Nurs Ethics. 2015 Jan 6. pii: 0969733014564907. [Epub ahead of print]

Coercion in nursing homes: Perspectives of patients and relatives.

Gjerberg E1, Lillemoen L2, Pedersen R2, Førde R2.

Author information

• 1University of Oslo, Norway elisabeth.gjerberg@medisin.uio.no.
• 2University of Oslo, Norway.

Abstract

BACKGROUND:

Studies have demonstrated the extensive use of coercion in Norwegian nursing homes, which represents ethical, professional as well as legal challenges to the staff. We have, however, limited knowledge of the experiences and views of nursing home patients and their relatives.

OBJECTIVES:

The aim of this study is to explore the perspectives of nursing home patients and next of kin on the use of coercion; are there situations where the use of coercion can be defended, and if so, under which circumstances?

METHODS:

The data are based on individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 60 relatives.

ETHICAL CONSIDERATIONS:

Participation was based on written informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics.

RESULTS:

More than half of the patients and the majority of the relatives accepted the use of coercion, trusting the staff to act in the patient's best interest. However, the acceptance of coercion is strongly related to the patients' lack of understanding, to prevent health risks and to preserve the patient's dignity.

CONCLUSION:

The majority of nursing home patients and relatives accepted the use of coercion in specific situations, while at the same time they emphasised the need to try alternative strategies first. There is still a need for good qualitative research on the use of coercion in nursing homes, especially with a closer focus on the perspectives and experiences of nursing home patients.

Ann Surg. 2015 Feb;261(2):237-239.

Ensuring Excellence in Centers of Excellence Programs.

Mehrotra A1, Dimick JB.

Author information

• 1*Department of Health Care Policy, Harvard Medical School, Boston, MA †Centers for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI.

Abstract

Studies have found associations between better outcomes and a variety of structural and process criteria that help explain the wide outcome variations that occur across hospitals. In response, Centers of Excellence programs have been developed by multiple third parties. Despite this, programs have yielded disappointing results and can have unintended consequences. To outweigh potential harms, outcomes at Centers of Excellence must be clearly superior. We need to change how hospitals are designated and provide evidence that Centers of Excellence are truly excellent.

Semin Reprod Med. 2015 Jan;33(1):53-60. Epub 2015 Jan 7.

The Health of Women and Girls: How Can We Address Gender Equality and Gender Equity?

Payne S1.

Author information

• 1School for Policy Studies, University of Bristol, Bristol, England.

Abstract

This article focuses on the health of women and girls, and the role of addressing gender inequalities experienced by women and girls. The health of both males and females is influenced by sex, or biological factors, and gender, or socially constructed influences, including gender differences in the distribution and impact of social determinants of health, access to health promoting resources, health behaviors and gender discourse, and the ways in which health systems are organized and financed, and how they deliver care. Various strategies to address the health of women and girls have been developed at intergovernmental, regional, and national level, and by international nongovernmental organizations. These include vertical programs which aim to target specific health risks and deliver services to meet women and girl's needs, and more cross-cutting approaches which aim at "gender" policy making. Much of this work has developed following the adoption of gender mainstreaming principles across different policyarenas and scales of policy making, and this article reviews some of these strategies and the evidence for their success, before concluding with a consideration of future directions in global policy.

J Law Med Ethics. 2014 Dec;42(4):412-419. doi: 10.1111/jlme.12164.

Commercial Pressures on Professionalism in American Medical Care: From Medicare to the Affordable Care Act.

Marmor TR1, Gordon RW.

Author information

• 1Teaches at the schools of Medicine and Management and at the Institute for Social Policy Studies at Yale University.

Abstract

Since the passage of Medicare, the self-regulation characteristic of professionalism in health care has come under steady assault. While Canadian physicians chose to relinquish financial autonomy, they have enjoyed far greater professional autonomy over their medical judgments than their U.S. counterparts who increasingly have their practices micromanaged. The Affordable Care Act illustrates the ways that managerial strategies and a market model of health care have shaped the financing and delivery of health care in the U.S., often with little or no evidence of their effectiveness.

J Law Med Ethics. 2014 Dec;42(4):455-474. doi: 10.1111/jlme.12168.

Beyond the Market: The Role of Constitutions in Health Care System Convergence in the United States of America and the United Kingdom.

Fletcher J1, Marriott J.

Author information

• 1Lecturer in Law at the University of Winchester in the United Kingdom.

Abstract

Health care reform in the United States (US) and United Kingdom (UK) has resulted in the cross-fertilization of policy. The "new" health care models adopted by the two jurisdictions utilize free market principles for reasons of quality, efficiency, and cost, but also feature characteristics of a state-run model, through the provision of a safety net for citizens and a buffer against the commodification of health. In this sense, the health care systems of the US and UK are more congruent than they were. Here we identify two distinct narratives that emerge from health care reform undertaken in these jurisdictions. The "revolutionary" narrative views the reforms as fundamental change whilst the "evolutionary" narrative accepts them as natural development. We argue that neither the revolutionary nor the evolutionary narrative adequately characterizes the reforms undertaken in health care because neither takes sufficient account of the broader setting in which reform has occurred. In seeking to examine and explain the jurisdictions' apparent drive to the middle, we propose a distinctive evolutionary narrative, that of "convergence," which, as well as adopting a less parochial perspective on developments in health care policy and provision, also situates the reforms politically, constitutionally, and comparatively.

J Law Med Ethics. 2014 Dec;42(4):475-491. doi: 10.1111/jlme.12169.

Trust and Transparency: Patient Perceptions of Physicians' Financial Relationships with Pharmaceutical Companies.

Perry JE1, Cox D, Cox AD.

Author information

• 1Assistant Professor of Business Law and Ethics and a Research Coordinator in the Center for the Business of Life Sciences at Indiana University's Kelley School of Business.

Abstract

Financial ties between physicians and pharmaceutical companies are pervasive and controversial. However, little is known about how patients perceive such ties. This paper describes an experiment examining how a national sample of U.S. adults perceived a variety of financial relationships between physicians and drug companies. Each respondent read a single scenario about a hypothetical physician and his financial ties to the pharmaceutical industry; scenarios varied in terms of payment type of (e.g., payment for meals vs. consulting fees) and amount. Respondents then evaluated the physician on several dimensions (e.g., expertise, trustworthiness, knowledge of new treatments, moral character, focus on patients' interests). Findings revealed that perceptions of the physician were more strongly influenced by payment type than by payment amount. Specifically, respondents were quite critical of doctors who owned drug company stock or received industry payments for meals and lodging, but were more forgiving of physicians who received free drug samples (which were perceived as benefiting patients) or consulting fees (which were seen as signaling physician expertise). Interestingly, physicians who received no payments, while seen as honest, were also viewed by some respondents as inexperienced or uninformed about new treatments. Implications for public policy and future research are discussed.

J Law Med Ethics. 2014 Dec;42(4):501-508. doi: 10.1111/jlme.12171.

Economism and the Commercialization of Health Care.

Brody H1.

Author information

• 1Director of the Institute for the Medical Humanities at the University of Texas Medical Branch, Galveston.

Abstract

Those concerned over the excessive commercialization of health care, to the detriment of both professional and patient-centered values, commonly propose remedies that assume that meaningful change can occur largely within the health care sector. I argue instead that a major shift in the public culture and political discourse of the U.S. will be required if the commercialization of health care is to be adequately addressed. The notion that health and health care are commodities to be bought and sold in the market is encouraged by the ideology that is preferably called economism, though also today labeled neoliberalism, market fundamentalism, market triumphalism, and other terms. This ideology has been successful in pushing aside alternative accounts and policies over the past four decades, so that economism-inspired policies seem both commonsensical and inevitable. This dominance of the public political discourse hides two important facts about economism - it is a quasi-religious ideology that pretends to be a reflection of economic science; and it is shot through with internal contradictions that ultimately render it self-defeating as a guide to policy. Advocates for reduced commercialism in health care must directly address economism and attempt to educate the public and policymakers about its flaws.

Would Canadians stigmatize somebody with depression?

Can J Psychiatry. 2014 Oct 1;59(10 Supplement 1):S27-S33.

Stigma in Canada: Results From a Rapid Response Survey.

Stuart H1, Patten SB2, Koller M3, Modgill G4, Liinamaa T5.

Author information

• 1Professor and Bell Canada Mental Health and Anti-Stigma Research Chair, Department of Public Health Sciences, Queen's University, Kingston, Ontario; Senior Consultant, Opening Minds Anti-Stigma Initiative, Mental Health Commission of Canada, Calgary, Alberta.
• 2Principal Investigator, Health Professionals, Opening Minds Anti-Stigma Initiative, Mental Health Commission of Canada, Calgary, Alberta; Professor, Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta; Member, Mathison Centre for Research & Education in Mental Health, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta.
• 3Student, Department of Public Health Sciences, Queen's University, Kingston, Ontario; Research Associate, Youth Projects, Opening Minds Anti-Stigma Initiative, Mental Health Commission of Canada, Calgary, Alberta.
• 4Research Associate, Opening Minds Anti-Stigma Initiative, Mental Health Commission of Canada, Calgary, Alberta.
• 5Research Associate, Centre for Health Services and Policy Research, Queen's University, Kingston, Ontario.

Abstract

OBJECTIVE::

Our paper presents findings from the first population survey of stigma in Canada using a new measure of stigma. Empirical objectives are to provide a descriptive profile of Canadian's expectations that people will devalue and discriminate against someone with depression, and to explore the relation between experiences of being stigmatized in the year prior to the survey among people having been treated for a mental illness with a selected number of sociodemographic and mental health-related variables.

METHOD::

Data were collected by Statistics Canada using a rapid response format on a representative sample of Canadians (n = 10 389) during May and June of 2010. Public expectations of stigma and personal experiences of stigma in the subgroup receiving treatment for a mental illness were measured.

RESULTS::

Over one-half of the sample endorsed 1 or more of the devaluation discrimination items, indicating that they believed Canadians would stigmatize someone with depression. The item most frequently endorsed concerned employers not considering an application from someone who has had depression. Over one-third of people who had received treatment in the year prior to the survey reported discrimination in 1 or more life domains. Experiences of discrimination were strongly associated with perceptions that Canadians would devalue someone with depression, younger age (12 to 15 years), and self-reported poor general mental health.

CONCLUSIONS::

The Mental Health Experiences Module reflects an important partnership between 2 national organizations that will help Canada fulfill its monitoring obligations under the United Nations Convention on the Rights of Persons with Disabilities and provide a legacy to researchers and policy-makers who are interested in monitoring changes in stigma over time.

Front Behav Neurosci. 2014 Dec 22;8:434. eCollection 2014.

Physiological and behavioral patterns of corruption.

Jaber-López T1, García-Gallego A2, Perakakis P3, Georgantzis N4.

Author information

• 1Laboratorio de Economía Experimental, Department of Economics, Universitat Jaume I Castellón, Spain.
• 2Laboratorio de Economía Experimental, Department of Economics, Universitat Jaume I Castellón, Spain ; Department of Economics, University of Reading Reading, UK.
• 3Department of Personality, Evaluation and Psychological Treatment, University of Granada Granada, Spain.
• 4Laboratorio de Economía Experimental, Department of Economics, Universitat Jaume I Castellón, Spain ; Economic and Social Sciences Unit, School of Agriculture Policy and Development, University of Reading Reading, UK.

Abstract

We study the behavior and emotional arousal of the participants in an experimental auction, leading to an asymmetric social dilemma involving an auctioneer and two bidders. An antisocial transfer (bribe) which is beneficial for the auctioneer (official) is paid, if promised, by the winner of the auction. Some pro-social behavior on both the auctioneers' and the bidders' sides is observed even in the absence of any punishment mechanism (Baseline, Treatment 0). However, pro-social behavior is adopted by the vast majority of subjects when the loser of the auction can inspect the transaction between the winner and the auctioneer (Inspection, Treatment 1). The inspection and punishment mechanism is such that, if a bribe is (not) revealed, both corrupt agents (the denouncing bidder) lose(s) this period's payoffs. This renders the inspection option unprofitable for the loser and is rarely used, especially toward the end of the session, when pro-social behavior becomes pervasive. Subjects' emotional arousal was obtained through skin conductance responses. Generally speaking, our findings suggest that stronger emotions are associated with decisions deviating from pure monetary reward maximization, rather than with (un)ethical behavior per se. In fact, using response times as a measure of the subject's reflection during the decision-making process, we can associate emotional arousal with the conflict between primary or instinctive and secondary or contemplative motivations and, more specifically, with deviations from the subject's pure monetary interest.

Am J Trop Med Hyg. 2015 Jan 5. pii: 14-0803. [Epub ahead of print]

Ebola Policies That Hinder Epidemic Response by Limiting Scientific Discourse.

Asgary R1, Pavlin JA2, Ripp JA2, Reithinger R2, Polyak CS2.

Author information

• 1Departments of Population Health and Medicine, New York University School of Medicine, New York, New York; Armed Forces Health Surveillance Center, Silver Spring, Maryland; Icahn School of Medicine at Mount Sinai, New York, New York; RTI International, Washington, DC; Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, Maryland gasgary@yahoo.com.
• 2Departments of Population Health and Medicine, New York University School of Medicine, New York, New York; Armed Forces Health Surveillance Center, Silver Spring, Maryland; Icahn School of Medicine at Mount Sinai, New York, New York; RTI International, Washington, DC; Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, Maryland.

Abstract

There is an unprecedented epidemic of Ebola virus disease (EVD) in west Africa. There has been a strong response from dedicated health professionals. However, there have also been irrational and fear-based responses that have contributed to misallocation of resources, stigma, and deincentivizing volunteers to combat Ebola at its source. Recently, the State of Louisiana Department of Health and Hospitals issued a ban on those coming from affected countries wishing to attend the annual meetings of American Society of Tropical Medicine and Hygiene and the American Public Health Association, both of which were held in New Orleans. We argue against such policies, question evidence and motivations, and discuss their practical and ethical implications in hampering effective responses to EVD by the scientific community. We aim to shed light on this issue and its implications for the future of public health interventions, reflect on the responsibility of health providers and professional societies as advocates for patients and the public health, and call for health professionals and societies to work to challenge inappropriate political responses to public health crises.

From U Penn: Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure

Am J Bioeth. 2015 Jan 2;15(1):29-36.

Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure.

Fiester A1.

Author information

• 1a University of Pennsylvania.

Abstract

Clinical ethics consultations (CECs) are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient "closure" for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as "bioethics mediation."

How to decide if obesity is a disability

• How to decide if obesity is a disability

• Sarah Rushton  
• 6 Jan 2015
• 
  
• 
  
• "The decision in the Kaltof case, which is binding on all EU member states, is seen as controversial in some quarters because some individuals regard obesity as a life choice rather than an illness.  However the Advocate General has been keen to point out that it does not matter whether the obesity is caused by an underlying medical condition or simply the over consumption of food.  The crucial issue is whether or not the employee is in fact suffering from a long term impairment."

• 
  

"...liberals and conservatives in the same country think as if they were from different cultures."

Pers Soc Psychol Bull. 2014 Dec 24. pii: 0146167214563672. [Epub ahead of print]

Liberals Think More Analytically (More "WEIRD") Than Conservatives.

Talhelm T1, Haidt J2, Oishi S3, Zhang X4, Miao FF3, Chen S5.

Author information

• 1University of Virginia, Charlottesville, USA tat8dc@virginia.edu.
• 2New York University, New York City, USA.
• 3University of Virginia, Charlottesville, USA.
• 4Beijing Normal University, China.
• 5China University of Mining and Technology, Xuzhou, China.

Abstract

Henrich, Heine, and Norenzayan summarized cultural differences in psychology and argued that people from one particular culture are outliers: people from societies that are Western, educated, industrialized, rich, and democratic (WEIRD). This study shows that liberals think WEIRDer than conservatives. In five studies with more than 5,000 participants, we found that liberals think more analytically (an element of WEIRD thought) than moderates and conservatives. Study 3 replicates this finding in the very different political culture of China, although it held only for people in more modernized urban centers. These results suggest that liberals and conservatives in the same country think as if they were from different cultures. Studies 4 to 5 show that briefly training people to think analytically causes them to form more liberal opinions, whereas training them to think holistically causes shifts to more conservative opinions.

From U Oxford: Do infant vocabulary skills predict school-age language and literacy outcomes?

J Child Psychol Psychiatry. 2015 Jan 4. doi: 10.1111/jcpp.12378. [Epub ahead of print]

Do infant vocabulary skills predict school-age language and literacy outcomes?

Duff FJ1, Reen G, Plunkett K, Nation K.

Author information

• 1Department of Experimental Psychology, University of Oxford, Oxford, UK.

Abstract

BACKGROUND:

Strong associations between infant vocabulary and school-age language and literacy skills would have important practical and theoretical implications: Preschool assessment of vocabulary skills could be used to identify children at risk of reading and language difficulties, and vocabulary could be viewed as a cognitive foundation for reading. However, evidence to date suggests predictive ability from infant vocabulary to later language and literacy is low. This study provides an investigation into, and interpretation of, the magnitude of such infant to school-age relationships.

METHODS:

Three hundred British infants whose vocabularies were assessed by parent report in the 2nd year of life (between 16 and 24 months) were followed up on average 5 years later (ages ranged from 4 to 9 years), when their vocabulary, phonological and reading skills were measured.

RESULTS:

Structural equation modelling of age-regressed scores was used to assess the strength of longitudinal relationships. Infant vocabulary (a latent factor of receptive and expressive vocabulary) was a statistically significant predictor of later vocabulary, phonological awareness, reading accuracy and reading comprehension (accounting for between 4% and 18% of variance). Family risk for language or literacy difficulties explained additional variance in reading (approximately 10%) but not language outcomes.

CONCLUSIONS:

Significant longitudinal relationships between preliteracy vocabulary knowledge and subsequent reading support the theory that vocabulary is a cognitive foundation of both reading accuracy and reading comprehension. Importantly however, the stability of vocabulary skills from infancy to later childhood is too low to be sufficiently predictive of language outcomes at an individual level - a finding that fits well with the observation that the majority of 'late talkers' resolve their early language difficulties. For reading outcomes, prediction of future difficulties is likely to be improved when considering family history of language/literacy difficulties alongside infant vocabulary levels.

Nat Rev Drug Discov. 2014 Dec 31;14(1):58-74. doi: 10.1038/nrd4467.

Muscle wasting in disease: molecular mechanisms and promising therapies.

Cohen S1, Nathan JA2, Goldberg AL3.

Author information

• 1Faculty of Biology, Technion Institute of Technology, Haifa, 32000, Israel.
• 2Cambridge Institute for Medical Research, Department of Medicine, University of Cambridge, Cambridge, CB2 0XY, UK.
• 3Department of Cell Biology, 240 Longwood Ave., Harvard Medical School, Boston, Massachusetts 02115, USA.

Abstract

Atrophy occurs in specific muscles with inactivity (for example, during plaster cast immobilization) or denervation (for example, in patients with spinal cord injuries). Muscle wasting occurs systemically in older people (a condition known as sarcopenia); as a physiological response to fasting or malnutrition; and in many diseases, including chronic obstructive pulmonary disorder, cancer-associated cachexia, diabetes, renal failure, cardiac failure, Cushing syndrome, sepsis, burns and trauma. The rapid loss of muscle mass and strength primarily results from excessive protein breakdown, which is often accompanied by reduced protein synthesis. This loss of muscle function can lead to reduced quality of life, increased morbidity and mortality. Exercise is the only accepted approach to prevent or slow atrophy. However, several promising therapeutic agents are in development, and major advances in our understanding of the cellular mechanisms that regulate the protein balance in muscle include the identification of several cytokines, particularly myostatin, and a common transcriptional programme that promotes muscle wasting. Here, we discuss these new insights and the rationally designed therapies that are emerging to combat muscle wasting.

Nurs Ethics. 2014 Dec 30. pii: 0969733014564908. [Epub ahead of print]

The meaning of vulnerability to older persons.

Sarvimäki A1, Stenbock-Hult B2.

Author information

• 1The Age Institute, Finland anneli.sarvimaki@ikainstituutti.fi.
• 2Arcada University of Applied Sciences, Finland.

Abstract

BACKGROUND:

Vulnerability is an important concept in nursing and nursing ethics. Vulnerability and ageing have generally been associated with frailty, which gives a limited view of both vulnerability and ageing.

OBJECTIVE:

The aim of this study was to illuminate the meaning of vulnerability to older persons themselves.

RESEARCH DESIGN:

A qualitative design based on interpretive description was adopted. The data were collected by interviews that were analysed by qualitative content analysis as interplay between analysis, interpretation and meaning construction.

PARTICIPANTS AND RESEARCH CONTEXT:

In total, 14 older persons aged 70-96 years were interviewed, 2 men and 12 women. Some of the participants lived in their own homes, some in service houses and some in nursing homes.

ETHICAL CONSIDERATIONS:

The ethical principles of informed consent, confidentiality and non-identification were respected.

FINDINGS:

The core meaning was a deeper sense of vulnerability as you grow old. This was expressed in six themes: Being easily harmed, Becoming an old person, Being an old person in society, Reactions when being violated and hurt, Protection and Vulnerability as strength.

DISCUSSION AND CONCLUSION:

The themes include frailty and threats to the dignity of older persons and also capacity to feel and develop. The results showed that although the frailty perspective dominated, vulnerability also had positive meanings for the older persons.

‘Healthy’ obesity is a misleading concept: Study

"More than 51 percent of the healthy obese participants became unhealthy obese over the 20-year study period, while only 11 percent lost weight and became healthy non-obese. The remaining 38 percent stayed in the healthy obese category during the term of the study, while 6 percent of participants originally in the healthy non-obese category became unhealthy obese."

Agencies Jan 06, 2015

J Med Ethics. 2014 Dec 31. pii: medethics-2013-101891. doi: 10.1136/medethics-2013-101891. [Epub ahead of print]

The ethics of molecular memory modification.

Hui K1, Fisher CE2.

Author information

• 1Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
• 2Division of Law, Ethics, and Psychiatry, Department of Psychiatry, Columbia University, New York, New York, USA Masters of Bioethics Program, Columbia University, New York, New York, USA.

Abstract

Novel molecular interventions have recently shown the potential to erase, enhance and alter specific long-term memories. Unique features of this form of memory modification call for a close examination of its possible applications. While there have been discussions of the ethics of memory modification in the literature, molecular memory modification (MMM) can provide special insights. Previously raised ethical concerns regarding memory enhancement, such as safety issues, the 'duty to remember', selfhood and personal identity, require re-evaluation in light of MMM. As a technology that exploits the brain's updating processes, MMM helps correct the common misconception that memory is a static entity by demonstrating how memory is plastic and subject to revision even in the absence of external manipulation. Furthermore, while putatively safer than other speculative technologies because of its high specificity, MMM raises notable safety issues, including potential insidious effects on the agent's emotions and personal identity. Nonetheless, MMM possesses characteristics of a more permissible form of modification, not only because it is theoretically safer, but because its unique mechanism of action requires a heightened level of cooperation from the agent. Discussions of memory modification must consider the specific mechanisms of action, which can alter the weight and relevance of various ethical concerns. MMM also highlights the need for conceptual accuracy regarding the term 'enhancement'; this umbrella term will have to be differentiated as new technologies are applied to a widening array of purposes.

Pediatr Rev. 2015 Jan;36(1):22-30. doi: 10.1542/pir.36-1-22.

The patient-parent-pediatrician relationship: everyday ethics in the office.

Lantos J1.

Author information

• 1Children's Mercy Bioethics Center and Department of Pediatrics, University of Missouri-Kansas, Kansas City, MO.

Abstract

Pediatricians and parents generally try to do what is best for children, but they do not always agree about what that is. Mothers and fathers may disagree with each other. Parents may disagree with pediatricians. Disagreements can arise about the goals, nature, and value of communication with children about health information. Disagreements can arise over the value of particular medical interventions. Some disagreements are grounded in different religious beliefs. Some are about moral values. Some are disagreements about ends, others about the best means to an agreed on end. If there is an intractable disagreement and discussion has failed to resolve that disagreement, pediatricians must decide whether to compromise their own values to preserve a therapeutic relationship, sever that relationship, or try to override a parental choice by referring a case to child protection authorities. Most cases can be resolved and a consensus found. This article discusses some common scenarios in which disagreements arise, including home birth, refusal of vitamin K, vaccine hesitancy, birth control for teens, corporal punishment, and surreptitious drug testing.

"... by continuing to inspire this surfeit of heedfulness in generation after generation, America risks heading downhill, and not in the fun way."

Home of the unbrave

Jan 5th 2015, 22:30 BY W.W. | CHATTANOOGA

"Is it worth devoting so much zeal to protecting America's young minds from brain damage if the finest among them wind up too conservative to seek anything but a sure paycheck? If Americans need something to fear, it should be that by continuing to inspire this surfeit of heedfulness in generation after generation, America risks heading downhill, and not in the fun way."    

HT: RW