Research on the effectiveness of short-term education programs in changing societal attitudes about mental illness has been mixed. Education efforts seem to be mediated by characteristics of the program participants. This study determines whether the effects of a specially prepared, semester-long course on severe mental illness are mediated by pre-education knowledge about and contact with severe mental illness. Eighty-three participants who were enrolled in either a course on severe mental illness or general psychology completed the Opinions about Mental Illness Questionnaire before beginning the course and at completion. Research participants also completed a pre-and posttest of knowledge about mental illness and a pretest on their contact with people who have severe mental illness. The education program had positive effects on some attitudes about mental illness. Interestingly, the effects of education group interacted with pre-education knowledge and contact and varied depending on attitude. Participants with more pre-education knowledge and contact were less likely to endorse benevolence attitudes after completing the education program. Participants with more intimate contact showed less improvement in attitudes about social restrictiveness. Implications of these augmentation and ceiling effects are discussed. (+info)
Autonomy, liberalism and advance care planning.
The justification for advance directives is grounded in the notion that they extend patient autonomy into future states of incompetency through patient participation in decision making about end-of-life care. Four objections challenge the necessity and sufficiency of individual autonomy, perceived to be a defining feature of liberal philosophical theory, as a basis of advance care planning. These objections are that the liberal concept of autonomy (i) implies a misconception of the individual self, (ii) entails the denial of values of social justice, (iii) does not account for justifiable acts of paternalism, and (iv) does not account for the importance of personal relationships in the advance care planning process. The last objection is especially pertinent in light of recent empirical research highlighting the importance of personal relationships in advance care planning. This article examines these four objections to autonomy, and the liberal theoretical framework with which it is associated, in order to re-evaluate the philosophical basis of advance care planning. We argue that liberal autonomy (i) is not a misconceived concept as critics assume, (ii) does not entail the denial of values of social justice, (iii) can account for justifiable acts of paternalism, though it (iv) is not the best account of the value of personal relationships that arise in advance care planning. In conclusion, we suggest that liberalism is a necessary component of a theoretical framework for advance care planning but that it needs to be supplemented with theories that focus explicitly on the significance of personal relationships. (+info)
Pregnancy, autonomy and paternalism.
Modern medicine is increasingly aware of the significance of patient autonomy in making treatment choices. This would seem to be particularly important where the therapy requested was "voluntary" as in fertility treatment or cosmetic surgery. However, the Hippocratic doctrine "Primum non nocere", seems especially relevant where the treatment sought may have a low chance of a successful outcome or even be life-threatening. Mrs A's case demonstrates the difficulty faced by the physician who wants to maximise her patient's autonomy, but "Above all, do no harm". (+info)
At the coalface, but on the receiving end.
In dealing with patients the doctor is very often paternalistic. No more so than when the patient is unable to help him--or herself. Modern technology allows people to be kept alive in "intensive care" where they often become an "object" at the centre of proceedings. Fortunately for them, most patients who survive intensive care cannot remember the experience though this does not mean that they were not suffering at the time. There is a strong case for explaining things as much as possible and for making practical procedures as tolerable as possible. The relatives and families of the seriously ill often have great difficulty in understanding what is happening to their loved ones and, in these situations, suffer a great deal of stress and foreboding regarding the ultimate outcome of their illness. The stress on the staff who may become "attached" to their patients often shows through as an indifferent attitude. Peter remembers three out of fourteen days in intensive care and Jane, his wife, remembers the whole experience. Here we tell our stories in the hope that they may help our medical and nursing colleagues to manage better the patients under their care in this situation. (+info)
People and work: some contemporary issues.
In advanced industrial societies social, economic, and technological changes are accompanied by changing values and attitudes to work, symptomatic of what some see as the transition to a post-industrial era. As a result existing job definitions and traditional forms of organization are being challenged and attempts made to restructure work so that it becomes meaningful and rewarding in the fullest sense, to the individual, to the enterprise, and to society. These range from programmes of job enlargement and job enrichment, within the framework of existing technologies, to experiments in the design of organizations as a whole in which fewer constraints are accepted as given. They entail and require a multidisciplinary approach as well as awareness of and commitment to the underlying values. The possibilities and benefits of restructuring work in these various ways have been demonstrated sufficiently to encourage interest at governmental level as well as by employers and trade unions. There are, however, no simple prescriptions or principles of universal application. Knowledge is still tentative and partial but there is consensus that the search for new ways of dealing with the organization of work and the allocation of resources is of fundamental importance. (+info)
Prejudice, social distance, and familiarity with mental illness.
In this study, the paths between two prejudicial attitudes (authoritarianism and benevolence) and a proxy measure of behavioral discrimination (social distance) were examined in a sample drawn from the general public. Moreover, the effects of two person variables (familiarity with mental illness and ethnicity) on prejudice were examined in the path analysis. One hundred fifty-one research participants completed measures of prejudice toward, social distance from, and familiarity with mental illness. Goodness-of-fit indexes from path analyses supported our hypotheses. Social distance is influenced by both kinds of prejudice: authoritarianism (the belief that persons with mental illness cannot care for themselves, so a paternalistic health system must do so) and benevolence (the belief that persons with mental illness are innocent and childlike). These forms of prejudice, in turn, are influenced by the believers' familiarity with mental illness and their ethnicity. We also discuss how these findings might contribute to a fuller understanding of mental illness stigma. (+info)
Doctors' authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany.
OBJECTIVES: The study was performed in order to investigate how end-of-life decisions are influenced by cultural and sociopolitical circumstances and to explore the compliance of doctors with patient wishes. PARTICIPANTS AND MEASUREMENT: Five hundred and thirty-five physicians were surveyed in Sweden (Umea), Germany (Rostock and Neubrandenburg), and in Russia (Arkhangelsk) by a questionnaire. The participants were recruited according to availability and are not representative. The questionnaire is based on the one developed by Molloy and co-workers in Canada which contains three case vignettes about an 82-year-old Alzheimer patient with an acute life-threatening condition; the questionnaire includes different levels of information about his treatment wishes. We have added various questions about attitudes determining doctors' decision making process (legal and ethical concerns, patient's and family wishes, hospital costs, patient's age and level of dementia and physician's religion). RESULTS: Swedish physicians chose fewer life-prolonging interventions as compared with the Russian and the German doctors. Swedish physicians would perform cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest less frequently, followed by the German doctors. More than half the Russian physicians decided to perform CPR irrespective of the available information about the patient's wishes. Level of dementia emerged as the most powerful determining attitude-variable for the decision making in all three countries. CONCLUSIONS: The lack of compliance with patient wishes among a substantial number of doctors points to the necessity of emphasising ethical aspects both in medical education and clinical practice. The inconsistency in the treatment decisions of doctors from different countries calls for social consensus in this matter. (+info)
Of doctor-patient sex and assisted suicide.
The ethical chapter of the Israel Medical Association has recently issued guidelines with regard to sexual relationships between doctors and patients or past patients. This paper juxtaposes the paternalistic and severe attitude to doctor-patient sex with the relaxation and individualization of decisions regarding doctors' involvement in assisted suicide, passive and active euthanasia. The discussion bears on our concepts of palliative care and our expectations from it. (+info)