Ethics and the Physician-Patient Relationship

Book Reviews in This Article:
Getting Rid of Patients: Contradictions in the Socialization of Physicians . By Terry Mizrahi
Physicians and Social Change . By John Colombotos and Corinne Kirchner
Changing Values in Medicine . Edited by Eric J. Cassell and Mark Siegler
Professional Ethics and Primary Care Medicine: Beyond Dilemmas and Decorum . By Harmon L. Smith and Larry R. Churchill
Physician—Patient Decision-Making: A Study in Medical Ethics . By Douglas N. Walton
With Dignity: The Search for Medicare and Medicaid . By Sheri I. David
The Dismissal of Students with Mental Disorders. Legal Issues, Policy Considerations, and Alternative Responses .
Courtroom Toxicology . By Marshall Houts, Randall C. Baselt, and Robert H. Cravey     

The Influence of Advisers and Decision Strategies on Foreign Policy Choices: President Clinton's Decision to Use Force in Kosovo

In the following paper, I analyze the influence of advisers and domestic political factors on President Clinton's decision to use force against Slobodan Milosevic and the Serbs in Kosovo in March 1999. I present an analysis and examination of President Clinton's decision-making process, using press reports, personal speeches, etc. In other words, I attempt to trace the process by which Clinton came to the decision to use force in Yugoslavia. Specifically, using the poliheuristic theory, I argue that President Clinton's decision was influenced by noncompensatory domestic political calculations and the strong influence of his Secretary of State, Madeleine K. Albright. Examining how advisers interact with one another, their status in the advisory group, and the manner in which presidents solicit information from advisers will further our understanding of how, when, and under what conditions national security-level decision makers make decisions.     

A Test of Generalizability of the Social Development Model Across Gender and Income Groups with Longitudinal Data from the Elementary School Developmental Period

The social development model (SDM) is a theory of behavior that has proven useful in explaining the etiology of delinquency, violence, and substance use among adolescents as well as early antisocial behavior among pre-adolescents. A further test of the model is its generalizability across population groups. A section of the SDM representing prosocial influences in the etiology of problem behavior was compared for boys and girls and for children from low- and non low-income families using three waves of child, parent and teacher survey data on a sample of 851 elementary school students. Multiple group structural equation modeling was used to assess differences across groups in both measurement of model constructs and hypothesized structural paths between constructs. The results indicate overall similarity in the reliability of measurement models and validity of structural models.     

Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland--monitoring early changes in HIV-seropositivity among risk groups and average population.

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.