.

Adult↗
PubMed1991

Development's 'downside': social and psychological pathology in countries undergoing social change.

Emphasis on the decline in mortality related to infectious disease, the improvement in child survival and the extension in longevity creates an optimistic view of the effects on health of social change. In contrast, attention to behavioural and social problems apparently stemming from current global social transformations leads to a more negative assessment. Specific historical processes shape local worlds of experience so as to yield complex patterns of social change with multiple outcomes. Study should be directed at the specific mediating social and moral processes that yield negative mental-health outcomes in order to develop international mental-health policy to guide prevention, and to control the dangerously destructive effects of specific social transformations, planned as well as unplanned.

Developing Countries↗
PubMed1998

The changing moral landscape of human reproduction: two moments in the history of in vitro fertilization.

Ethical attitudes toward in vitro fertilization (IVF) have varied historically. This paper discusses the changes in views about the morality of human IVF by exploring the response to a pair of critical moments in the history of this reproductive technology: the announcement of the first successful IVF experiment by John Rock and Miriam Menkin in 1944 and the first successful IVF live birth of Louise Brown in 1978. By exploring public and private reactions to these two events in the context of wider social and political developments, this paper demonstrates the degree to which our notions of the morality of medical experimentation and of reproductive technologies are socially constructed and historically contingent.

England↗
PubMed2005

Morale and job perception of community mental health professionals in Berlin and London.

INTRODUCTION: Morale and job perception of staff in community mental health care may influence feasibility and quality of care, and some research has suggested particularly high burnout of staff in the community. The aims of this study were to: a) assess morale, i. e. team identity, job satisfaction and burnout, in psychiatrists, community psychiatric nurses and social workers in community mental health care in Berlin and London; b) compare findings between the groups and test whether personal characteristics, place of working and professional group predict morale; and c) explore what tasks, obstacles, skills, enjoyable and stressful aspects interviewees perceived as important in their jobs. METHODS: In all, 189 mental health professionals (a minimum of 30 in each of the six groups) responded to a postal survey and reported activities per week using pre-formed categories. Perception of professional role was assessed on the Team Identity Scale, job satisfaction on the Minnesota Job Satisfaction Scale, and burnout on the Maslach Burnout Inventory. Seven simple open questions were used to elicit the main tasks, skills that staff did and did not feel competent in, aspects that they did and did not enjoy in their job, and obstacles and factors that caused pressure. Answers were subjected to content analysis using a posteriori formed categories. RESULTS: Weekly activities and morale varied between sites and professional groups. Some mean scores for groups in London exceeded the threshold for a burnout syndrome, and are particularly less favourable for social workers. Working in London predicted higher burnout, lower job satisfaction and lower team identity. Being a psychiatrist predicted higher team identity, whilst being a social worker was associated with higher burnout and lower job satisfaction. Male gender predicted lower burnout and higher team identity. However, professional group and site interacted in predicting burnout and job satisfaction. Psychiatrists in London had much more favourable scores than the other two groups, whilst this did not hold true in Berlin. Answers to open questions revealed universal aspects, such as enjoying direct patient contact and disliking bureaucracy, but also various views that were specific to a site or professional group or both. CONCLUSIONS: Burnout remains a problem for some, but not all, professional groups in community mental health care, and social workers in London appear to be a group with particularly low morale. Differences between professional groups depend on the location, and it remains unclear to what extent job-related and general factors impact on the morale of mental health professionals. Answers to open questions reveal general as well as specific aspects of the job perception of the professional groups, some of which may be relevant for service development, training and supervision. More conceptual and methodological work and more extensive studies are required to develop a better understanding of how community mental health professionals perceive their job and how morale may be improved.

Adult↗
PubMed1990

Developing specialty-wide standards of practice: the experience of ophthalmology.

In 1986, the American Academy of Ophthalmology (AAO) developed national guidelines for the diagnosis and treatment of major eye disease. A core committee of 10 AAO members detailed the framework and goals for the guidelines and wrote a series of broad criteria outlining the ophthalmologist's moral and ethical responsibilities. Several panels of AAO-physician experts were formed to develop guidelines for specific conditions. The panels were formed according to subspecialty and were assigned well-defined issues, such as the diagnosis and management of chronic, adult-onset open-angle glaucoma. Process and structure standards were developed first; outcome standards are scheduled for future development. The first five sets of practice guidelines have been approved by the AAO's Governing Council. These include standards for the comprehensive eye exam, as well as four disease-specific guidelines--open-angle glaucoma, glaucoma suspect, diabetic eye disease, and cataract.

Clinical Protocols↗
PubMed2002

Principles of ethical decision making regarding embryonic stem cell research in Germany.

The availability of embryonic stem (ES) cells isolated from human blastocysts may open novel avenues for medical treatment of otherwise incurable diseases. Yet the generation of human ES cells requires the destruction of early human embryos. This confronts us with the moral problem of whether it is justifiable to sacrifice human life in order to treat other human life. This article outlines the development of the German debate about research with ES cells and explicates the arguments that are central to that debate with respect to the aims and means of research with ES cells. With regard to the means, the isolation of ES cells from human embryos raises the question of the moral status of the human embryo. A restrictive position acknowledges the human dignity of the embryo in its very early stage of development and claims that the embryo's life must be protected accordingly. In contrast, a gradualist position acknowledges human dignity, and therefore the full level of protection, only when the embryo has reached a certain stage of development. In addition, the intentions behind the generation of human embryos, i.e. exclusively for research purposes, and the mode of generating them, i.e. by nuclear transfer technology, have strong ethical relevance in the German debate. Based on these results, the ethical reasoning underlying the draft of a Stem Cell Act recently passed by the German Parliament is outlined.

Advisory Committees↗
PubMedDate not supplied

Developing a patient information brochure.

In light of increasing consumer demands for information and the growing complexity of healthcare facilities, the need has arisen to present the public with useful information concerning your medical group. A patient information brochure can be a valuable public relations device as well as a time saver. It can serve as a written record of key policies and procedures and can also be a morale builder for patients and staff. If your medical group has not yet developed a patient information brochure, you will be able to glean many practical tips from this article. Drawing from experience, the author traces through the steps of developing the brochure--from exploring current models and choosing an appropriate team for the project, through production details.

Group Practice↗
PubMed1991

Self-defeating personality and perceptions of family environment.

People scoring higher on a scale of self-defeating personality perceived their family environments as lacking cohesiveness. Men also perceived their family environments as discouraging open expression of feelings, being unconcerned about school and work achievement, and providing no ethical or religious values. Results were seen as lending validity to clinical theories of masochism which relate lack of family support and lack of reinforcement for assertive, efficacious behavior to the development of self-defeating behavior patterns.

Achievement↗
PubMed2003

Strategies of control, aggression, and morality in preschoolers: an evolutionary perspective.

Moral reasoning, moral affect, social problem solving skills, and social preferences were assessed in 163 ethnically mixed preschoolers (2.86-5.95 years). Participants were rated by their teachers on prosocial and coercive strategies of control, success at resource control, and aggression (overt and relational). Based on their employment of coercive and prosocial strategies of resource control, the children were categorized as bistrategic controllers, coercive controllers, prosocial controllers, noncontrollers, or typicals. Teacher-rated relational aggression was positively associated with moral maturity in girls. Bistrategic controllers, although aggressive, were morally mature and preferred play partners by their peers. The results are discussed in terms of hypotheses that arise from evolutionary theory which suggests that highly effective resource controllers would be simultaneously aggressive and yet well aware of moral norms. The findings are contrasted with alternative hypotheses that might arise variously from traditional and prevailing approaches.

Affect↗
PubMed1992

[Constraint and inclination for reducing complexity--social cognitive aspects of moral judgment in children].

When processing information about their reality human beings systematically reduce objective complexity. This is not only true in cognitive problem solving, but also in other every-day situations, e.g., when decisions in situations of moral relevance are required. From a developmental psychological point of view the adequate handling of such situations requires, on the one hand, an age-related differentiation of social cognitions, and, on the other hand, an increasingly effective structuring and integration of information. The latter developmental process, however, bears the danger that an adequate psychosocial development is substituted by a tendency toward complexity reduction in the sense of oversimplification due to the fact that such a tendency may suggest situation-specific alternative actions which are seemingly "easier to handle". In an empirical study with 176 students from Polytechnical High Schools in (East-)Berlin the hypothesis is tested if a tendency toward oversimplification in (fictitious) situations of moral relevance is systematically related to deviant behavior at school. Results show that indeed deviant students have a stronger tendency toward oversimplifying social cognitions than non-deviant students. Furthermore, it can be shown that this result is not moderated by possible sex, age or academic performance effects. As results with regard to moral judgement in the Kohlbergian sense differ substantially in their relation to academic performance and to behavioral deviance, it is assumed that the two judgement processes differ conceptually.

Adolescent↗
PubMed2005

Developing human-nonhuman chimeras in human stem cell research: ethical issues and boundaries.

The transplantation of adult human neural stem cells into prenatal non-humans offers an avenue for studying human neural cell development without direct use of human embryos. However, such experiments raise significant ethical concerns about mixing human and nonhuman materials in ways that could result in the development of human-nonhuman chimeras. This paper examines four arguments against such research, the moral taboo, species integrity, "unnaturalness," and human dignity arguments, and finds the last plausible. It argues that the transfer of human brain or retinal stem cells to nonhuman embryos would not result in the development of human-nonhuman chimeras that denigrate human dignity, provided such stem cells are dissociated. The article provides guidelines that set ethical boundaries for conducting such research that are consonant with the requirements of human dignity.

Animal Experimentation↗
PubMed2005

Registered Nurses' personal rights vs. professional responsibility in caring for members of underserved and disenfranchised populations.

AIMS: Health disparities exist and refer to the chasms in health status between the advantaged and disadvantaged. Intense multiculturalism will require different approaches and moral obligations to work with these groups and urgency exists to develop nursing caring strategies when dealing with these populations. Development of nursing curricula which identify prejudicial thinking and intolerance for marginalized groups will help to decrease fears and increase nurses' willingness to provide culturally competent health care for underserved and disenfranchised populations. BACKGROUND: Caring for members of disenfranchised groups instills fear at some level in nurses who are working with these individuals. This fear may be due, in part, to the potential harm nurses perceive the patient may cause them, or perhaps it is because they feel they could possibly be in the individual's situation at some point in their lives. Prejudice and discrimination continue to exist in society and have adversely affected the health care system and the nursing profession. Discrimination may be based on differences due to age, ability, gender, race, ethnicity, religion, sexual orientation, or any characteristics by which people differ. RELEVANCE TO CLINICAL PRACTICE: Registered Nurses are accountable for nursing decisions and actions regardless of personal preferences. Due to the rapidly changing healthcare system the nurse faces increasing ethical dilemmas and human rights issues. Nurses are individually accountable for caring for each patient and the right to refuse an assignment should be carefully interpreted to avoid patient abandonment. Nurses' objections can be based on moral, ethical, or religious beliefs not on personal preferences and in an emergency the nurse must provide treatment regardless of any personal objections.

Attitude of Health Personnel↗
PubMed1994

Erythromycin ototoxicity in liver transplant patients.

We report on three liver transplant patients who developed erythromycin-related ototoxicity. This complication has been described in renal transplant patients and in patients with liver dysfunction, but to our knowledge it has not yet been reported in liver transplant patients. The influence of hepatic dysfunction, common renal failure, and the interaction between cyclosporin and erythromycin in the development of erythromycin ototoxicity are discussed.

Adult↗
PubMed2006

Reduced expression of the LIM-homeobox gene Lhx3 impairs growth and differentiation of Rathke's pouch and increases cell apoptosis during mouse pituitary development.

The formation of the anterior and intermediate lobes of the pituitary gland is a multi-step process regulated by cell-cell interactions involving a number of signaling pathways and by cascades of cell-intrinsic transcription factors. The LIM-homeodoamin protein Lhx3 has previously been shown to play an essential role in the growth of Rathke's pouch, a primordium of the anterior and intermediate lobes of the pituitary. However, the mechanisms underlying the function and regulation of Lhx3 remain to be elucidated. Here we report that a targeted insertion of a DNA fragment in the 3'-untranslated region of the Lhx3 gene reduces the expression of both Lhx3 mRNA and protein in Rathke's pouch. Mutant mice homozygous for this Lhx3 allele show severe hypoplasia of the pouch, a defect identical to that observed in Lhx3-null mutants. To gain insights into the mechanism of Lhx3 function in pituitary development, we further analyzed the Lhx3 deficient mutants by examination of early pituitary marker expression, cell proliferation, and cell apoptosis. Our results revealed an increase in cell apoptosis and a loss of Islet1 and Calbindin marker expression in Rathke's pouch of these mutants. Recently, increased cell apoptosis in Rathke's pouch has been described in mutant mice impaired in the function of the bicoid-like homeodomain proteins Pitx1 and Pitx2. In those mutants, the expression of Lhx3 is absent. Our results thus underscore the view that Lhx3 functions downstream of the Pitx factors in the same transcriptional cascade that controls growth and early cell differentiation of the developing pituitary gland.

Animals↗