36 results
Search Results
2. Moral experience: a framework for bioethics research.
- Author
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Hunt, Matthew R. and Camevale, Franco A.
- Subjects
ETHICS ,BIOETHICS ,MEDICAL care ,DECISION making ,PROBLEM solving - Abstract
Theoretical and empirical research in bioethics frequently focuses on ethical dilemmas or problems. This paper draws on anthropological and phenomenological sources to develop an alternative framework for bioethical enquiry that allows examination of a broader range of how the moral is experienced in the everyday lives of individuals and groups. Our account of moral experience is subjective and hermeneutic. We define moral experience as "Encompassing a person's sense that values that he or she deem important are being realised or thwarted in everyday life. This includes a person's interpretations of a lived encounter, or a set of lived encounters, that fall on spectrums of right-wrong, good-bad or just-unjust". In our conceptualisation, moral experience is not limited to situations that are heavily freighted with ethically-troubling ramifications or are sources of debate and disagreement. Important aspects of moral experience are played out in mundane and everyday settings. Moral experience provides a research framework, the scope of which extends beyond the evaluation of ethical dilemmas, processes of moral justification and decision-making, and moral distress. This broad research focus is consistent with views expressed by commentators within and beyond bioethics who have called for deeper and more sustained attention in bioethics scholarship to a wider set of concerns, experiences and issues that better captures what is ethically at stake for individuals and communities. In this paper we present our conceptualisation of moral experience, articulate its epistemological and ontological foundations and discuss opportunities for empirical bioethics research using this framework. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
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3. Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?
- Author
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McDougall, Rosalind J., Gillam, Lynn, Delany, Clare, and Jayasinghe, Yasmin
- Subjects
FERTILITY preservation ,MEDICAL ethics ,QUALITY of life ,DECISION making ,ETHICS - Abstract
Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. 'Fertility preservation' for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such 'experimental' procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents' decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children's Hospital in Melbourne, Australia. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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4. Absent virtues: the poacher becomes gameskeeper.
- Author
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Koch, T.
- Subjects
BIOETHICS ,PATERNALISM ,ELITISM ,DECISION making ,MEDICAL ethics ,ETHICS - Abstract
Since its inception, bioethics' principled stance has been to argue against paternalism and elitism, and for an inclusive ethical perspective. But at least in North America, the growth of bioethics as a special area of applied ethics has created conflicts within the field itself. Those who, a generation earlier, argued against paternalism and for both professional and public accountability in medical decision making are now part of the decision making process. Too often, it is argued in this paper, their allegiance is to the employer, or to a view of medicine that is institutionally based. As a result, it is suggested by this review, medical ethicists have adopted the perspective that, in the early 1970s, they most criticised. The answer, it is argued here, is to revisit a lexicographical ordering of responsibility in bioethics, one that recognises professionals as individuals with responsibilities, as citizens with a public posture, and finally, as professionals involved in the process of medical decision making. [ABSTRACT FROM AUTHOR]
- Published
- 2003
- Full Text
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5. Medicine, ethics and religion: rational or irrational?
- Author
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Orr, Robert D, Genesen, Leigh B, Orr, R D, and Genesen, L B
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MEDICINE ,ETHICS ,RELIGION ,DECISION making ,LOGIC ,MEDICAL ethics ,RELIGION & medicine ,PHYSICIANS ,CULTURAL pluralism ,PREJUDICES ,PSYCHOLOGY & religion ,RESOURCE allocation ,SOCIAL values ,PSYCHOLOGICAL stress ,OCCUPATIONAL roles ,PATIENTS' attitudes - Abstract
Savulescu maintains that our paper, which encourages clinicians to honour requests for "inappropriate treatment" is prejudicial to his atheistic beliefs, and therefore wrong. In this paper we clarify and expand on our ideas, and respond to his assertion that medicine, ethics and atheism are objective, rational and true, while religion is irrational and false. [ABSTRACT FROM AUTHOR]
- Published
- 1998
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6. Canada on course to introduce permissive assisted dying regime.
- Author
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Schuklenk, Udo
- Subjects
EUTHANASIA ,ASSISTED suicide ,MEDICAL care ,HEALTH policy ,CRIMINAL codes ,EUTHANASIA laws ,ADVANCE directives (Medical care) -- Law & legislation ,CONSENSUS (Social sciences) ,DECISION making ,ETHICS ,POLICY sciences - Abstract
Canada's Supreme Court decided in February 2015 that the criminalisation of assisted dying in the country violates the country's citizens and residents constitutional rights. This paper reviews policy recommendations produced by a special expert advisory panel appointed by Canada's provinces and territories, where the responsibility for the provision of health care lies. It also reviews a similar document produced by a special federal parliamentary committee. Based on the review of these two milestone documents it is argued that a Canadian consensus seems to emerge that foreshadows a permissive regulatory regime in that country. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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7. Ethical considerations for choosing between possible models for using NIPD for aneuploidy detection.
- Author
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Deans, Zuzana and Newson, Ainsley Janelle
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PRENATAL diagnosis ,ANEUPLOIDY ,MATERNAL health ,DECISION making ,MEDICAL screening & ethics ,MEDICAL ethics ,ETHICS - Abstract
Recent scientific advances mean the widespread introduction of non-invasive prenatal diagnosis (NIPD) for chromosomal aneuploidies may be close at hand, raising the question of how NIPD should be introduced as part of antenatal care pathways for pregnant women. In this paper, the authors examine the ethical implications of three hypothetical models for using NIPD for aneuploidy in state-funded healthcare systems and assess which model is ethically preferable. In comparing the models, the authors consider their respective timings; how each model would fit with current screening and diagnostic tests offered to pregnant women; the implications of offering NIPD at different stages of pregnancy; and the potential for each model to support reproductive autonomy and informed decision-making. The authors conclude by favouring a model that would be offered at 11 -- 13 weeks gestation, alongside existing combined screening, provided that this is accompanied by measures to maximise informed decision-making, for example, provision of adequate pretest and post-test counselling. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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8. Juggling law, ethics, and intuition: practical answers to awkward questions.
- Author
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Sommerville, A.
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ETHICS ,DECISION making ,MEDICAL ethics ,INTUITION - Abstract
The eclectic problem solving methodology used by the British Medical Association (BMA) is described in this paper. It has grown from the daily need to respond to doctors' practical queries and incorporates reference to law, traditional professional codes, and established BMA policies--all of which must be regularly assessed against the benchmark of contemporary societal expectations. The two Jehovah's Witness scenarios are analysed, using this methodology and in both cases the four principles solution is found to concur with that of the BMA's approach. The author's overall conclusion is that although the BMA resorts to a lengthier list of thins to consider, the solutions that emerge are often likely to coincide with the four principles approach. [ABSTRACT FROM AUTHOR]
- Published
- 2003
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9. Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions.
- Author
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Pang, Mei-che Samantha and Pang, M C
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MEDICAL ethics ,MEDICINE ,AUTONOMY (Psychology) ,BENEVOLENCE ,CULTURE ,DECISION making ,ETHICS ,INFORMED consent (Medical law) ,LIFE expectancy ,PATIENT-professional relations ,PATERNALISM ,CULTURAL pluralism ,SOCIAL values ,TRUST ,VALUE (Economics) ,PATIENTS' rights ,DISCLOSURE ,SOCIAL responsibility ,EMPIRICAL research ,AT-risk people - Abstract
The first part of this paper examines the practice of informed treatment decisions in the protective medical system in China today. The second part examines how health care professionals in China perceive and carry out their responsibilities when relaying information to vulnerable patients, based on the findings of an empirical study that I had undertaken to examine the moral experience of nurses in practice situations. In the Chinese medical ethics tradition, refinement [jing] in skills and sincerity [cheng] in relating to patients are two cardinal virtues that health care professionals are required to possess. This notion of absolute sincerity carries a strong sense of parental protectiveness. The empirical findings reveal that most nurses are ambivalent about telling the truth to patients. Truth-telling would become an insincere act if a patient were to lose hope and confidence in life after learning of his or her disease. In this system of protective medical care, it is arguable as to whose interests are being protected: the patient, the family or the hospital. I would suggest that the interests of the hospital and the family members who legitimately represent the patient's interests are being honoured, but at the expense of the patient's right to know. [ABSTRACT FROM AUTHOR]
- Published
- 1999
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10. The principle of QALY maximisation as the basis for allocating health care resources.
- Author
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Cubbon, J
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COMPARATIVE studies ,DECISION making ,ETHICS ,HEALTH care rationing ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL ethics ,HEALTH policy ,PHYSICIAN-patient relations ,QUALITY of life ,RESEARCH ,RESOURCE allocation ,EVALUATION research ,PATIENT selection - Abstract
This paper presents a case for allocating health care resources so as to maximise Quality Adjusted Life Years (QALYs). Throughout parallels are drawn with the grounds for adopting utilitarianism. QALYs are desirable because they are essential for human flourishing and goal-attainment. In conditions of scarcity the principle of QALY maximisation may involve unequal treatment of different groups of people; and it is argued that this is not objectionable. Doctors in their dealings with patients should not be continually consulting the principle (though it can sometimes be useful); instead by following existing ethical codes more QALYs will be produced overall. In the formulation of policy, however, the principle should be applied in a thoroughgoing way and, if it is, it will not have some of the counterintuitive consequences it may have in interpersonal situations. [ABSTRACT FROM PUBLISHER]
- Published
- 1991
11. Causes and consequences of delays in treatment-withdrawal from PVS patients: a case study of [2016] EWCOP 32.
- Author
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Kitzinger, Jenny and Kitzinger, Celia
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LEGAL status of patients ,CONSCIOUSNESS ,PATIENTS ,PERSISTENT vegetative state ,MEDICAL care ,MEDICAL ethics ,ACTIONS & defenses (Law) ,CONFLICT (Psychology) ,DECISION making ,ETHICS ,JURISPRUDENCE ,HEALTH policy ,LIFE support systems in critical care ,NATIONAL health services ,PASSIVE euthanasia ,LAW - Abstract
Life-extending treatment, in the form of artificial nutrition and hydration, is often provided to people in permanent vegetative states (PVS) in England and Wales for many years, even when their family believes the patient would not want it and despite the fact that no court in the UK has ever found in favour of continuing such treatment for a patient with a confirmed PVS diagnosis. The first half of this article presents a close analysis of the recent case of Cumbria NHS Clinical Commissioning Group v Miss S and Ors [2016] EWCOP 32. It examines the causes of delay in bringing this case to court and reaching a final judgment. It draws not only on the published judgment, but also on the two authors' involvement in supporting the family (before, during and subsequent to the court hearings) as a result of their academic and policy-related work in this area. This includes conversations with the family and with members of the clinical and legal teams, and observations in court. The second part of the article draws out the ethical and practical implications of the findings for theory and policy and suggests ways forward in relation to (a) the provision and inspection of care for these patients; (b) legal practice in relation to 'best interests' and (c) the perceived requirement under English law for a court application before life-prolonging treatment can be withdrawn from PVS patients-even in the absence of any 'in principle' opposition. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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12. The role of law in decisions to withhold and withdraw life-sustaining treatment from adults who lack capacity: a cross-sectional study.
- Author
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White, Benjamin P., Willmott, Lindy, Williams, Gail, Cartwright, Colleen, and Parker, Malcolm
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TERMINAL care laws ,CRITICAL care medicine ,DECISION making ,PHYSICIANS ,MEDICAL care ,SICK people ,TERMINAL care ethics ,ADVANCE directives (Medical care) ,ATTITUDE (Psychology) ,CATASTROPHIC illness ,COMPARATIVE studies ,HEALTH attitudes ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL personnel ,MEDICAL protocols ,RESEARCH ,EVALUATION research ,CROSS-sectional method ,PASSIVE euthanasia ,ETHICS - Abstract
Objectives: To determine the role played by law in medical specialists' decision-making about withholding and withdrawing life-sustaining treatment from adults who lack capacity, and the extent to which legal knowledge affects whether law is followed.Design: Cross-sectional postal survey of medical specialists.Setting: The two largest Australian states by population.Participants: 649 medical specialists from seven specialties most likely to be involved in end-of-life decision-making in the acute setting.Main Outcome Measures: Compliance with law and the impact of legal knowledge on compliance.Results: 649 medical specialists (of 2104 potential participants) completed the survey (response rate 31%). Responses to a hypothetical scenario found a potential low rate of legal compliance, 32% (95% CI 28% to 36%). Knowledge of the law and legal compliance were associated: within compliers, 86% (95% CI 83% to 91%) had specific knowledge of the relevant aspect of the law, compared with 60% (95% CI 55% to 65%) within non-compliers. However, the reasons medical specialists gave for making decisions did not vary according to legal knowledge.Conclusions: Medical specialists prioritise patient-related clinical factors over law when confronted with a scenario where legal compliance is inconsistent with what they believe is clinically indicated. Although legally knowledgeable specialists were more likely to comply with the law, compliance in the scenario was not motivated by an intention to follow law. Ethical considerations (which are different from, but often align with, law) are suggested as a more important influence in clinical decision-making. More education and training of doctors is needed to demonstrate the role, relevance and utility of law in end-of-life care. [ABSTRACT FROM AUTHOR]- Published
- 2017
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13. Informed consent to HIV cure research.
- Author
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Bromwich, Danielle and Millum, Joseph R.
- Subjects
INFORMED consent (Medical law) ,THERAPEUTICS ,HIV infections ,AIDS ,HIV ,HIV-positive persons ,HIV prevention ,INFORMED consent & ethics ,MEDICAL research ethics ,COMMUNICATION ,DECISION making ,MEDICAL research ,MOTIVATION (Psychology) ,PATIENT education ,READABILITY (Literary style) ,RISK assessment ,COMMUNICATION ethics ,INFORMATION literacy ,INSTITUTIONAL review boards ,DISEASE eradication ,ETHICS - Abstract
Trials with highly unfavourable risk-benefit ratios for participants, like HIV cure trials, raise questions about the quality of the consent of research participants. Why, it may be asked, would a person with HIV who is doing well on antiretroviral therapy be willing to jeopardise his health by enrolling in such a trial? We distinguish three concerns: first, how information is communicated to potential participants; second, participants' motivations for enrolling in potentially high risk research with no prospect of direct benefit; and third, participants' understanding of the details of the trials in which they enrol. We argue that the communication concern is relevant to the validity of informed consent and the quality of decision making, that the motivation concern does not identify a genuine problem with either the validity of consent or the quality of decision making and that the understanding concern may not be relevant to the validity of consent but is relevant to the quality of decision making. In doing so, we derive guidance points for researchers recruiting and enrolling participants into their HIV cure trials, as well as the research ethics committees reviewing proposed studies. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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14. Why high-risk, non-expected-utility-maximising gambles can be rational and beneficial: the case of HIV cure studies.
- Author
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Buchak, Lara
- Subjects
HIV infections ,THERAPEUTICS ,HEALTH risk assessment ,PROBABILITY theory ,HEALTH status indicators ,PUBLIC health ,HIV prevention ,MEDICAL research ethics ,ATTITUDE (Psychology) ,DECISION making ,ETHICS ,MEDICAL ethics ,MEDICAL personnel ,PROFESSIONAL ethics ,RESEARCH funding ,RISK assessment ,SOCIAL responsibility ,RESEARCH personnel - Abstract
Some early phase clinical studies of candidate HIV cure and remission interventions appear to have adverse medical risk-benefit ratios for participants. Why, then, do people participate? And is it ethically permissible to allow them to participate? Recent work in decision theory sheds light on both of these questions, by casting doubt on the idea that rational individuals prefer choices that maximise expected utility, and therefore by casting doubt on the idea that researchers have an ethical obligation not to enrol participants in studies with high risk-benefit ratios. This work supports the view that researchers should instead defer to the considered preferences of the participants themselves. This essay briefly explains this recent work, and then explores its application to these two questions in more detail. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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15. Why do parents decline newborn intramuscular vitamin K prophylaxis?
- Author
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Miller, Hayleigh, Kerruish, Nicola, Broadbent, Roland S., Barker, David, and Wheeler, Benjamin J.
- Subjects
INTRAMUSCULAR injections ,VITAMIN K ,PREVENTIVE medicine ,NEWBORN infants ,DECISION making ,MEDICAL care ,EDUCATION of parents ,HEALTH attitudes ,HEMORRHAGIC disease of newborn ,PSYCHOLOGY of parents ,QUALITATIVE research ,ETHICS ,PATIENT refusal of treatment ,PSYCHOLOGY ,PREVENTION - Abstract
Objective: To explore the influencing factors and reasoning of parents who opt out of intramuscular vitamin K prophylaxis for their newborn.Design: We conducted a qualitative study with 15 families from the Otago/Southland region of New Zealand. Semistructured interviews explored their choice to opt out of intramuscular vitamin K prophylaxis and thematic analysis was used to elucidate themes that captured important aspects of this parental decision-making process.Results: Parents opt out of intramuscular vitamin K for a variety of reasons. These were clustered into three main themes: parents' beliefs and values (philosophy and spirituality), concerns about their child's welfare (pain and potential side effects) and external influencing factors (family, friends, media and health professionals). As part of a wider family hesitancy towards medical intervention, the majority of parents also raised concerns regarding other perinatal or childhood interventions.Conclusion: Many factors influence parental decision making and lead to a decision to opt out of newborn intramuscular vitamin K prophylaxis. Due to strong parallels with other common childhood interventions, these findings have relevance for vitamin K prophylaxis and for other healthcare interventions in childhood. [ABSTRACT FROM AUTHOR]- Published
- 2016
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16. Intending, hastening and causing death in non-treatment decisions: a physician interview study.
- Author
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Magelssen, Morten, Kaushal, Sophia, and Nyembwe, Kalala Ariel
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TERMINAL care ,PHYSICIANS' attitudes ,PHYSICIANS ,TREATMENT delay (Medicine) ,DECISION making -- Testing ,ASSISTED suicide & ethics ,ASSISTED suicide ,PHYSICIAN-patient relations ,TERMINAL care ethics ,ANXIETY testing ,ATTITUDE (Psychology) ,DECISION making ,FEAR of death ,INTENTION ,INTERVIEWING ,MEDICAL ethics ,MEDICAL personnel ,OCCUPATIONAL roles ,ETHICS ,PSYCHOLOGY - Abstract
Purpose: To explore how physicians analyse their non-treatment decisions in light of the concepts of hastening, causing and intending the patient's death.Methods: Sixteen Norwegian physicians from relevant specialties were interviewed and the results analysed by systematic text condensation, a qualitative analysis framework.Results: The physicians' chief dilemma in non-treatment decisions was the attempt to achieve the proper balance for the level of treatment at life's end. Respondents framed their challenges in medical and not ethical terms. They treated the concepts of intending, hastening and causing the patient's death as alien to their practical deliberations and, for many, irrelevant to the moral appraisal of their end-of-life practices.Conclusions: The core concepts of traditional medico-ethical analyses of end-of-life decision-making do not map the practical terrain well. Research on physician intentions must be designed and interpreted in light of this. [ABSTRACT FROM AUTHOR]- Published
- 2016
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17. Reasons doctors provide futile treatment at the end of life: a qualitative study.
- Author
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Willmott, Lindy, White, Benjamin, Gallois, Cindy, Parker, Malcolm, Graves, Nicholas, Winch, Sarah, Callaway, Leonie Kaye, Shepherd, Nicole, and Close, Eliana
- Subjects
THERAPEUTICS ,DEATH ,MEDICAL personnel ,MEDICINE ,MEDICAL care ,PALLIATIVE treatment ,TERMINAL care ethics ,FUTILE medical care ,ATTITUDE (Psychology) ,COMMUNICATION ,COMPARATIVE studies ,DECISION making ,ETHICS ,RESEARCH methodology ,MEDICAL cooperation ,PATIENT-professional relations ,PSYCHOLOGY of physicians ,RESEARCH ,PSYCHOLOGY of the terminally ill ,QUALITATIVE research ,EVALUATION research - Abstract
Objective: Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient's life.Design: Semistructured in-depth interviews.Setting: Three large tertiary public hospitals in Brisbane, Australia.Participants: 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling.Results: Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the main reasons for futile care.Conclusions: Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level. [ABSTRACT FROM AUTHOR]- Published
- 2016
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18. Premortem interventions in dying children to optimise organ donation: an ethical analysis.
- Author
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Brierley, Joe and Shaw, David
- Subjects
ORGAN donation ,MEDICAL ethics ,CHILD death ,TRANSPLANTATION of organs, tissues, etc. ,PARENTAL consent (Medical law) ,ORGAN donation & ethics ,INFORMED consent & ethics ,ORGAN donors ,PEDIATRICS & ethics ,BRAIN death ,DECISION making ,ETHICS ,INTENSIVE care units ,PSYCHOLOGY of parents ,PEDIATRICS ,PSYCHOLOGY - Abstract
A range of interventions in dying patients can improve both the possibility of successful organ donation and the likely long-term success of transplantation. The ethical and legal issues surrounding such interventions, which most frequently occur in the context of donation after circulatory determination of death, are complex, controversial and many remain unresolved. This is true with adults, but even more so with children, where the issue of organ donation and premortem interventions to facilitate it, are highly sensitive. Essentially, such interventions are being undertaken in dying children who cannot medically benefit from them, though arguments have been advanced that becoming a donor might be in a child's extended best interest. However, certain interventions carry a potential risk, although small, of direct harm and of course overall objections to child donation after circulatory determination of death per se are still expressed in the literature. But, unlike the case in critically ill adults, those giving permission for such interventions are normally able to fully participate in decision-making, and indeed to consent, to both donation and premortem interventions. We review the issue of the use of premortem interventions in dying children to facilitate organ donation, including decision-making and ethical justification. Individual interventions are then considered, including an ethical analyse of their use. Finally, we recommend an approach using a combination of welfare checklist strategy, coupled with the establishment of an agreed zone of parental discretion about individual interventions which might be used in dying children to increase the possibility of successful organ donation. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
19. In what circumstances will a neonatologist decide a patient is not a resuscitation candidate?
- Author
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Murray, Peter Daniel, Esserman, Denise, and Mercurio, Mark Randolph
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INFANT mortality ,MEDICAL ethics ,NEONATOLOGISTS ,DO-not-resuscitate orders ,RESUSCITATION ,CRITICAL care medicine ,ATTITUDE (Psychology) ,CATASTROPHIC illness ,DECISION making ,MEDICAL personnel ,PROGNOSIS ,QUALITY of life ,ETHICS - Abstract
Objective: The purpose of this study was to determine the opinions of practising neonatologists regarding the ethical permissibility of unilateral Do Not Attempt Resuscitation (DNAR) decisions in the neonatal intensive care unit.Study Design: An anonymous survey regarding the permissibility of unilateral DNAR orders for three clinical vignettes was sent to members of the American Academy of Pediatrics Section of Perinatal Medicine.Results: There were 490 out of a possible 3000 respondents (16%). A majority (76%) responded that a unilateral DNAR decision would be permissible in cases for which survival was felt to be impossible. A minority (25%) responded 'yes' when asked if a unilateral DNAR order would be permissible based solely on neurological prognosis.Conclusions: A majority of neonatologists believed unilateral DNAR decisions are ethically permissible if survival is felt to be impossible, but not permissible based solely on poor neurological prognosis. This has significant implications for clinical care. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
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20. A framework for luck egalitarianism in health and healthcare.
- Author
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Albertsen, Andreas and Knight, Carl
- Subjects
DISTRIBUTIVE justice ,EQUALITY ,DECISION making ,CHOICE (Psychology) ,MEDICAL decision making - Abstract
Several attempts have been made to apply the choice-sensitive theory of distributive justice, luck egalitarianism, in the context of health and healthcare. This article presents a framework for this discussion by highlighting different normative decisions to be made in such an application, some of the objections to which luck egalitarians must provide answers and some of the practical implications associated with applying such an approach in the real world. It is argued that luck egalitarians should address distributions of health rather than healthcare, endorse an integrationist theory that combines health concerns with general distributive concerns and be pluralist in their approach. It further suggests that choice-sensitive policies need not be the result of applying luck egalitarianism in this context. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
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21. A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan.
- Author
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Ivo, Kwon, Younsuck, Koh, Ho, Yun Young, Sang-Yeon, Suh, Seog, Heo Dae, Hyunah, Bae, Kenji, Hattori, and Xiaomei, Zhai
- Subjects
MEDICAL ethics ,DECISION making ,PROBLEM solving ,PATIENT advocacy ,ETHICS - Abstract
Purpose The debate about the end-of-life care decision is becoming a serious ethical and legal concern in the Far-Eastern countries of Korea, China and Japan. However, the issues regarding end-of-life care will reflect the cultural background, current medical practices and socioeconomic conditions of the countries, which are different from Western countries and between each other. Understanding the genuine thoughts of patients who are critically ill is the first step in confronting the issues, and a comparative descriptive study of these perspectives was conducted by collaboration between researchers in all three countries. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
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22. Ethical decision-making about older adults and moral intensity: an international study of physicians.
- Author
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Malloy, D. C., Williams, J., Hadjistavropoulos, T., Krishnan, B., Jeyaraj, M., McCarthy, E. F., Murakami, M., Paholpak, S., Mafukidze, J., and Hillis, B.
- Subjects
ETHICS ,DECISION making ,DILEMMA ,MEDICAL students ,PHYSICIANS - Abstract
Through discourse with international groups of physicians, we conducted a cross-cultural analysis of the types of ethical dilemmas physicians face. Qualitative analysis was used to categorise the dilemmas into seven themes, which we compared among the physicians by country of practice. These themes were a-theoretically-driven and grounded heavily within the text. We then subjected the dilemmas to an analysis of moral intensity, which represents an important (albeit novel within healthcare research) theoretical perspective of ethical decision making. These constructs (ie, culture and moral intensity) represent salient determinants of ethical behaviour and our cross-cultural sample afforded us the opportunity to consider both the pragmatic aspects of culture, as they are perceived by physicians, as well as the theory-driven concept of moral intensity. By examining both culture and moral intensity, we hope to better elucidate the complexities of ethical decision-making determinants among physicians in their daily practice. Doing so may potentially have practical implications for ethics training of medical students and foreign physicians. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
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23. Publish and perish: a case study of publication ethics in a rural community.
- Author
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Fraser, J. and Alexander, C.
- Subjects
DECISION making ,ETHICS ,MEDICAL ethics ,RURAL health ,BIOETHICS - Abstract
Background: Health researchers must weigh the benefits and risks of publishing their findings. Objective: To explore differences in decision making between rural health researchers and managers on the publication of research from small identifiable populations. Method: A survey that investigated the altitudes of Australian rural general practitioners (GPs) to nurse practitioners was explored. Decisions on the study's publication were analysed with bioethical principles and health service management ethical decision-making models. Results: Response rate was 78.5% (62/79 GPs). 84-94% of GP responders considered it to be undesirable for nurse practitioners to initiate referrals to medical specialists (n = 58), to initiate diagnostic imaging (n = 56) and to prescribe medication (n = 52). Bioethical analysis: It was concluded that the principle of beneficence outweighed the principle of nonmaleficence and that a valid justification for the publication of these results existed. Decision-making models of health service managers: On the basis of models of ethical decision making in health service management, the decisions of the area's health managers resulted in approval to publish this project's results being denied. This was because the perceived risks to the health service outweighed benefits. Confidentiality could not be ensured by publication under a regional nom de plume. Conclusions: A conflict of interests between rural researchers and health managers on publication of results is shown by this case study. Researchers and managers at times awe competing duties to key stakeholders. Both weigh the estimated risks and benefits of the effect of research findings. This is particularly true in a rural area, where identification of the subjects becomes more likely. [ABSTRACT FROM AUTHOR]
- Published
- 2006
- Full Text
- View/download PDF
24. Clinical ethical dilemmas: convergent and divergent views of two scholarly communities.
- Author
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Stiggelbout, A. M., Elstein, A. S., Molewijk, B., Otten, W., and Kievit, J.
- Subjects
MEDICAL ethics ,DECISION making ,ETHICS ,BIOETHICS ,SOCIETIES ,PHYSICIANS ,MEDICINE - Abstract
Objective: To survey members of the American Society for Bioethics and Humanities (ASBH; n = 327) and of the Society for Medical Decision Making (SMDM; n = 77) to elicit the similarities and differences in their reasoning about two clinical cases that involved ethical dilemmas. Cases: Case 1 was that of a patient refusing treatment that a surgeon thought would be beneficial. Case 2 dealt with end-of-life care. The argument was whether intensive treatment should be continued of an unconscious patient with multiorgan failure. Method: Four questions, with structured multiple alternatives, were asked about each case: identified core problems, needed additional information, appropriate next steps and who the decision maker should be. Observations and results: Substantial similarities were noticed between the two groups in identifying the core problems, the information needed and the appropriate next steps. SMDM members gave more weight to outcomes and trade-offs and ASBH members had patient autonomy trump other considerations more strongly. In case 1, more than 60% of ASBH respondents identified the patient alone as the decision maker, whereas members of SMDM were almost evenly divided between having the patient as the solo decision maker or preferring a group of some sort as the decision maker, a significant difference (p<0.02). In case 2, both groups agreed that the question of discontinuing treatment should be discussed with the family and that the family alone should not be the decision maker. Conclusion: Despite distinctively different methods of case analysis and little communication between the two professional communities, many similarities were observed in the actual decisions they reached on the two clinical dilemmas. [ABSTRACT FROM AUTHOR]
- Published
- 2006
- Full Text
- View/download PDF
25. Evaluation and ethical review of a tool to explore patient preferences for information and involvement in decision making.
- Author
-
Murtagh, F. E. M. and Thorns, A.
- Subjects
DECISION making ,ETHICS ,QUESTIONNAIRES ,COMMUNICATION ,PATIENTS - Abstract
Aim: To improve clinical and ethical understanding of patient preferences for information and involvement in decision making. Objectives: To develop and evaluate a clinical tool to elicit these preferences and to consider the ethical issues raised. Design: A before and after study. Setting: Three UK hospices. Participants: Patients with advanced life-threatening illnesses and their doctors. Intervention: Questionnaire on information and decision-making preferences. Main outcome measures: Patient-based outcome measures were satisfaction with the amount of information given, with the way information was given, with family or carer information, and confidence about future decision making. Doctor-based outcome measures were confidence in matching information to patient preference, matching family or carer communication to patient preference, knowing patient preferences and matching future decision making with patient preference. Results: Of 336 admissions, 101 patients (mean age 67.3 years, 47.5% men) completed the study (control, n = 40; intervention, n = 61). Patient satisfaction with the way information was given (χ² = 6.38, dr = 2, p = 0.041) and family communication (χ² = 14.65, df = 2, p<0.001) improved after introduction of the tool. Doctor confidence improved across all outcome measures (all p values<0.001). Conclusions: Patient satisfaction and doctor confidence were improved by administering the questionnaire, but complex ethical issues were raised by implementing and applying this research. The balance of ethical considerations were changed by advanced life-threatening illness, because there is increased risk of harm through delivery of information discordant with the patient's own preferences. The importance of truly understanding patient preferences towards the end of life is highlighted by this study. [ABSTRACT FROM AUTHOR]
- Published
- 2006
- Full Text
- View/download PDF
26. Consent, sectionalisation and the concept of a medical procedure.
- Author
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Maclean, A. R.
- Subjects
THERAPEUTICS ,MEDICAL practice ,MALPRACTICE ,INFORMED consent (Medical law) ,AUTONOMY (Psychology) ,DECISION making ,ETHICS ,MATHEMATICAL models ,PROFESSIONS ,OPERATIVE surgery ,PATIENT participation ,DISCLOSURE ,THEORY - Abstract
Consent transforms an otherwise illegitimate act into a legitimate one. To be valid, however, it must be adequately informed. The legal requirement is vague and provides little assistance in predicting when it will be satisfied. This is particularly so when a patient consents to a procedure and the physician subsequently varies one of the components of that procedure. Using three legal judgments and one General Medical Council (GMC) decision as a springboard, I have explored the concept of a medical procedure within the context of consent and developed a theoretical model to elucidate a more predictable and consistent informational requirement. [ABSTRACT FROM AUTHOR]
- Published
- 2002
- Full Text
- View/download PDF
27. The decision making process regarding the withdrawal or withholding of potential life-saving treatments in a children's hospital.
- Author
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Street, Karen, Ashcroft, Richard, Henderson, John, and Campbell, Alastair V.
- Subjects
MEDICINE ,LIFE support systems in critical care ,CHILDREN'S hospitals ,DECISION making ,ETHICS - Abstract
Objectives--To investigate the factors considered by staff, and the practicalities involved in the decision making process regarding the withdrawal or withholding of potential life-sustaining treatment in a children's hospital. To compare our current practice with that recommended by the Royal College of Paediatrics and Child Health (RCPCH) guidelines, published in 1997. Design--A prospective, observational study using self-reported questionnaires. Setting--Tertiary paediatric hospital. Patients and participants--Consecutive patients identified during a six-month period, about whom a formal discussion took place between medical staff, nursing staff and family regarding the withholding or withdrawal of potentially life-sustaining treatments. The primary physician and primary nurse involved in the discussion were identified. Method--Two questionnaires completed independently by the primary physician and nurse. Results--Twenty-two patients were identified (median age 1 year; range 1 day--34 years). In 20 cases treatment was withdrawn or withheld, in two cases treatment was continued. Nursing staff considered family wishes and family perceptions of patient suffering as significantly more important factors in decision making than medical staff, who considered prognostic factors as most important. In only two cases were the patient's expressed wishes apparently available. In most cases staff considered the patient's best interests were served and the process would not be enhanced by the involvement of an independent ethics committee. The exceptions were those cases in which treatment was continued following disagreement between parties. Conclusions--Our current practice is consistent with that recommended by the RCPCH. The contribution of the patient, provision of staff counselling and general practitioner (GP) involvement were identified as areas for improvement. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
28. Choices without reasons: citizens' juries and policy evaluation.
- Author
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Price, David and Price, D
- Subjects
JURY ,MEDICAL care ,POLICY sciences ,DECISION making ,ETHICS ,HEALTH care rationing ,HEALTH planning ,RESEARCH methodology ,NATIONAL health services ,PRACTICAL politics ,RESOURCE allocation ,SOCIAL justice ,SOCIAL values - Abstract
Citizens' juries are commended as a new technique for democratising health service reviews. Their usefulness is said to derive from a reliance on citizens' rational deliberation rather than on the immediate preferences of the consumer. The author questions the assertion of critical detachment and asks whether juries do in fact employ reason as a means of resolving fundamental disagreements about service provision. He shows that juries promote not so much a critically detached point of view as a particular evaluative framework suited to the bureaucratic idiom of social welfare maximisation. Reports of jury practice reveal a tendency among juries to suppress by non-rational means the everyday moral language of health care evaluation and substitute for it a system of thought in which it can be deemed permissible to deny treatment to sick people. The author concludes that juries are chiefly concerned with non-rational persuasion and because of this they are morally and democratically irrelevant. Juries are no substitute for voting when it comes to protecting the public from zealous minorities. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
29. Can compulsory removal ever be justified for adults who are mentally competent?
- Author
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Greaves, D A
- Subjects
PUBLIC welfare laws ,AUTONOMY (Psychology) ,CAPACITY (Law) ,DECISION making ,ETHICS ,PATERNALISM ,PATIENT advocacy ,PHYSICIAN-patient relations ,SOCIAL values ,PATIENT refusal of treatment ,LAW ,LEGISLATION - Abstract
Section 47 of the National Assistance Act is controversial in that it makes provision for the compulsory removal and care of mentally competent adults in certain limited circumstances. A case is described in which it is argued that compulsory management could be justified. This is because the diversity and potentially conflicting nature of the relevant considerations involved in this and a restricted range of other cases, defies their being captured in any wholly rational moral scheme. It follows that if the law is to be both sensitive and just it cannot always provide definitive guidance as to how the community doctor, as the designated decision-maker, should act. The acceptance of his or her judgement is therefore necessary and depends for its proper working on trust, which can only be gained through compassion and respect for the patients concerned. [ABSTRACT FROM AUTHOR]
- Published
- 1991
30. 'Absolutely not!' Contextual values and equality of voices in mental health.
- Author
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Fulford, K. W. M. and Crepaz-Keay, David
- Subjects
MENTAL health ,QUALITY of life ,HUMAN rights ,DECISION making ,ATTITUDE (Psychology) ,ETHICS ,MEDICAL personnel ,MEDICAL protocols ,MENTAL health services ,PHILOSOPHY ,PATIENT-centered care - Published
- 2018
- Full Text
- View/download PDF
31. Duties to rescue: individual, professional and institutional.
- Author
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Douglas, Thomas
- Subjects
RESCUE doctrine (Law) ,TORTS ,BIOETHICS ,DECISION making ,MEDICAL ethics ,ORGANIZATIONS & ethics ,RESCUE work ,MEDICAL personnel ,DEVELOPING countries ,POVERTY ,SOCIAL justice ,SOCIAL values ,DEVELOPED countries ,SOCIAL responsibility ,ETHICS - Abstract
The article explores concerns regarding the conceptions of rescue duties which are duty of easy rescue and the rule of rescue. Topics addressed include the problems facing the duty of easy rescue which include the risk of over-extending, the re-conceptualization of rescue duties that will render them both plausible and useful for guiding bioethical decisionmaking, and description of the issue of demandingness.
- Published
- 2016
- Full Text
- View/download PDF
32. Understanding (and) consent: a response to MacKay.
- Author
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Saunders, Ben
- Subjects
PROCUREMENT of organs, tissues, etc. ,ORGAN donation ,ORGAN donation & ethics ,INFORMED consent & ethics ,DECISION making ,ORGAN donors - Abstract
A response from the author of the article "Opt-out organ donation without presumptions" that was published in a 2012 issue.
- Published
- 2016
- Full Text
- View/download PDF
33. The Francis Inquiry: from diagnosis to treatment.
- Author
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Smith, Judith A
- Subjects
COMPASSION ,PHYSICIANS ,DECISION making ,HEALTH services administrators - Abstract
The article comments on the article "Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire" by Chris Newdick and Christopher Danbury published in the 2015 issue. Topics include the article focusing on the clash of priorities between doctors and managers, differing approaches to decision making across professional groups at Stafford, and four issues to be addressed which included patient voice, a duty of candour and managerial culture.
- Published
- 2015
- Full Text
- View/download PDF
34. Ethical issues in decision making by hospital health committee members in Turkey.
- Author
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Sari, Nil and Sari, Hidayet
- Subjects
HOSPITAL administration ,DECISION making ,MEDICAL care costs ,HEALTH care rationing ,SOCIAL security ,ETHICS ,SOCIETIES - Abstract
Hospital health committees (HHC) in Turkey review medical reports from clinical practitioners and decide whether or not they are justified. As a rule, each HHC member is expected to observe and examine each patient and then evaluate the report. If the report from the patient's doctor is approved, then the Social Security Administration, a state organisation, will meet all of the patient's expenses covering treatment, medication and operations. Justification of health expenditure is crucial for the state because health resources have to be carefully allocated. Conflicts of obligation also generate ethical issues which have to be resolved as well. However, HHCs are not designed to make ethical decisions. An overall concept of organisational ethics needs to be developed. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
35. Human reproduction: irrational but in most cases morally defensible.
- Author
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Bennett, R.
- Subjects
HUMAN reproduction ,REPRODUCTIVE health ,PREGNANCY ,DECISION making ,ETHICS - Abstract
Tackles the ethical aspects of human reproduction. Notions about the value of human existence; Morality issues associated with the decision to conceive a child; Concept of individual freedom in child-bearing decision making.
- Published
- 2004
- Full Text
- View/download PDF
36. Why it is not strongly irrational to have children.
- Author
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Holm, Søren
- Subjects
HUMAN reproduction ,PREGNANCY & psychology ,CHILDREN ,DECISION making ,ETHICS - Abstract
Comments on the article "A Rational Cure for Prereproductive Stress Syndrome," by Matti Häyry. Arguments on the notions concerning the irrationality of having children; Social implications of having and not having children; Ethical aspects of deciding whether or not to have children.
- Published
- 2004
- Full Text
- View/download PDF
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