Institutional responses to medical mistakes: ethical and legal perspectives.

Health care institutions must decide whether to inform the patient of a medical error. The barriers to disclosure are an aversion to admitting errors, a concern about implicating other practitioners, and a fear of lawsuits and liability. However, admission of medical errors is the ethical thing to do and may be required by law. When examined, the barriers to such disclosures have little merit, and, in fact, lawsuits and liability may actually be reduced by informing the patient of medical errors. Therefore, a health care institution should implement a written policy providing for disclosure of medical errors, using a process such as that outlined in the article.     

The use of consultation in psychological practice: ethical, legal, and clinical considerations

The importance of consulting with other professionals to maintain acceptable standards of care is well documented in many health care professions. However, evidence indicates that many psychologists fail to utilize consultation when needed, and that consultation use varies along dimensions such as the education and training of the consultee, the type of setting, number of years in practice, and proximity to available consultants. In this article, we review the research on the use of consultation by psychologists as well as other health care professionals. We discuss the clinical, ethical, and legal implications of seeking consultation as a professional psychologist. Finally, a detailed and practical model for the regular use of consultation is given to improve the routine use of consultation in clinical practice.     

Conflicting codes: Professional, ethical, and legal obligations in archaeology

Archaeologists employed in governmental positions often deal with issues that produce conflicts between their professional duties to their employer, their ethical responsibilities to the resource, and their obligations as established by legislation. The paper examines some of the conflicts imposed on governmental archaeologists by each of these systems but focuses on the conflicts imposed by federal legislation and regulations on governmental archaeologists, using “Kennewick Man” as an example. This is a revised edition of a paper written for the symposium: “Ethics in Science: Special Problems in Anthropology and Archaeology,” organized by Merrilee Salmon; 1998 Annual Meeting of the American Association for the Advancement of Science (Philadelphia, February 15, 1998). The original paper was in a more conversational style as befitting a discussion atmosphere. Revisions, comments, and opinions are entirely the author’s. Joe Watkins is the Anadarko Agency Archaeologist at the Bureau of Indian Affairs and is a Research Associate in the Department of Anthropology, Indiana University.     

Depression in children: Parent,teacher, and child perspectives

Depressed and nondepressed children were found to differ in the types of behavior problems manifested at home and at school. Children rated as depressed by their parents on the Personality Inventory for Children evidenced significantly more conduct problems, anxiety, impulsive hyperactivity, learning problems, psychosomatic problems, perfectionism, and muscular tension at home than children rated as nondepressed. Depressed children were rated by their teachers as displaying more inattentionpassivity than nondepressed children. A significant but modest relationship was found between parent report and child selfreport of the child's depression. Depressed children attributed positive events to external causes and negative events to internal causes significantly more than did nondepressed children. The specificity of these results to depression was also examined;the particular features of childhood depression are compared to the features of adult depression. The investigators would like to thank Jim McFerren and Ralph Zalazar for their work as research assistants and David Watson for his help with the statistical analyses. The helpful comments of Eric Klinger and Auke Tellegen are gratefully acknowledged. The cooperation of Dr. Loren Benson, director of personnel services of the Hopkins School District #274; Mr. Edward Ryshavy, principal of Glen Lake Elementary School; and the teachers of that school is greatly appreciated.     

Provision of antiretroviral prophylaxis to child rape victims in South Africa: HIV status and delayed reporting

In a sample of 780 South African child victims of rape (girls under the age of 18 years; age M= 10.5 yr., SD=4.8), 10% did not qualify for antiretroviral prophylaxis because HIV status at presentation was positive and a further 34.1% did not qualify because the rape was reported more than 72 hours after the alleged offense. Regression analyses indicated that child rape victims who reported that they had been sexually active prior to the rape constitute a particularly high risk group for HIV infection and suggest primary and secondary prevention programs should be designed to decrease sexual activity among children and to encourage more immediate reporting of rape among younger children, children who are not sexually active, and children who are incestuously abused.     

Counselling in the Post Office: Facing up to the legal and ethical dilemmas

The legal and ethical dilemmas faced by counsellors working in organisations are outlined, together with the need for the counselling profession to set clear competency and supervision standards for practitioners.     

Biotechnologies that empower transgender persons to self-actualize as individuals,partners, spouses,and parents are defining new ways to conceive a child: psychological considerations and ethical issues

Today, thanks to biomedical technologies advances, some persons with fertility issues can conceive. Transgender persons benefit also from these advances and can not only actualize their self-identified sexual identities but also experience parenthood. Based on clinical multidisciplinary seminars that gathered child psychiatrists and psychoanalysts interested in the fields of assisted reproduction technology (ART) and gender dysphoria, philosophers interested in bioethics, biologists interested in ART, and endocrinologists interested in pubertal suppression, we explore how new biotechnical advances, whether in gender transition or procreation, could create new ways to conceive a child possible. After reviewing the various medical/surgical techniques for physical gender transition and the current ART options, we discuss how these new ways for persons to self-actualize and to experience parenthood can not only improve the condition of transgender persons (and the human condition as a whole through greater equity) but also introduce some elements of change in the habitual patterns of thinking especially in France. Finally, we discuss the ethical issues that accompany the arrival of these children and provide creative solutions to help society handle, accept, and support the advances made in this area.     

Conflict of interest in medicine in Lithuania: legal and ethical aspects

The current legal framework within the Lithuanian health system is described including a review of the physician’s autonomy, rights and duties, and patients’ rights including the right to reimbursement. The role of ethical codes and the law are discussed. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Perceptions of mothers: Effects of employment status,marital status,and age of child

Ninety-six female and 96 male college students evaluated a briefly described adult female stimulus person on 24 7-point bipolar scales that described personality traits and professional performance characteristics. Each subject rated 1 of 8 mothers, who was described as either employed or nonemployed, either divorced or married, and as having either a 1-year-old or 11-year-old child. Employed mothers were viewed as less family oriented, but as more instrumental than nonemployed mothers. Divorced mothers were perceived as less well adjusted but more instrumental than married mothers. Employed mothers with a 1-year-old child were rated as most professionally competent, while employed mothers with an 11-year-old child were rated as most instrumental.Portions of this paper were presented at the meeting of the Midwestern Psychological Association, Chicago, May 1987.     

Down to cases: the ethical value of "non-scientificity" in dyadic psychoanalysis

The efficacy of the dyadic psychoanalytic method cannot be verified empirically, due to the impossibility of counterfactuals, controls, or double-blind experiments, although inventive psychoanalytic researchers have established validation methodologies for analyzing groups of case studies, outcomes, and even theoretical precepts. The unavailability of complete empirical validation for the most basic method of the discipline of psychoanalysis, or of its fundamental "report of findings"--the case study--means that the field's scientific rationale must be supplemented with public reasoning of another sort. Fortunately, the very conditions of uncertainty that make it impossible to falsify the findings of dyadic psychoanalysis lend it its ethical force by compelling its participants to confront the basic human dilemmas of freedom, meaning, and judgment, the ethical horizon of human affairs. One substantial value of psychoanalysis, then, is its capacity for generating "ethical knowledge" of the sort adumbrated by Aristotle's conception of practical knowledge (phronesis). Case studies written for a lay audience to highlight these basic dilemmas can demonstrate that psychoanalysis produces crucial knowledge, specific to individuals, for living a healthy and satisfying life.     

Seeking an ethical and legal way of procuring transplantable organs from the dying without further attempts to redefine human death

Because complex organs taken from unequivocally dead people are not suitable for transplantation, human death has been redefined so that it can be certified at some earlier stage in the dying process and thereby make viable organs available without legal problems. Redefinitions based on concepts of "brain death" have underpinned transplant practice for many years although those concepts have never found universal philosophical acceptance. Neither is there consensus about the clinical tests which have been held sufficient to diagnose the irreversible cessation of all brain function – or as much of it as is deemed relevant – while the body remains alive.