RESUMEN
In the fall of 2019, a much-publicized court case brought to national attention the issues of patient-doctor confidentiality when it comes to reporting the deaths of newborns in the United States. It is unclear whether the recent overturning of Roe v. Wade will lead to more cases like this. This article discusses issues of countertransference, as well as the ethical and legal implications were it to be a psychiatrist, in active treatment of such a patient, who would be required to make such a report. More specifically, as in the publicized court case, the patient could be a minor at the time, receiving treatment from a child psychiatrist. The implications of such a case include how countertransference affects the perception of fatal child neglect compared to intentional neonaticide; the ethical dilemma of generating a mandated report with the goal of child safety when such a report could lead to real legal consequences for a minor child; and considerations regarding continued treatment of a patient after such a report is made. It is likely that countertransference, shaped by attitudes toward mothers and idealized views on mothering, may play a large role in all these circumstances.
Asunto(s)
Maltrato a los Niños , Contratransferencia , Notificación Obligatoria , Humanos , Maltrato a los Niños/legislación & jurisprudencia , Maltrato a los Niños/ética , Notificación Obligatoria/ética , Estados Unidos , Recién Nacido , Niño , FemeninoRESUMEN
This Viewpoint discusses the importance of obtaining federal certificates of confidentiality to free researchers to perform important research into child sexual abuse.
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Confidencialidad , Notificación Obligatoria , Confidencialidad/legislación & jurisprudencia , Humanos , Notificación Obligatoria/ética , Estados Unidos , NiñoAsunto(s)
Ensayos Clínicos como Asunto/legislación & jurisprudencia , Adhesión a Directriz/ética , Notificación Obligatoria/ética , Proyectos de Investigación/legislación & jurisprudencia , Personal Administrativo/ética , Sesgo , Lista de Verificación/normas , Ensayos Clínicos como Asunto/ética , Humanos , Proyectos de Investigación/normas , Revisiones Sistemáticas como AsuntoAsunto(s)
Notificación Obligatoria/ética , Preceptoría/métodos , Estudiantes/estadística & datos numéricos , Sesgo , Prácticas Clínicas/tendencias , Defensa del Consumidor/ética , Cultura , Curriculum/estadística & datos numéricos , Personal de Salud/educación , Personal de Salud/ética , Conducta de Ayuda , Humanos , Liderazgo , Discriminación Social/prevención & control , Responsabilidad SocialAsunto(s)
Negro o Afroamericano , Complicidad , Notificación Obligatoria/ética , Médicos/ética , Embarazo , Racismo/ética , Conducta Criminal , Femenino , Historia del Siglo XX , Humanos , Notificación Obligatoria/historia , Rol del Médico , Racismo/historia , Estigma Social , Sociedades Médicas , Trastornos Relacionados con Sustancias/historia , Estados UnidosRESUMEN
The aim of this article is to make a case for mandatory disclosure in assisted reproduction. This refers to a system whereby those who are born through gamete donation and/or surrogacy would be notified about the manner of their birth and the availability of information about their genetic and/or gestational origins. The article argues that, to date, the law has interpreted an individual's interest in knowing their origins as being predominately about identity. However, the central importance of the principle of autonomy in the conceptualisation of this interest has been overlooked. A reconceptualisation of the interest in knowing one's origins as being concerned predominantly with autonomy provides a justification for mandatory disclosure. It is argued that the interest of individuals born through assisted reproduction in having autonomous choice regarding the significance of information about their origins should be prioritised over the autonomous choices of parents not to disclose to their offspring the manner of their birth.
Asunto(s)
Revelación/ética , Revelación/legislación & jurisprudencia , Concepción de Donantes/legislación & jurisprudencia , Notificación Obligatoria/ética , Autonomía Personal , Personeidad , Reducción del Daño , Humanos , Menores/legislación & jurisprudencia , Menores/psicologíaRESUMEN
BACKGROUND: Evidences points to the importance of health professionals to recognize child abuse, but also to a high frequency of underreporting, even in countries where reporting is mandatory, like Brazil. OBJECTIVE: To evaluate the frequency of non-reporting behavior of child physical abuse (CPA) among Brazilian primary care health professionals who recognized some cases in their careers and associated factors with reporting. METHODS: Cross-sectional study conducted with a representative sample of dentists, nurses, family physicians, and pediatricians from the Family Health Strategy network in the city of Belo Horizonte, Brazil. A validated self-administered questionnaire for use in Brazil was applied in-person to professionals in 2014 and 2015. Pearson's chi-squared test (p < 0.05) and a binary logistic regression model was used. RESULTS: A total of 715 professionals participated (response rate: 98.89%), 414 (57.3%) recognized cases, of which 171 (41.3%) reported. Reporting was associated with the type of profession, as pediatricians reported cases more than dentists [OR = 6.05 (95% CI: 1.24-29.50)], with the willingness to become involved [OR = 2.01 (95% CI: 1.02-3.97)] and knowledge regarding where to report cases [OR = 2.68 (95% CI: 1.25-5.74)]. Confidentiality was the barrier associated with a lower probability of reporting CPA cases [OR = 0.22 (95% CI: 0.08-0.66)]. CONCLUSIONS: There is a high frequency of non-reporting behavior. Pediatricians reported more CPA cases, followed by family doctors and nurses. Dentists were those who reported fewer cases. Reporting was also associated with a willingness to be involved in detecting/reporting abuse and knowing where to report CPA.
Asunto(s)
Maltrato a los Niños/estadística & datos numéricos , Personal de Salud/normas , Notificación Obligatoria/ética , Abuso Físico/estadística & datos numéricos , Adolescente , Adulto , Brasil , Niño , Maltrato a los Niños/psicología , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Abuso Físico/psicología , Adulto JovenRESUMEN
Objetivo: descrever o tipo de agressão sofrida pela mulher no período da gestação, bem como as conseqüências para o binômio mãe-filho. Método: estudo bibliográfico, descritivo e exploratório, realizou-se uma busca no banco de dados da Biblioteca Virtual em Saúde (BVS), Sistema Latino-Americano e do Caribe de Informações em Ciências da Saúde (LILACS), Scientific Eletrônic Library Online (SCIELO) e Bancos de dados em enfermagem (BDENF). Resultado: A violência doméstica é caracterizada como qualquer forma de violência praticada dentro do contexto familiar, seja ela física, sexual, psicológica, moral ou patrimonial. Entre os tipos de violência sofrida pela mulher, os mais citados e de maiores danos são a verbal, física e emocional. A violência doméstica contribui para o aumento da mortalidade materna, bem como para o aumento dos números de óbitos perinatais, baixo peso ao nascer, abortos e nascimentos prematuros. Conclusão: Percebeu-se que a violência contra gestantes não tem momento para acontecer e independem de raça, cor, escolaridade e classe social. Observou-se que o profissional deve ampliar seu olhar para os pequenos sinais implícitos nas palavras das mulheres violentadas, pois ele tem um papel de extrema importância no enfrentamento desse problema, afinal ele é o primeiro contato com a gestante vulnerável. (AU)
This study aimed to describe the type of aggression suffered by women during gestation as well as the consequences for the mother-child binomial. Method: a descriptive and exploratory bibliographic study, a search was made in the database of the Virtual Health Library (BVS), Latin American and Caribbean Information System in Health Sciences (LILACS), Scientific Eletrônic Library Online (SCIELO) Nursing Databases (BDENF). Results: Domestic violence is characterized by any form of violence practiced within the family context, be it physical, sexual, psychological, moral or patrimonial. Among the types of violence suffered by women, more cited and larger damage is the verbal, physical and emotional. Domestic violence contributes to increased maternal mortality as well as for the increase of numbers of perinatal deaths, low birth weight, abortions and premature births. Conclusions: It was noticed that violence against pregnant women has no time to happen and is independent of race, color, schooling and social class. It was observed that the professional should widen his eyes to the small signs implied in the words of the violated women, since he plays an extremely important role in facing this problem, after all he is the first contact with the vulnerable pregnant woman. (AU)
Asunto(s)
Humanos , Femenino , Embarazo , Salud Pública , Violencia Doméstica , Mujeres Embarazadas , Violencia contra la Mujer , Delitos Sexuales , Mujeres Maltratadas , Notificación Obligatoria/éticaRESUMEN
INTRODUCTION: In the present study, farm animal practitioners in Switzerland were questioned about their reported violations of the animal welfare law in cattle and their response to the detection of violations in the year 2017. The answers from 34 participants could be included in the evaluation. In 2017, 7.8% of the farms seen by participating practices were found to be in violation of the animal welfare law. It could be shown that the participating veterinarians reported only a small part (8.7%) of the detected offenses to the veterinary offices. In 91.7% of the cases, they responded to the violations and in only 8.3% of the cases they did not respond or they waited. Most often, they informed the livestock owners about the violation (66.1%) or advised them on the implementation of the animal welfare law (24.0%). The most common reason for the decision of reporting violations or not was the severity of the offense or animal suffering. There are many reasons why violations are not reported. The improvement of the situation after a reference, advice or threat of reporting to the veterinary office and the perception of the violation as minor are the most common ones. In addition, veterinarians see their role more in information and advice than in surveillance and repression.
INTRODUCTION: Dans le cadre de la présente étude, des vétérinaires praticiens dans le domaine des animaux de rente en Suisse ont été interrogés sur les violations de la Loi sur la protection des animaux qu'ils avaient constatées chez les bovins et sur leurs réactions à ces violations en 2017. Les réponses de 34 participants ont pu être incluses dans l'évaluation. En 2017, 7,8% des exploitations vues par les pratiques participantes ont été jugées en violation de la loi sur la protection des animaux. Il a pu être démontré que les vétérinaires participants n'ont signalé qu'une petite partie (8,7%) des infractions constatées aux services vétérinaires. Dans 91,7% des cas, ils ont réagi aux violations et dans seulement 8,3% des cas, ils ne l'ont pas fait ou ont attendu. Le plus souvent, ils ont rendu les éleveurs attentifs à la violation (66,1%) ou les ont conseillés sur la mise en Åuvre de la loi sur la protection des animaux (24,0%). La raison la plus courante de la décision de signaler ou non les violations était la gravité de l'infraction ou l'estimation personnelle de la souffrance des animaux. Il existe de nombreuses raisons pour lesquelles les violations ne sont pas signalées. L'amélioration de la situation après une information, un avis ou une menace de dénonciation aux services vétérinaires et la perception de la violation comme mineure sont les plus courantes. De plus, les vétérinaires voient davantage leur rôle dans l'information et les conseils que dans la surveillance et la répression.
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Crianza de Animales Domésticos/ética , Bienestar del Animal/ética , Bienestar del Animal/legislación & jurisprudencia , Animales Domésticos , Veterinarios/ética , Animales , Bovinos , Humanos , Notificación Obligatoria/ética , SuizaRESUMEN
BACKGROUND: Emerging research suggests technology-facilitated crisis services are a promising method to support young people during child maltreatment disclosure. Little is known about how employees/volunteers respond to child maltreatment disclosure in these platforms and how they may support young victims through the disclosure process. OBJECTIVES: We sought to determine how crisis counselors respond to child maltreatment disclosures using a content analysis of all conversations within a text-based crisis organization that resulted in a mandatory report. METHODS: We conducted an iterative team-based content analysis of 244 conversations (24,730 text messages) between a young person and a crisis counselor from an anonymous text-based crisis service. All conversations included in the sample resulted in a mandatory report to child protective services. RESULTS: There were two crucial points in maltreatment disclosure conversations. The first occurred immediately after the disclosure. At this point, crisis counselors most often provided sympathy and affirmation. The second crucial point after disclosure was the discussion of mandatory reporting. In many cases, crisis counselors confirmed both parties understood mandatory reporting and encouraged young people to consider the repercussions of their decision to share identifiable information that would permit a mandatory report. CONCLUSION: Understanding how crisis counselors responded to young people in one text-based crisis service, particularly characteristics of well-received conversations, may inform the policies and processes for other organizations. Continued exploration of crisis text-based services may improve the disclosure process for young victims.
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Maltrato a los Niños/psicología , Notificación Obligatoria/ética , Envío de Mensajes de Texto/normas , Adolescente , Femenino , Humanos , Masculino , Encuestas y CuestionariosAsunto(s)
Exactitud de los Datos , Historia de la Enfermería , Notificación Obligatoria/ética , Notificación Obligatoria/historia , Personal de Enfermería/psicología , Observación/métodos , Revelación de la Verdad/ética , Adulto , Femenino , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Masculino , Persona de Mediana EdadRESUMEN
In the absence of a mandatory reporting (MR) structure, it is unclear how nurses perceive or exercise their role in child protection. This study examined knowledge and perceptions of child protection and MR among nurses working in Hong Kong. This cross-sectional web-based survey used the Child Abuse Report Intention Scale to measure nurses' child protection knowledge and attitudes, and their perceived norms, control, and intention to report suspected maltreatment. Nurses also indicated if they support MR and to provide an explanation for their preference. Quantitative data were described and analyzed using bivariate and regression analyses. Open-ended responses were analyzed using directed content analysis. A convenient sample of 91 nurses working in Hong Kong completed the survey. The majority (86%) were female with a mean of 9.5 years of nursing experience; their mean knowledge score was 6.64 out of 13 (range 2-10). Compared with other maltreatment types, sexual abuse was perceived to be most severe and most likely to be reported. Perceived severity and attitudes toward child maltreatment was significantly associated with nurses' intention to report. Over half (58%) supported MR; those against MR expressed concerns about lack of support from management. Although nurses working in Hong Kong still hold polarized views about MR, findings point to the importance of creating a supportive reporting culture, and designing training programs that focus on changing perceptions about child protection in order to improve their tendency to report.
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Conocimiento , Notificación Obligatoria/ética , Enfermeras y Enfermeros/psicología , Percepción , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Hong Kong , Humanos , Masculino , Enfermeras y Enfermeros/estadística & datos numéricos , Encuestas y CuestionariosAsunto(s)
Violencia de Pareja/prevención & control , Notificación Obligatoria/ética , Tamizaje Masivo/ética , Rol del Médico , Canadá , Pruebas Diagnósticas de Rutina , Violencia Doméstica/prevención & control , Violencia Doméstica/estadística & datos numéricos , Medicina de Emergencia/ética , Medicina de Emergencia/métodos , Servicio de Urgencia en Hospital , Femenino , Humanos , Violencia de Pareja/estadística & datos numéricos , Masculino , Medición de RiesgoRESUMEN
The Government of India has passed a notification making the non-reporting of tuberculosis (TB) by a clinical establishment a punishable offence. This article examines this move from an ethical standpoint. One of the main ethical concerns relates to the violation of patient confidentiality that may result from this. Also as regards improvement in patient care, there appears to be a poor cost-benefit ratio in terms of the actionable data obtained by this There may be possible adverse consequences by a limiting of access to care due to penalising of non-reporting. In terms of the bigger picture, the notification may lead to an increased tension between the private sector and Government. Moreover, it is the position of the authors that such a step distracts attention from the more important issues that plague TB care in India today.
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Confidencialidad/ética , Revelación/ética , Notificación de Enfermedades/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Notificación Obligatoria/ética , Tuberculosis/epidemiología , Humanos , India/epidemiología , Sector Privado/legislación & jurisprudencia , Salud Pública/legislación & jurisprudenciaAsunto(s)
Empleo/ética , Notificación Obligatoria/ética , Pobreza/ética , Sistema de Registros/ética , Derechos de la Mujer/ética , Adulto , Población Negra , Niño , Protección a la Infancia/economía , Protección a la Infancia/ética , Protección a la Infancia/etnología , Femenino , Humanos , Pobreza/etnologíaRESUMEN
AIMS: The public reporting of healthcare outcomes has a number of potential benefits; however, unintended consequences may limit its effectiveness as a quality improvement process. We aimed to assess whether the introduction of individual operator specific outcome reporting after percutaneous coronary intervention (PCI) in the UK was associated with a change in patient risk factor profiles, procedural management, or 30-day mortality outcomes in a large cohort of consecutive patients. METHODS AND RESULTS: This was an observational cohort study of 123 780 consecutive PCI procedures from the Pan-London (UK) PCI registry, from January 2005 to December 2015. Outcomes were compared pre- (2005-11) and post- (2011-15) public reporting including the use of an interrupted time series analysis. Patients treated after public reporting was introduced were older and had more complex medical problems. Despite this, reported in-hospital major adverse cardiovascular and cerebrovascular events rates were significantly lower after the introduction of public reporting (2.3 vs. 2.7%, P < 0.0001). Interrupted time series analysis demonstrated evidence of a reduction in 30-day mortality rates after the introduction of public reporting, which was over and above the existing trend in mortality before the introduction of public outcome reporting (35% decrease relative risk 0.64, 95% confidence interval 0.55-0.77; P < 0.0001). CONCLUSION: The introduction of public reporting has been associated with an improvement in outcomes after PCI in this data set, without evidence of risk-averse behaviour. However, the lower reported complication rates might suggest a change in operator behaviour and decision-making confirming the need for continued surveillance of the impact of public reporting on outcomes and operator behaviour.
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Síndrome Coronario Agudo/cirugía , Angina Estable/cirugía , Cardiólogos/psicología , Análisis de Series de Tiempo Interrumpido/métodos , Manejo de Atención al Paciente/estadística & datos numéricos , Síndrome Coronario Agudo/diagnóstico , Anciano , Angina Estable/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Estudios de Casos y Controles , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/mortalidad , Toma de Decisiones Clínicas/ética , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Notificación Obligatoria/ética , Persona de Mediana Edad , Manejo de Atención al Paciente/ética , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Intervención Coronaria Percutánea/estadística & datos numéricos , Mala Conducta Profesional/estadística & datos numéricos , Estudios Prospectivos , Mejoramiento de la Calidad/normas , Sistema de Registros , Factores de Riesgo , Resultado del Tratamiento , Reino Unido/epidemiologíaRESUMEN
Social scientists have long sought to explain why people donate resources for the good of a community. Less attention has been paid to the difficult task of motivating the first adopters of these important behaviors. In a field experiment in Nigeria, we tested two campaigns that encouraged people to try reporting corruption by text message. Psychological theories about how to shift perceived norms and how to reduce barriers to action drove the design of each campaign. The first, a film featuring actors reporting corruption, and the second, a mass text message reducing the effort required to report, caused a total of 1181 people in 106 communities to text, including 241 people who sent concrete corruption reports. Psychological theories of social norms and behavior change can illuminate the early stages of the evolution of cooperation and collective action, when adoption is still relatively rare.