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The practice of proxy consent
March 15th, 2011D&E procedure
January 5th, 20110
The D&E procedure can be performed in freestanding
clinics, but often ambulatory surgical services in a
hospital setting are chosen for the procedures performed
later in pregnancy (after the fourteenth week) because
emergency care can be quickly provided in case of a complication.
Informed-consent procedures require that the various
methods of abortion be discussed as well as the possible
anesthesia alternatives.
The other abortion procedure used fairly commonly in
the second trimester is instillation abortion, in which a
solution instilled into the amniotic cavity through the
abdomen via amniocentesis results in the death of the fetus
and termination of the pregnancy. Uterine contractions
signaling labor begin twelve to twenty-four hours later and
culminate with the expulsion of the fetus. Anesthesia is not
commonly used for instillation procedures. Discomfort
varies widely among patients, usually in relation to the
length of labor and the time before complete expulsion of
the fetus and placenta.
NUTRITION AND HYDRATION
December 27th, 20090
While observational studies with case-control or cohort design have provided insight into this area, ultimately, a decision to live with enteral tube feedings when oral intake ability has been lost or impaired becomes an individual one and personal values can be a critical variable. Advanced dementia, terminal cancer, and catastrophic neurological injury are clinical circumstances in which this option is often considered. In the past, when long-term artificial feeding was considered, surgical gastrostomy provided enteral access. This has been largely replaced by endoscopic gastrostomy that can be performed, if necessary, at the bedside. This technique does not require general anesthesia, has less associated morbidity, and can be performed for a fraction of the cost of that for surgical techniques. Endoscopic placement, or percutaneous endoscopic gastrostomy (PEG), was first reported by Michael Gauderer in pediatric patients. It has since been adapted to many clinical situations, involving patients of all ages who are unable to eat and are thought to need nutritional support. In the Medicare population alone, PEG procedures more than doubled from 1991 to 1999, numbering more than 160,000 annually.
BIOLOGY, PHILOSOPHY
December 26th, 20090
Over time, philosophy of biology came to include
much richer and detailed involvement with both current
biology and the history of biology. Many philosophers came
to ground their philosophical insights in rich historical
accounts of various periods in the history of biology or in
contemporary debates of active concern to practicing biologists.
This naturalistic turn occurred in many parts of
philosophy of science, but seems to have been most acute in
philosophy of biology, at least partly for institutional reasons,
including the creation of the International Society for
the History, Philosophy, and Social Studies of Biology
(Callebaut).
Through these developments, the field still largely
avoided normative issues and focused on evolutionary biology.
Recently several attempts have been made to move the
field to other parts of biology. There are a number of
philosophers working on developmental biology and using
it as an alternative for framing traditional issues (Oyama,
Griffiths, and Gray). Kenneth Schaffner has made a notable
and unusual attempt to discuss the more medical parts of
biology. Paul Thagard has similarly attempted to use work in
the biomedical sciences (attempts at explaining the causes of
ulcers) to address general philosophical issues in the nature
of explanation.
There are a number of topics within philosophy of
biology that especially bear on issues within bioethics.
Over time, philosophy of biology came to include much richer and detailed involvement with both current biology and the history of biology. Many philosophers came to ground their philosophical insights in rich historical accounts of various periods in the history of biology or in contemporary debates of active concern to practicing biologists. This naturalistic turn occurred in many parts of philosophy of science, but seems to have been most acute in philosophy of biology, at least partly for institutional reasons, including the creation of the International Society for the History, Philosophy, and Social Studies of Biology (Callebaut).
Through these developments, the field still largely avoided normative issues and focused on evolutionary biology. Recently several attempts have been made to move the field to other parts of biology. There are a number of philosophers working on developmental biology and using it as an alternative for framing traditional issues (Oyama, Griffiths, and Gray). Kenneth Schaffner has made a notable
and unusual attempt to discuss the more medical parts of biology. Paul Thagard has similarly attempted to use work in the biomedical sciences (attempts at explaining the causes of ulcers) to address general philosophical issues in the nature of explanation.
There are a number of topics within philosophy of biology that especially bear on issues within bioethics.
Necessity of Bioethics Education
December 26th, 20090
A second factor distinguishing bioethics education for
the groups under discussion is that many claim, as the
rationale for their very existence, the mastery of a particular
technology. Reliance on technology may drastically alter the
complexion of the traditional health professional–patient
relationship. First, technology may create a detrimental
distance between health professionals and patients. Patients
and health professionals alike may place unrealistic expectations
on technologies to bring about “miracles,†creating
dissent and distrust when they fail to do so. And the high
cost of many technologies may add undue burdens on
patients and families.
Since the professional–patient relationship is at the
heart of professional ethics, germane bioethics education is
crucial so that health professionals can respond well to the
larger human dilemmas created by technology. The types of
technology the various professions employ will differ, but
the generic challenges are similar for all. A list of “dos and
don’ts†will not suffice. The concepts and methods of ethics
are needed for thinking through and acting on technologyrelated
challenges.
A third factor is the presence of inequities in healthcare.
The tools of bioethics enable students to understand why
inequities are morally unacceptable in the healthcare system.
They also provide an opportunity to encourage reflection on
how professionals can contribute to the advancement of just
and fair policies.
Since bioethics education in the professions under
discussion in this entry encourages critical thinking, considered
action, and the exercise of ethically appropriate character
traits, it will continue to be a powerful resource as new
developments in healthcare and society give rise to ethical
issues.
A second factor distinguishing bioethics education for the groups under discussion is that many claim, as the rationale for their very existence, the mastery of a particular technology. Reliance on technology may drastically alter the complexion of the traditional health professional–patient relationship. First, technology may create a detrimental distance between health professionals and patients. Patients and health professionals alike may place unrealistic expectations on technologies to bring about “miracles,†creating
dissent and distrust when they fail to do so. And the high cost of many technologies may add undue burdens on patients and families.
Since the professional–patient relationship is at the heart of professional ethics, germane bioethics education is crucial so that health professionals can respond well to the larger human dilemmas created by technology. The types of technology the various professions employ will differ, but the generic challenges are similar for all. A list of “dos and don’ts†will not suffice. The concepts and methods of ethics are needed for thinking through and acting on technologyrelated challenges. A third factor is the presence of inequities in healthcare. The tools of bioethics enable students to understand why inequities are morally unacceptable in the healthcare system. They also provide an opportunity to encourage reflection on
how professionals can contribute to the advancement of just and fair policies. Since bioethics education in the professions under
discussion in this entry encourages critical thinking, considered action, and the exercise of ethically appropriate character
traits, it will continue to be a powerful resource as new developments in healthcare and society give rise to ethical issues.
Behavoiur Therepies
December 19th, 20090
By virtue of the inclusion of cognitive and contextual
variables in theory and application, contemporary behavior
therapy is a considerably advanced over early behavior
therapy, which was based largely on animal models of
learning. Behavior therapy is unique among current psychotherapeutic
schools in that practitioners rely on repeated,
data-based, objective assessments of client behaviors, thoughts,
and feelings to aid in the establishment of therapeutic goals
and the continuous assessment of therapeutic progress.
Contemporary behavior therapy is a diverse field in which
theoretical progress and practice are based on demonstrable
advances in scientific knowledge, rather than on the pronouncements
of authorities or “gurus.†Although not yet
fully integrated into behavior-therapy practice, developments
in basic psychology, human rule-governed behavior
(Hayes), cognitive sciences, and computer science all hold
promise for enhancing both treatment efficacy and sensitivity
to ethical constraints. As practitioners of a discipline and
through organizations such as the Association for Advancement
of Behavior Therapy, behavior therapists are learning
how to apply these rigorous standards to themselves and to
their personal interactions with clients, colleagues, students,
and society at large.
By virtue of the inclusion of cognitive and contextual variables in theory and application, contemporary behavior therapy is a considerably advanced over early behavior therapy, which was based largely on animal models of learning. Behavior therapy is unique among current psychotherapeutic schools in that practitioners rely on repeated, data-based, objective assessments of client behaviors, thoughts, and feelings to aid in the establishment of therapeutic goals and the continuous assessment of therapeutic progress. Contemporary behavior therapy is a diverse field in which theoretical progress and practice are based on demonstrable advances in scientific knowledge, rather than on the pronouncements of authorities or “gurus.†Although not yet fully integrated into behavior-therapy practice, developments in basic psychology, human rule-governed behavior (Hayes), cognitive sciences, and computer science all hold promise for enhancing both treatment efficacy and sensitivity to ethical constraints. As practitioners of a discipline and through organizations such as the Association for Advancement of Behavior Therapy, behavior therapists are learning how to apply these rigorous standards to themselves and to their personal interactions with clients, colleagues, students, and society at large.
The Image of Behavior Therapy
December 19th, 20090
As noted, the image of early behavior therapy among
nonbehavioral professionals and the lay public was often
extremely negative. Grossly inaccurate notions about the
nature of behavior therapy were commonplace, and behavior
therapy was lumped with such alien procedures as
psychosurgery and Erhard Seminar Training. Such misconceptions
are now infrequent. This is due largely to the
incorporation of behavior therapy into the mental health
mainstream, to increased sophistication and greater acceptance
of behavior therapy by the general public, and, perhaps
above all, to the concerted attempts of behavior therapists,
both as individuals and as members of professional organizations,
to correct these misconceptions and thereby improve
the image of behavior therapy.
There is a continuing need to modify misconceptions
through well-planned public education. Behavior therapists
also need continuing educational training in the maintenance
of good ethical practice. Measures of consumer satisfaction
are the rule rather than the exception in both clinical
research and treatment. Behavior therapists must increasingly
think in terms of public relations and the necessity for
keeping patients informed at all stages of the intervention
process. For example, behavior therapists in private practice
are beginning to make available written descriptions of the
treatment procedures and policies for discussion and review
before treatment begins (Franks).
As noted, the image of early behavior therapy among nonbehavioral professionals and the lay public was often extremely negative. Grossly inaccurate notions about the nature of behavior therapy were commonplace, and behavior therapy was lumped with such alien procedures as psychosurgery and Erhard Seminar Training. Such misconceptions are now infrequent. This is due largely to the incorporation of behavior therapy into the mental health mainstream, to increased sophistication and greater acceptance of behavior therapy by the general public, and, perhaps above all, to the concerted attempts of behavior therapists, both as individuals and as members of professional organizations, to correct these misconceptions and thereby improve
the image of behavior therapy. There is a continuing need to modify misconceptions through well-planned public education. Behavior therapists also need continuing educational training in the maintenance of good ethical practice. Measures of consumer satisfaction are the rule rather than the exception in both clinical research and treatment. Behavior therapists must increasingly think in terms of public relations and the necessity for
keeping patients informed at all stages of the intervention process. For example, behavior therapists in private practice are beginning to make available written descriptions of the procedures and policies for discussion and review before treatment begins (Franks).
Hello world!
December 10th, 20090
Check out our new tutorial section full of helpful text and short video guides that explain different elements of using Blogetery.