Addiction in the light of African values: Undermining vitality and community.

I address the question of what makes addiction morally problematic, and seek to answer it by drawing on values salient in the sub-Saharan African philosophical tradition. Specifically, I appeal to life-force and communal relationship, each of which African philosophers have at times advanced as a foundational value, and spell out how addiction, or at least salient instances of it, could be viewed as unethical for flouting them. I do not seek to defend either vitality or community as the best explanation of when and why addiction is immoral, instead arguing that each of these characteristically African values grounds an independent and plausible account of that. I conclude that both vitalism and communalism merit consideration as rivals to accounts that western ethicists would typically make, according to which addiction is immoral insofar as it degrades rationality or autonomy, as per Kantianism, or causes pain or dissatisfaction, à la utilitarianism.

Alternative Medicine and the Ethics Of Commerce.

Is it ethical to market complementary and alternative medicines? Complementary and alternative medicines (CAM) are medical products and services outside the mainstream of medical practice. But they are not just medicines (or supposed medicines) offered and provided for the prevention and treatment of illness. They are also products and services - things offered for sale in the marketplace. Most discussion of the ethics of CAM has focused on bioethical issues - issues having to do with therapeutic value, and the relationship between patients and those purveyors of CAM. This article aims instead to consider CAM from the perspective of commercial ethics. That is, we consider the ethics not of prescribing or administering CAM (activities most closely associated with health professionals) but the ethics of selling CAM.

Interrupted (self -)medication with pancuronium(bromide) and fatal outcome.

Pancuronium(bromide) is used because of its relaxing effect on striated muscles and usually requires artificial respiration. A 52-year-old woman suffered from long-standing "generalized dystonia", which had become resistant to conventional therapy. Therefore, an anesthetist established a permanent medication scheme with pancuronium using a PCA pump. This pump had been controlled by the patient herself ensuring an acceptable quality of life with broad personal autonomy. Finally, the woman was found dead in her flat by a member of a home nursing service. The infusion hose showed a fixed knot and further blocking by a clamp. The autopsy findings were non-specific, except for the presence of opioid tablets in the colon. Toxicological analyses showed 72ng/ml pancuronium and 21 ng/ml oxycodone (therapeutic) in the femoral venous blood. The range of published pancuronium levels varies from approx. 80 to 2,000 ng/ml. Thus it had to be assumed that the pancuronium level was too low (72 ng/ml) so that symptoms of dystonia recurred. Based on extensive literature research, the described case can be qualified as unique. The therapy concept had been innovative, sufficient and effective for more than 10 years. It allowed the patient to enjoy a maximum of autonomy. Ultimately, death was due to the blocked pancuronium infusion. The relatively low pancuronium level had provoked the dystonia to return with generalized spasms also involving the respiratory muscles resulting in respiratory arrest. During the police investigations, two previous suicide attempts came to light.

Against homeopathy--a utilitarian perspective.

I examine the positive and negative features of homeopathy from an ethical perspective. I consider: (a) several potentially beneficial features of homeopathy, including non-invasiveness, cost-effectiveness, holism, placebo benefits and agent autonomy; and (b) several potentially negative features of homeopathy, including failure to seek effective healthcare, wastage of resources, promulgation of false beliefs and a weakening of commitment to scientific medicine. A utilitarian analysis of the utilities and disutilities leads to the conclusion that homeopathy is ethically unacceptable and ought to be actively rejected by healthcare professionals.

A coisa em psicanálise e o objeto no lísis de Platão / The thing in psychoanalysis and object in Plato's lysis / La cosa en psicoanálisis y el objeto en lisis de Platón

Este artigo propõe o estudo sobre o conceito de outro como semelhante e como objeto. Partindo de textos que interpelam a alteridade na psicanálise e remetendo aos temas do complexo semelhante, da satisfação, da perda, do luto, da negativa, da repetição; avalia o conceito de outro articulando textos de diversos autores. A partir da psicanálise freudiana, estuda o das Ding e a negação, discriminando com estes termos um objeto estruturante na origem do psiquismo. Aborda textos técnicos da psicanálise para delimitar o tema da repetição. Também a recordação e a repetição são vinculadas ao objeto e estudadas na perspectiva da filosofia moderna. São retomados temas do diálogo platônicos para definir o lugar do erótico e da amizade. No fim do presente artigo, propomos o termo clássico grego Oikos com valor equivalente ao da Coisa freudiana e como esta aparece em escritos psicanalíticos.(AU)

This article studies the concept of other as similar and object. It is based on texts that question the alterity in psychoanalysis and refers to the themes of otherness complex, loss, grief, negative, repetition, and evaluates the concept of other, using articles of diverse authors. Based on Freudian psychoanalysis, it studies the Thing and the denial and discriminates a structuring object in the origin of psychism. It approaches technical texts of psychoanalysis to delimitate the theme of repetition. The recordation and repetition are also linked to the object and studied from the perspective of modern philosophy. Themes of the platonic dialogues are resumed to define the place of the erotic and the friendship. In the end of the article, we propose the greek classic term Oikos, with equal value to the Freudian Thing, as this one appears in psychoanalytic writings.(AU)

Este artículo estudia el concepto Otro como semejante y como objeto. A partir de textos que interpelan la alteridad en psicoanálisis y que se refieren a temas del complejo semejante, de la satisfacción, de la pérdida, del duelo, de la negación, de la repetición, se evalúa el concepto de Otro articulando textos de diferentes autores. Basado en el psicoanálisis freudiano, se aborda Ding y la negación, discriminando con estos términos un objeto estructurante en el origen de lo psíquico. Se abordan textos técnicos del psicoanálisis para delimitar el tema de la repetición; el recuerdo y la repetición son vinculadas al objeto y estudiadas desde la perspectiva de la filosofía moderna; y se retoman temas de los diálogos platónicos para definir el lugar de lo erótico y la amistad. Al culminar este artículo se propone leer el término griego clásico Oikos con un valor equivalente al de la Cosa freudiana como aparece en los escritos psicoanalíticos.(AU)

Notas para decolonizar os estudos transpessoais no brasil: contribuições do pluriperspectivismo participativo / Notes for decolonizing transpersonal studies in brazil: contributions of participatory pluriperspectivism / Apuntes para la decolonización de los estudios transpersonales en brasil: aportes del pluriperspectivismo participativo

O campo dos estudos transpessoais tem avançado em diversas áreas no Brasil. Comemorou seus 40 anos com uma inserção ativa nas Instituições de Ensino Superior (IES) e uma ampliação de núcleos formativos e apoiadores de ensino, pesquisa e ações sociais, além de diálogos com o Sistema de Conselhos de Psicologia. Desafios são apresentados a partir do levantamento de uma série de questões importantes e ignoradas dentro da Psicologia Transpessoal no Brasil. Apresentamos o pluriperspectivismo participativo como possibilidade de decolonizar as matrizes eurocêntricas e estadunidenses, que dão suporte ao pensamento transpessoal brasileiro, buscando honrar nossas raízes históricas e incluir outras epistemologias e ontologias, que dão continuidade à crítica à lógica cartesiana moderna. Indicamos uma breve agenda de notas temáticas que carecem de um processo decolonizador no campo transpessoal: a) crítica às perspectivas de um pensamento hegemônico, em termos globais por meio da dominação Norte-Sul ou no campo das relações sociais; b) revisão das formas de "centrocentrismo"; c) questionamento da noção de universalismo das ciências e da ética; d) aprofundamento da análise crítica da supremacia restritiva da racionalidade formal técnico-científica em relação às formas de subjetividade, de vivências holísticas e integradoras e de valorização do corpo; e) revisão da noção de sujeito moderno desprovida da cocriação do humano com a comunidade, a história, a natureza e o cosmos.(AU)

The field of transpersonal studies has advanced in several areas in Brazil. It celebrated its 40th anniversary with an active insertion in Higher Education Institutions (HEI) and an expansion of training centers and supporters of teaching, research, and social actions, in addition to dialogues with the System of Councils of Psychology. Challenges are presented based on a survey of a series of important and ignored issues within Transpersonal Psychology in Brazil. We present participatory pluriperspectivism as a possibility to decolonize the Eurocentric and North American matrices that support Brazilian transpersonal thought, seeking to honor our historical roots and include other epistemologies and ontologies, which continue the critique of modern Cartesian logic. We indicate a brief agenda of thematic notes that lack a decolonizing process in the transpersonal field: a) criticism of the perspectives of a hegemonic thought, whether in global terms via North-South domination or in the field of social relations; b) review of the forms of "centrocentrism"; c) questioning of the notion of universalism of science and ethics; d) deepening of the critical analysis of the restrictive supremacy of the technical-scientific formal rationality in relation to the forms of subjectivity, of holistic and integrative experiences, and of valuing the body; e) review of the notion of the modern subject devoid of the co-creation of the human with the community, the history, the nature, and the cosmos.(AU)

El campo de los estudios transpersonales ha avanzado en varias áreas de Brasil. Se celebró su 40.º aniversario con una inserción activa en Instituciones de Educación Superior (IES) y una ampliación de los centros de formación y promotores de la docencia, la investigación y la acción social, además de diálogos con el Sistema de Consejos de Psicología. Los desafíos se presentan a partir de una encuesta de una serie de temas importantes e ignorados dentro de la Psicología Transpersonal en Brasil. Presentamos el pluriperspectivismo participativo como una posibilidad para decolonizar las matrices eurocéntrica y americana, que sustentan el pensamiento transpersonal brasileño, buscando honrar nuestras raíces históricas e incluir otras epistemologías y ontologías que continúan la crítica de la lógica cartesiana moderna. Indicamos una breve agenda de apuntes temáticos que carecen de un proceso decolonizador en el campo transpersonal: a) crítica de las perspectivas de un pensamiento hegemónico, ya sea en términos globales a través del dominio Norte-Sur o en el campo de las relaciones sociales; b) revisión de las formas de "centrocentrismo"; c) cuestionamiento de la noción de universalismo de la ciencia y la ética; d) profundización del análisis crítico de la supremacía restrictiva de la racionalidad formal técnico-científica en relación a las formas de subjetividad, de experiencias holísticas e integradoras y de valoración del cuerpo; e) revisión de la noción de sujeto moderno desprovisto de la cocreación de lo humano con la comunidad, la historia, la naturaleza y el cosmos.(AU)

What's a pharmacist to do?

KIE: A case study is presented in which a pharmacist in a Drug Information Center is queried by a patient about how to obtain a homeopathic medicine. There appear to be no scientific data regarding the efficacy or safety of the medication. The pharmacist has three options: to inform the patient how to obtain the medicine, to tell the patient that the medicine is ineffective and withhold information on how to obtain it, or to discuss its therapeutic uncertainty and provide ordering information. Resnik and Resnik recommend that the pharmacist choose the third option after balancing obligations to respect autonomy, avoid harm, and provide benefits. Arnold, Nissen, and Haupt comment on three models of pharmacist-consumer interaction: the librarian, the priestly, and the counselor. The authors favor the last option, to counsel the patient on appropriate care and tell her how to obtain the medication.^ieng

Research with human subjects.

Ackerman reviews three recent books on moral issues in human research: Who Goes First? The Story of Self-Experimentation in Medicine, by Lawrence K. Altman (Random House; 1987); The Patient as Partner: A Theory of Human-Experimentation Ethics, by Robert M. Veatch (Indiana University Press; 1987); and Ethics and Regulation of Clinical Research, 2d ed., by Robert J. Levine (Urban & Schwarzenberg; 1986).

[Autonomy attitudes in the treatment compliance of a cohort of subjects with continuous psychotropic drug administration]. / Les attitudes d'autonomie dans l'observance thérapeutique d'une cohorte de consommateurs continus de psychotropes.

Prescriptions for psychotropic drugs are part of a general practitioner's daily routine. As with all drugs, they need to be controlled by a phenomenon of observance. Respecting prescriptions is in fact a major public health concern. Our problematic is centred on the analysis of the association between observance and autonomy in order to gain a better understanding of the links between the drug, how it is to be taken, and how the patients adapt and control it. Identifying and comparing autonomous practices psychotrope users associated with attitudes put into play by those who claim to observe or not to observe their treatment is the aim of this project. The qualitative analysis of the speech is based on the categorial analysis of the contents of 46 transcriptions of 23 women et 23 men continuous (regular monthly intake for at least 5 years), aged between 50 and 65. The majority live in couples, have professional activities, and are executives. The psychotropes with the largest consumption are: anxiolytics and antidepressors. The average duration of their consumption is more than 17 years. Two types of attitude can be distinguished through the qualitative analyse. The attitudes of non-observers towards the psychotropic drug and dependence show controlled, autonomous acts. Autonomy is an influencing factor in their observation of the prescribed treatment, it is a major component of their non-observance regarding psychotropes; thus our hypothesis is confirmed. The strategy adopted around the medication arises from autonomy of action. Organising the treatment is seen as a sign of autonomy, as taking an initiative in relation to the medical prescription, and not as rebellious, or carefree behaviour, or as a sign of inconsistency. Non-observers seem more to be involved in a step towards self-regulation. Active taking verbs such as stop, diminish, increase , and success verbs succeed the I is greatly used, reinforced in some cases by myself ; this vocabulary situates the patient as an actor facing the drug and shows that he is capable of action. For observers, taking the drug is qualified as regular and some users categorically refuse to bypass the doctor's advice never . Looking for additional information is an act of autonomy. It is found partly with the doctor; but also from the media, the exchanges with the others and the reading of the notes. But talking to other people and reading the information leaflets are more often done by non-observers. Recognizing oneself in the indications and the dosage marked on the leaflet seems to be the first step to adopting the drug so as to know it better and to gain mastery of it. Autonomy is gained through finding alternative, substitutive or complementary solutions with a large share left to herbal medicine and homeopathy. Non-observers seem to be more active than observers in diminishing or stopping taking psychotropes. Affirming one's autonomy is also shown in the direction given to each person's trajectory of life, behaviour referring to it, the projection into the future, and the dynamics of life. These actions underlie a capacity of resistance, non-observers using evocative terms such as taking things in hand , recognizing the while, in certain cases, the need to be supported. This capacity of action is far less present in observers who acknowledge their difficulties in facing up to events. The intentionality and the determination of their behaviour and their choices depend on the autonomy of willpower. Adjusting the amount taken is shown by expressions of intention, and justifies self-regulation. Non-observers direct their behaviour towards a reduction in the medication and commit themselves not to go over a certain amount. Stopping usage is declared as certain , it is planned. On the other hand, it remains unpredictable for observers for whom consumption is linked to the description of a need to have long-lasting health. Observers describe taking their medication as automatic, routine, and easy. A sort of fatality and resignation is attached to the prescription, linked to a negative perception of their health. The medication is at the same time nourishing and destructive . The disagreeable sensations caused by its suppression and the secondary effects appear less important than the benefits to be had from it. Autonomy can be recognized in the type of commitment established with the professional. It can be shown around a prescription negociated for treatment and delivered in mutual agreement. It places the patient in an active partnership. The presence of I and of more frequent active verbs in non-observers shows the role played by the patient. His conversation organizes itself round how the medication is to be taken. Systematic use of the prescription reinforces the instrumental recourse to the doctor for a renewal especially for non-observers. For observers, the prescription is followed despite disagreements. The professional is appreciated for his expertise in advice, how to use the medication . Confidence results from this know-how. The feeling of fear inspired by the psychotrope puts taking the medication into perspective and removes the guilt from non-observance. This process contributes to the patient's carrying on taking the medication. The positive effects found again thanks to the medication strengthen the later's perpetuation. When the patient is asked to participate in the prescription, this participation is described differently in the two groups. In observers, it is understood from the viewpoint of the doctor-patient association with, us and for the other group from the viewpoint of cooperation I, one . In non-observers, a type of delegation is highlighted leave it to be managed , the patient's confidence in the doctor lets him manage his medication under medical control . The autonomy of willpower is shown by the degree of openness to the Other Person. Non-observers have quite open and trendy character traits and give a rather positive image of themselves. These elements are absent from the speech of observers in favour of a negative self-image. The autonomy of willpower shows up in their free expression within the family, and with friends, the patient is freed from the influence of other people. For non-observers it is admitted easily . Observers show reserve through a concern of being discrete; rules of good behaviour do not allow them to speak about their consumption since it lifts the veil on their person and its affects. Two types of attitude can be distinguished: Observers for whom the psychotrope supports them against an unhappy life and is part of a habit which is hidden from other people, they keep to the prescribed doses and don't try to change them, they have absolute confidence in the medical profession; non-observers for whom psychotropes are a crutch which they mistrust. They are conscious of the bad effects and state their intention and their will to control this medication by planning on a reduction in, or even an end to, consumption. In order to give a meaning to the prescription and to avoid too great a feeling of guilt, they legitimize the later by an obligation created by a need, and by an improvement in symptomatology, and they minimize the quantity and the effects of taking the medication. They cooperate with the doctor and are involved in a close relationship with my doctor . They show a certain familiarity to the medication and talk openly about their consumption. Autonomy is a means to responsibility and to valorise a part of the patients in particular those which are non-observing so as to strengthen their capacity to manage their health as best they can. It contributes to a better observance of treatment in as much as autonomous patients are more inclined to negotiate with their doctors. Looking for self-regulatory behaviour allows us a better understanding of those patients non-observers who are willing, and helps them to develop their aptitude to face up to their illness.

Reclaiming our moral tradition. Catholic teaching calls us to accept the limits of medical technology.

The success of science and medical technology has led to medical brinkmanship, pushing aggressive treatment as far as it can go. But medicine lacks the precision necessary for such brinkmanship to succeed, and the resulting cycle of expectation and disappointment in technology has, in part, led to an increasing acceptance of euthanasia and assisted suicide, linked closely with advocacy for patient autonomy. At the opposite extreme lies medical vitalism, which refers to attempts to preserve the patient's life in and of itself without any significant hope for recovery. The Catholic moral tradition offers a middle ground, well expressed in the 1994 Ethical and Religious Directives for Catholic Health Care Services. The tradition does not deny the good of technology or state that some lives are not worth living. Rather, it calls us to accept the fact that medical technology has limits. In reclaiming this tradition, we reclaim the naturalness of death. Reclaiming the tradition has practical consequences for the use of life-prolonging technology at the end of life and for end-of-life decision making. These can be placed in three broad categories: the Christian understanding of care, the ambiguity inherent in end-of-life decision making, and the task of Christian formation.

Processos psicossociais da aquisição de uma deficiência / Psychosocial processes of acquiring a disability / Procesos psicosociales de la adquisición de una discapacidad

A aquisição de uma deficiência pode ter extenso impacto na vida de uma pessoa, pois ocorre, muitas vezes, sob condições traumáticas e obriga tanto a ressignificações subjetivas quanto a adaptações práticas no cotidiano. O principal objetivo do trabalho aqui descrito consistiu em compreender aspectos psicossociais do processo de aquisição de uma deficiência, considerando diversos fatores que podem interferir nestas experiências. Para a realização da pesquisa, foram entrevistadas, de forma semiestruturada, 13 pessoas que adquiriram uma deficiência física, auditiva ou visual na idade adulta, sendo os relatos analisados pelo método de análise de conteúdo. Ao se discutir as falas dos pesquisados, são traçadas algumas semelhanças e distinções entre as experiências dos participantes, buscando também tecer considerações com base na literatura acadêmico-científica sobre o tema. Observou-se que os processos psicossociais de aquisição da deficiência foram permeados tanto por sentimentos negativos, relacionados à angústia e à depressão, bem como por reações mais harmônicas e de valorização da vida, em que se relativiza a perda do membro ou da capacidade sensorial. Representando um momento marcante na vida de quem a adquire, a deficiência pode levar à aprendizagem e ao amadurecimento, à medida que o tempo após a aquisição aumenta. Entende-se que os estudos acerca da deficiência, em especial a adquirida, devem ser ampliados e aprofundados, tendo em vista que o campo de estudos sobre esta temática ainda precisa de mais contribuições a respeito.(AU)

Becoming disabled may cause a considerable impact in someone's life, because, in most of the cases, it happens under traumatic conditions and it results in subjective resignification and practical adaptations. The main objective of this study is to understand the psychosocial aspects involved in becoming disabled, considering several factors which may interfere these experiences. For this research, 13 people who got a physical disability, a hearing or visual impairment in adulthood were interviewed in a semi-structured way and the results were evaluated using the content analysis method of Bardin (2011). When the speeches of the interviewed people are evaluated, some comparisons and distinctions among experiences of the participants are made for establishing relations with academic-scientific literature on this theme. It was noticed that the psychosocial processes involved in becoming disabled were permeated by negative feelings related to anguish and depression, as well as more harmonic reactions and valorization of life, in which the loss of a member or of a sensorial capability is relativized. As a defining moment in the lives of those who acquired it, the disability may result in learning and maturating over the years after the event. It is recommended that the studies concerning disability, especially the acquired ones, get broadened and deepened because there is a need for more contributions about this subject.(AU)

La adquisición de una discapacidad puede tener un amplio impacto en la vida de una persona, pues ocurre, muchas veces, bajo condiciones traumáticas y requiere tanto la reinterpretación subjetiva como las adaptaciones prácticas en la vida cotidiana. El principal objetivo del trabajo que se describe aquí fue entender los aspectos psicosociales del proceso de adquisición de una discapacidad, teniendo en cuenta diversos factores que pueden interferir en estas experiencias. Para la investigación, fueron entrevistadas de manera semiestructurada, 13 personas que adquirieron una discapacidad física, auditiva o visual en la edad adulta, siendo los relatos analizados por el método de análisis de contenido. En la discusión de los relatos de los entrevistados, son trazadas algunas similitudes y diferencias entre las experiencias de los participantes, buscando también tejer consideraciones con base en la literatura académica y científica sobre el tema. Se observó que los procesos psicosociales de adquisición de la discapacidad fueron permeados tanto por sentimientos negativos relacionados con la angustia y la depresión, así como por las reacciones más armónicas y de valorización de la vida, en que se relativiza la pérdida de un miembro o la capacidad sensorial. Representando un momento decisivo en la vida de quién la adquiere, la discapacidad puede llevar al aprendizaje y al crecimiento, a medida que el tiempo después de la adquisición aumenta. Se entiende que los estudios acerca de la discapacidad, en especial la adquirida, deben ser ampliados y profundizados, teniendo en cuenta que el campo de los estudios sobre este tema aún necesita más contribuciones al respecto.(AU)

Consentimento informado: estratégia para mitigar a vulnerabilidade na assistência hospitalar / Informed consent: a strategy to mitigate vulnerability in hospital care / Consentimiento informado: estrategia para mitigar la vulnerabilidad en la asistencia hospitalaria

Resumo Este texto trata de identificar vulnerabilidade como característica inerente ao ser humano e apresentar o consentimento informado como estratégia para minimizá-la no contexto da assistência hospitalar. Sujeitos que vivenciam internação hospitalar têm seu padrão de vulnerabilidade ampliado por estarem em ambiente desconhecido, sobre o qual não possuem domínio nem conhecimento; e também por estarem subordinados ao médico, que tem poder para determinar condutas terapêuticas que podem comprometer a existência do paciente e seus projetos de vida. A vulnerabilidade pode ser reduzida por meio do consentimento informado, que prioriza informação, compreensão e possibilidade de deliberação e que respeita a autodeterminação do paciente na escolha do tratamento proposto. Nesse sentido, o consentimento informado é capaz de reduzir o padrão de vulnerabilidade do paciente em ambiente de internação hospitalar.

Abstract This text aims at identifying vulnerability as an inherent characteristic of human beings and introducing informed consent as a strategy to minimize it in the context of hospital care. Subjects who experience hospitalization are enclosed in an unknown environment upon which they have no control or knowledge. In addition, they are subordinate to the physician, who possesses the power to determine therapeutic conducts that may compromise their existence and life goals. As a result, their degree of vulnerability is increased. Vulnerability can be reduced through the informed consent that prioritizes information, understanding, possibility of deliberation and respects the patient’s self-determination in the choice of the proposed treatment. Thus, the application of the informed consent process can reduce the patient' s vulnerability pattern in a hospital environment.

Resumen Este texto trata acerca de la identificación de la vulnerabilidad como una característica inherente al ser humano y presenta al consentimiento informado como estrategia para minimizarla en el contexto de la asistencia hospitalaria. Los sujetos que atraviesan una internación hospitalaria tienen su patrón de vulnerabilidad ampliado porque se encuentran en un ambiente desconocido sobre el cual no poseen dominio ni conocimiento; y también porque están subordinados al médico, el cual tiene poder para determinar conductas terapéuticas que pueden comprometer su existencia y sus proyectos de vida. La vulnerabilidad puede reducirse mediante el consentimiento informado que da prioridad a la información, la comprensión, la posibilidad de deliberación y que respeta la autodeterminación del paciente en la elección del tratamiento propuesto. En este sentido, el empleo del proceso de consentimiento informado es capaz de reducir el patrón de vulnerabilidad del paciente en el ambiente de internación hospitalaria.

Midwives' support for Complementary and Alternative Medicine: a literature review.

OBJECTIVE: There is evidence that the use of Complementary and Alternative Medicine by childbearing women is becoming increasingly popular in industrialised countries. The aim of this is paper is to review the research literature investigating the midwives' support for the use of these therapies. METHOD: A search for relevant research published from 2000 to 2009 was undertaken using a range of databases and by examining relevant bibliographies. A total of thirteen studies were selected for inclusion in this review. RESULTS: The findings indicate that the use of Complementary and Alternative Medicine is widespread in midwifery practice. Common indications for use include; labour induction and augmentation, nausea and vomiting, relaxation, back pain, anaemia, mal-presentation, perineal discomfort, postnatal depression and lactation problems. The most popular therapies recommended by midwives are massage therapy, herbal medicines, relaxation techniques, nutritional supplements, aromatherapy, homeopathy and acupuncture. Midwives support the use Complementary and Alternative Medicine because they believe it is philosophically congruent; it provides safe alternatives to medical interventions; it supports the woman's autonomy, and; incorporating Complementary and Alternative Medicine can enhance their own professional autonomy. CONCLUSIONS: There is considerable support by midwives for the use of Complementary and Alternative Medicine by expectant women. Despite this enthusiasm, currently there are few educational opportunities and only limited research evidence regarding CAM use in midwifery practice. These shortfalls need to be addressed by the profession. Midwives are encouraged to have an open dialogue with childbearing women, to document use and to base any advice on the best available evidence.

Limites do poder familiar nas decisões sobre a saúde de seus filhos – diretrizes / The limits of parental power in health decisions relating children ‒ guidelines / Límites del poder familiar en las decisiones acerca de la salud de sus hijos ‒ directrices

O respeito pelo ser humano é um dos princípios fundamentais da bioética, que se manifesta no exercício da autonomia. Quando o paciente não tem competência para tomar suas próprias decisões em relação à saúde, como no caso de crianças com menos de 12 anos, há a presunção de que seus pais decidem por elas, no exercício do poder familiar. O que queremos discutir é a legitimidade e a justiça dessa decisão, quando suas opções ultrapassam os limites tolerados pela ética, pela lei e pela sociedade em determinadas situações, e qual é a prática usual no Brasil quando há conflito de interesses entre a proposta terapêutica do médico e o desejo dos pais.

Respect for human beings is one of the fundamental principles of bioethics, and is manifested through the exercise of autonomy. When a patient is not competent to make decisions regarding his or her health, as is the case with children under twelve years of age, there is a presumption that parents should make decisions on behalf of the child through the exercise of parental authority. The present study discusses the legitimacy and judicial right of parents to make decisions for their children when the choices involved go beyond the boundaries permitted by ethics, law and society. The study also considers common practice in Brazil, when there is a conflict of interest between the treatment proposed by the medical professiomal and the wishes of parents.

El respecto por el ser humano es uno de los principios fundamentales de la bioética, que se manifiesta a través del ejercicio de la autonomía. Cuando el paciente no tiene competencia para tomar sus propias decisiones em relación a la salud, como es el caso de niños menores de doze años de edad, existe la presunción de que sus padres, a través del ejercicio del poder familiar, decidan por ellos. Lo que queremos discutir es la legitimidade y la justicia de padres decidiendo por sus hijos menores de edad, cuando sus opciones sobrepasan los limites tolerados por la ética, por la ley y por la sociedad en determinadas situaciones y cuál es la práctica usual em el Brasil, cuando hay conflicto de interés entre la propuesta terapéutica del médico y el deseo de los padres.

Cultural differences in the relationships among autonomy support, psychological need satisfaction, subjective vitality, and effort in British and Chinese physical education.

Using basic psychological needs theory (BPNT; Ryan & Deci, 2000) as our guiding framework, we explored cultural differences in the relationships among physical education students' perceptions of teacher autonomy support, psychological need satisfaction, subjective vitality and effort in class. Seven hundred and fifteen students (age range from 13 to 15 years) from the U.K. and Hong Kong, China, completed a multisection inventory during a timetabled physical education class. Multilevel analyses revealed that the relationships among autonomy support, subjective vitality and effort were mediated by students' perceptions of psychological need satisfaction. The relationship between autonomy support and perceptions of competence was stronger in the Chinese sample, compared with the U.K. sample. In addition, the relationship between perceptions of relatedness and effort was not significant in the Chinese students. The findings generally support the pan-cultural utility of BPNT and imply that a teacher-created autonomy supportive environment may promote positive student experiences in both cultures.

Reconhecimento da suspensão de juízo do princípio de semelhança na promoção de saúde de mulheres em situação de violência e vulnerabilidade / Recognition of suspension of judgment of the principle of similarity in health promotion for women in situations of violence and vulnerability

A violência consiste em objetificação dos sujeitos com compressões sobre a ação comunicativa e, portanto, sobre a práxis de autonomia. A solução interessa à promoção de saúde, em suas articulações no contexto da democracia e do direito, conjuntamente, e da mesma forma, à medicina homeopática e ao princípio de semelhança que a fundamenta, em que ambas possibilitem o agir comunicativo, conferindo brevidade a acordos em acolhimento de singularidades diversas. Objetivou-se, com esse estudo, reconhecer a suspensão de juízo do princípio de semelhança enquanto promoção de saúde em sujeitos em situação de violência e vulnerabilidade. Foi desenvolvida pesquisa qualitativa com análise de conteúdo categorial temática, com base em dados de dezesseis entrevistas em profundidade com mulheres participantes, bem como de doze observações participativas das rodas de conversas do ambulatório do Instituto Jenny de Andrade Faria, do Hospital das Clínicas da UFMG, do programa "Para Elas. Por Elas, Por Eles, Por Nós". A partir da análise dos dados, estabeleceram-se três categorias que compreendessem os objetivos propostos. Observou-se que o princípio de semelhança, como verbo em ação nas rodas de conversas, onde a suspensão de juízo se faz presente, com espantoso e oportuno poder de conciliação de momento, permite abraços em assimilação entre as partes, com perdão de diferenças, aconjuntando-as, favorecendo participação e fortalecendo-as, amenizando padecimentos, onde apropriam-se de saberes provenientes da própria roda e a conversa reconduz a conversões rumo ao bem comum. Destarte, pode-se entender que a suspensão de juízo do princípio de semelhança favorece promoção de saúde como fluxo desimpedido da vida e, consequentemente, prevenção da violência.

Violence consists in objectifying the subjects with compressions over communicative action and, therefore, over autonomy praxis. The solution is of interest to health promotion, in its articulations in the context of democracy and law, together, and in the same way, to homeopathic medicine and its fundamental principle of similarity, in which both enable communicative action, giving brevity to agreements in the reception of diverse singularities. The objective of this study was to recognize the suspension of judgment of the principle of similarity as health promotion in subjects in situations of violence and vulnerability. A qualitative research with thematic categorical content analysis was developed, based on data from sixteen in-depth interviews with participating women, as well as twelve participatory observations from the conversation wheels of the "Jenny de Andrade Faria" Institute outpatient clinic, "UFMG Hospital das Clínicas", of the program "Para Elas. Por Elas, Por Eles, Por Nós". From the data analysis, three categories were established that would the proposed objectives. It was observed that the principle of similarity, as verb in action in the conversation wheels, where the suspension of judgment is present, with astonishing and timely conciliation power of the moment, allows hugs in assimilation between the individual parts, with forgiveness of differences, bringing them together, favoring participation and strengthening them, alleviating suffering, where they appropriate knowledge from what rolls on the wheel, and conversation leads to conversions towards the common good. Thus, it can be understood that the suspension of judgment of the principle of similarity favors health promotion as an unimpeded flow of life and, consequently, prevention of violence.

Rationing health care and the need for credible scarcity: why Americans can't say no.

With adequate cost containment unlikely in the foreseeable future, health care use will have to be curtailed, ideally with open and explicit criteria for equitably allocating resources or rationing. Yet, consensus on any such criteria appears remote because Americans cannot say no to health care. Americans may refuse to accept rationing for two reasons. The absence of any global limitation on health care resources may encourage patients to believe that health care resources are not scarce and do not need to be rationed. A belief in vitalism--that everyone is morally entitled to unlimited longevity and good health--may discourage setting limits on one's own care. Together, these characteristics may foster the belief that denials of health care services, especially by health insurers, are arbitrary or unfair refusals to pay for existing resources and not a necessary method of rationing scarce resources. If this hypothesis is true, Americans are unlikely to achieve consensus on any equitable allocation of health care unless they face an actual shortage (credible scarcity) of health care resources that makes it necessary to ration care.

Live attenuated vaccine trials in medically informed volunteers: a special case?

A group of activist clinicians have offered to volunteer for clinical trials of live attenuated HIV vaccines. This has provided an important conceptual challenge to medical ethics, and to work on the development of HIV vaccines. In exploring these issues, this article highlights how the HIV field has altered the content as well as the tone of ethical discourse. The balance of expertise and authority between research subjects and triallists is profoundly changed, raising questions about the limits of voluntarism and differing perspectives on risk-benefit analysis. Care is needed to ensure that the novelty of the situation does not confuse the central ethical and scientific issues.