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PubMed2006

ESHRE Task Force on Ethics and Law 11: Posthumous assisted reproduction.

This article analyses the different ethical aspects of posthumous assisted reproduction. Two situations are distinguished: cases in which the gametes or embryos are used by the surviving partner and cases in which the gametes or embryos are made available for third persons. The moral evaluation of the procedure depends on whether the act is restricted to the existing parental project. A major difficulty for the moral evaluation is the inconclusiveness of the empirical data on the psychosocial development of children born after this procedure. The Task Force concluded that posthumous reproduction by a partner is acceptable if the following conditions are met: written consent has been given by the deceased person, the partner received extensive counselling and a minimum waiting period of 1 year is imposed before a treatment can be started. For use by third parties, the usual conditions for gamete and embryo donation apply.

Advisory Committees↗
PubMed1997

Embryo research and public policy: a philosopher's appraisal.

The development of public policy on bioethical issues can be approached through substantive moral and philosophic reasoning, or through balancing perceived societal views as to what is ethically acceptable. The Human Embryo Research Panel had to apply the first approach to the question of the moral status of the preimplantation embryo. Only after concluding that the preimplantation embryo was not a full human subject could the panel consider the conditions under which embryo research was ethically acceptable, given a range of societal views, concerns, and interests.

Advisory Committees↗
PubMed1986

In-vitro fertilization: the ethics.

This paper is addressed to practitioners. It seeks to acquaint them with 'ethical' arguments against their work which, because they are simple and plausible, persuade many people. These arguments are briefly rehearsed and as briefly examined. A more positive ethics of in-vitro fertilization is presented which seeks to respect (a) what is known in the relevant science and done in developing practice; (b) the inseparability of research from clinical application; (c) a moral tradition of long-standing which relates the protection of fetal life pari passu with its own morphological growth towards maturity; (d) the moral sense of properly informed persons whose judgements we trust in other areas of life. Practitioners themselves are to be defended as the proper moral agents (that is, to be entrusted with decisions) provided that they are careful (a) to keep public confidence by means of a corporate self-discipline; (b) to keep faith with patients and research subjects; (c) to maintain mutual trust between research scientists and clinical practitioners; (d) to safeguard the liberty of disciplined enquiry, of purposeful curiosity, as being inherent in the notion of a science, necessary to therapeutic advance, and proper to the nature of man. The author writes from within the theological tradition of the Church of England.

Abortion, Legal↗
PubMed2005

Sleep patterns of young men and women enrolled at the United States Military Academy: results from year 1 of a 4-year longitudinal study.

STUDY OBJECTIVES: Sleep patterns of young adults are different from those of other age groups.. This study examined sleep patterns of cadets during their first year at the United States Military Academy. DESIGN: This paper presents initial results of a 4-year longitudinal investigation into sleep patterns of college-age men and women. SETTING: Data were collected at the United States Military Academy, a 4-year undergraduate institution that develops men and women in 4 areas: intellectual, physical, military, and moral-ethical. PARTICIPANTS: Survey data were obtained from all members of the Class of 2007 (N approximately 1300), who ranged in age from 17 to 22 years. A stratified sample (n = 80) was selected to wear wrist-activity monitors. An additional 40 members of the junior and senior classes participated in the summer portion of the study. MEASUREMENTS AND RESULTS: Sleep patterns prior to entering the United States Military Academy were compared with patterns during cadet basic training and fall and spring semesters. Actigraphy data were recorded on a sample of the class (n = 80) for 50 days during cadet basic training and 30 days during fall and spring semesters. During cadet basic training, incoming cadets received 5 hours 40 minutes of sleep per night. During fall 2003 semester, these same cadets received 4 hours 50 minutes of sleep on school nights and 6 hours 32 minutes on weekends. Sleep received during spring 2004 semester was similar, with 5 hours 06 minutes on school nights and 6 hours 29 minutes on weekends. CONCLUSIONS: This first year of baseline data collection describes cadet sleep patterns and sets the stage to assess the effectiveness of follow-on interventions.

Adolescent↗
PubMed1991

The concept of hope revisited for nursing.

The development of nursing knowledge and interventions involve understanding human responses and needs. The human response of hope was identified as a concept in need of further clarification. The purpose of this paper was to review definitions and contextual usage of the word 'hope' from the literature and answer the conceptual question 'What is hope?' Literature from theology, philosophy, psychology and nursing was reviewed for contextual usage of the word 'hope'. In the literature, hope was viewed as part of human development, a process, a theory and a source of meaning in life. In addition, antecedents, attributes and outcomes of hope were identified from the literature that contributed to a clearer understanding of the concept.

Affect↗
PubMed2005

The ethics of relation: public health nurses and child protection clients.

AIM: The aim of this paper is to show how a framework of relational ethics may be used in establishing trusting relationships with at-risk families. BACKGROUND: Public health nurses have historically carried out assessment and monitoring of parenting within the family home, particularly with at-risk families. In this role, they are placed in the position of simultaneously supporting and policing the family. A trusting relationship may be difficult to develop if parents feel threatened by the surveillance aspect of home visiting and the threat of action (such as removal of children) being taken against the family. DISCUSSION: Development of optimal trust relationships may be a challenge when families are experiencing powerlessness and oppression. The four themes of relational ethics--mutual respect, engaged interaction, embodiment and creating environment--provide a framework for developing trusting relationships with families. CONCLUSION: It is possible to have a moral and trusting relationship with at-risk families, but this needs to based on critical self-reflection by nurses and mutually respectful nurse-family relations.

Attitude of Health Personnel↗
PubMed2006

Medicating the mind: a Kantian analysis of overprescribing psychoactive drugs.

Psychoactive drugs are being prescribed to millions of Americans at an increasing rate. In many cases these drugs are necessary in order to overcome debilitating emotional problems. Yet in other instances, these drugs are used to supplant, not supplement, interpersonal therapy. The process of overcoming emotional obstacles by introspection and the attainment of self knowledge is gradually being eroded via the gratuitous use of psychoactive medication in order to rapidly attain a release from the common problems that life inevitably presents us with. In this paper, I argue that Kant's formula of humanity, which maintains that persons ought never to treat others or themselves soley as a means to an end, proscribes this. Moreover, Kant argues that we have an imperfect duty of self development, and I argue that we fail to adhere to such a duty whenever we seek to evade the process of introspection and self knowledge in favour of the expedient results that drugs may provide us with as we attempt to overcome the emotional hurdles in our lives.

Attitude of Health Personnel↗
PubMed2001

Is it possible to assess the "ethics" of medical school applicants?

Questions surrounding the assessment of medical school applicants' morality are difficult but they are nevertheless important for medical schools to consider. It is probably inappropriate to attempt to assess medical school applicants' ethical knowledge, moral reasoning, or beliefs about ethical issues as these all may be developed during the process of education. Attitudes towards ethical issues and ethical sensitivity, however, might be tested in the context of testing for personality attributes. Before any "ethics" testing is introduced as part of screening for admission to medical school it would require validation. We suggest a number of ways in which this might be achieved.

Attitude to Health↗
PubMed1975

Personality.

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Cognition↗
PubMed2003

Mental health.

OBJECTIVE: Only in the last 30 years has psychiatry begun to develop empirical approaches to conceptualizing and assessing positive mental health. Six models of mental health are reviewed here. METHOD: The author points out pitfalls in research on mental health, e.g., equating average with healthy, failing to distinguish trait from state, overlooking cultural norms, and conversely, blindly accepting the culture's values. He describes the six models and provides history and research needs for each. RESULTS: The first model, being "above normal," is epitomized by DSM-IV's axis V, the Global Assessment of Functioning Scale. High scores represent "superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities." The goal of the second model, positive psychology, is intervention to maximize positive qualities, such as self-efficacy. Maturity and Erikson's four developmental tasks (identity, intimacy, generativity, integrity) are the basis of the third model. The author adds two other tasks: career consolidation and "keeper of the meaning." The fourth model is emotional or social intelligence, the ability to read other people's emotions. Surprisingly, subjective well-being, the fifth model, is as much a characteristic of temperament as of a benign environment. The last model, resilience, is epitomized by DSM-IV's Defense Function Scale, which categorizes coping mechanisms in terms of adaptational value. CONCLUSIONS: As with the blind men and the elephant, each model describes only some aspects of mental health. Further research may reveal the contribution of each.

Achievement↗
PubMed1971

Student dissent.

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Attitude↗
PubMedDate not supplied

Farmers' self-surveillance of pesticide poisoning: a 12-month pilot in northern Vietnam.

This pilot program was designed to: 1) determine whether farmers could use a simple self-reporting system to estimate the incidence of occupationally related, self-limited pesticide poisonings; 2) describe the frequencies and types of pesticide products used in spraying operations; and 3) assess whether self-reporting and feedback would influence spraying behaviors. For 12 months, 50 farmers in northern Vietnam recorded after every spraying session any adverse health effect and the pesticide used. Data were also gathered from 50 controls. Of the 1,798 recorded spray operations, 8% were asymptomatic, 61% associated with vague ill-defined effects, and 31% accompanied by a least one clear or symptom of poisoning. After six months, the self-reporting farmers' spraying frequency and use of highly hazardous products (Ia/Ib) had declined more significantly than in the controls, as had their moderate adverse health effects. This low-cost surveillance method influenced the behaviors of farmers given access to IPM farmer field schools. The study also demonstrated the value of farmers as informants.

Adult↗
PubMed2005

Wastage in the health workforce: some perspectives from African countries.

BACKGROUND: Sub-Saharan Africa faces a human resources crisis in the health sector. Over the past two decades its population has increased substantially, with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers, but this notwithstanding, sub-Saharan African countries also experience significant wastage of their human resources stock. METHODS: This paper is a desk review to illustrate suggestions that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers. The paper suggests data types for use in measuring various forms of "wastage". RESULTS: "Direct" wastage--or avoidable increases in loss of staff through factors such as emigration and death--is on the rise, perhaps as a result of the HIV/AIDS epidemic. "Indirect" wastage--which is the result of losses in output and productivity from health professionals' misapplied skills, absenteeism, poor support and lack of supervision--is also common. HIV/AIDS represents a special cause of wastage in Africa. Deaths of health workers, fear of infection, burnout, absenteeism, heavy workloads and stress affect productivity. CONCLUSION: The paper reviews strategies that have been proposed and/or implemented. It suggests areas needing further attention, including: developing and using indicators for monitoring and managing wastage; enhancing motivation and morale of health workers; protecting and valuing the health worker with enhanced occupational safety and welfare systems; and establishing the moral leadership to effectively tackle HIV/AIDS and the brain drain.

Journal Article↗
PubMed2001

Clinical course and outcome of patients admitted to an ICU for status asthmaticus.

STUDY OBJECTIVES: To describe the prognostic factors, clinical course, and outcome of patients with status asthmaticus treated in a medical ICU (MICU). DESIGN: Analysis of prospective data. SETTING: A multidisciplinary MICU of an inner-city university hospital. PATIENTS: We collected data on 132 hospital admissions of 89 patients with status asthmaticus treated in our MICU from August 1995 through July 1998. MEASUREMENTS: APACHE (acute physiology and chronic health evaluation) II scores were among the parameters measured. RESULTS: Seventy-nine percent of the patients were female, and 67% were African American (mean +/- SD age, 42.4 +/- 15.1 years). Patients in 48 of the 132 hospital admissions (36%) required invasive mechanical ventilation; sepsis developed in patients during 17 hospital admissions (13%), nonpulmonary organ failure developed during 16 hospital admissions (12%), and ARDS developed during 2 hospital admissions (2%). Pneumothorax developed in four patients and required tube thoracostomy in all four patients. The median APACHE II score was 11. Predicted mortality and actual mortality were 6.7% and 8.3%, respectively. The two most common immediate causes of death were pneumothorax (n = 3) and nosocomial infection (n = 3). All the deaths occurred in female patients. Compared with survivors, nonsurvivors had higher APACHE II scores (median, 26 vs 15; p < 0.0001), PaCO(2) (63.8 +/- 21.3 mm Hg vs 47.8 +/- 19.1 mm Hg, p = 0.0101), and lower arterial pH (7.09 +/- 0.12 vs 7.27 +/- 0.12, p < 0.0001), respectively. Patients in 10 of 48 hospital admissions (21%) who required mechanical ventilation died. CONCLUSIONS: The hospital mortality of patients admitted to an MICU for status asthmaticus is higher than expected. Higher APACHE II score and PaCO(2) and lower arterial pH within 24 h of hospital admission are associated with increased mortality. Sepsis and nonpulmonary organ failure are more likely to develop in nonsurvivors than survivors.

APACHE↗