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41.
Bates BR 《Journal of genetic counseling》2005,14(6):423-434
Critics of genetic discourse are concerned that deterministic and discriminatory views of genetics are increasingly becoming
adopted. These views argue that current genetic discourse becomes a source of power whereby powerful institutions harm people
with so-called “bad” genes. This essay argues that current analyses of the power of genetics discourse are grounded in an
improper reading that disempowers patients. Deploying Michel Foucault's concept “care of the self,” this essay claims that
genetics discourse is better understood as a way that patients take on power through rhetoric rather than a force that has
power over patients. Through a close reading of the “My Family Health Portrait” program, this paper argues that patients experience
a process of “subjection” wherein they become agents of and objects of genetics discourse both. This alternative mode of analyzing
the power of genetics discourse has implications for our collective understanding of the operations of the care of the self
and the uses of genetic information that we propose. 相似文献
42.
43.
McIntyre A 《Theoretical medicine and bioethics》2004,25(1):61-74
The U.S. Supreme Court's majorityopinion in Vacco v. Quill assumes thatthe principle of double effect explains thepermissibility of hastening death in thecontext of ordinary palliative care and inextraordinary cases in which painkilling drugshave failed to relieve especially intractablesuffering and terminal sedation has beenadopted as a last resort. The traditionaldoctrine of double effect, understood asproviding a prohibition on instrumental harmingas opposed to incidental harming or harming asa side effect, must be distinguished from otherways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care. 相似文献
44.
Szawarski Z 《Science and engineering ethics》2004,10(1):57-64
This paper attempts to define the concept of placebo as it is used in the clinical context The author claims that X is a placebo
if and only if X has such a property dp, that whenever in a therapeutic situation T a stimulus S appears, then in attending conditions A, it will cause a beneficial
reaction R in the patient. Formally, the same structure may be used to define any pharmacologically active drug. The main
difference between the drug and a placebo is in the range of possible substitutions for X and the property d. For the active
drug there is only one possible substitution for X and property d and it can be scientifically explained why, and how the
drug works. In the case of a placebo a set of possible substitutions for X and d is open, and so far it is impossible to offer
any scientifically valid explanation of the action mechanism of placebo. 相似文献
45.
Self-help and psychoeducation have been identified as effective methods for delivering treatment, yet not everyone benefits from these brief interventions. Therefore it is clinically and economically useful to identify who is likely to require more intensive assistance. This paper develops a prognostic scale which predicts who will recover from panic attacks and who will require more assistance. Method: Random regression models were used to evaluate the relationship between predictive variables, baseline severity, and the rate of improvement in 117 people with DSMIV panic attacks who participated in a trial of a psycho-educational booklet, a self-help workbook, and brief group CBT over a 9-month period. ROC analysis was used to choose cut-off points on a scale made up of significant predictors. Results: Panic disorder and agoraphobia symptom measures were predicted by baseline social anxiety, and general mental health. There was no significant effect on the outcome for baseline depression or anxiety sensitivity. While general mental health (SF12 Mental Component scores) was predicted by the age at first panic attack, neuroticism, panic disorder and/or agoraphobia symptoms and a positive screen for alcohol use disorders. A prognostic scale based on simple additive scoring was equivalent to standard scores and significantly better than chance at predicting who would recover and who required face-to-face therapy. Conclusions: The prognostic scale may be used to guide the choice of psychoeducation, self-help or face-to-face therapy as the first step in stepped care. 相似文献
46.
We evaluated the efficacy of a brief staff-training procedure to increase the use of graduated prompting by 2 certified nursing assistants (CNAs) while they helped to dress 3 persons with dementia in a seven-bed dementia care unit. The multiple baseline design across participants showed that CNAs dressed residents with minimal resident involvement during baseline observations. Following brief in-service training, CNAs provided graduated prompts and praise appropriately, suggesting that CNAs can promote active involvement in personal care routines by older adults with dementia. 相似文献
47.
Bermann K 《Theoretical medicine and bioethics》2003,24(6):511-523
Nursing homes and other institutionsdesigned for persons with impairments are not,in fact, designed for persons with impairments.They
are typically designed for theimpairments, not the persons, and therebybecome a part of the problem by reinforcingphysical
and cultural manifestations of theimpairments. In the essay that follows, Idescribe an architectural design project inwhich
students were asked to make changes to anexisting nursing home for the persons who livedthere. This requires not only becoming
familiarwith the spaces, but with the personsthemselves and designing space to helparticulate their voices and being.
This revised version was published online in June 2006 with corrections to the Cover Date. 相似文献
48.
Lea DH 《Journal of genetic counseling》1999,8(3):175-181
Genetic counseling and the many roles a genetic counselor must assume to provide quality genetic health care are becoming increasingly complex, especially when the genetic condition is rare, and DNA testing is costly and not yet routinely used. A case study of a couple with a family history of retinoblastoma and their pursuit of DNA testing for prenatal diagnosis is presented. The case study illustrates the instrumental role of the genetic counselor in advocating for clients for genetic services such as DNA testing and in educating insurance companies in the nature and importance of such services to achieve improved client health care outcomes. 相似文献
49.
Pauline Jivanjee 《Journal of child and family studies》1999,8(4):451-461
There has been an increasing focus on family involvement in the treatment of children with serious emotional disorders, but it has received only limited attention in relation to out-of-home placements. I present the findings from a qualitative study of family involvement from the perspectives of parents whose children were placed in therapeutic foster care (TFC). Parents' perspectives on their involvement in placement decisions, relationships with professionals and TFC providers, practices related to family involvement, barriers to involvement, and strategies to enhance family involvement are described. Parents of children in TFC wanted to have contact with their children and to participate in decision making. They described relationships and practices that contributed to their involvement. 相似文献
50.
Edward P. Sheridan Reuben J. Silver 《Journal of clinical psychology in medical settings》1999,6(2):155-160
While psychologists have been active faculty members in medical schools for over 85 years, they lacked organization on the national level until 1981. This history traces the background of psychology's involvement in medical schools, landmark events that affected the discipline, and progress since formal organization has occurred.
Office of the Senior Vice President and Provost 相似文献