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     

Paternity testing in a kidnapping case

A case of kidnapping involving the concept of paternity testing is described. The couple arrested and charged with kidnapping stated the child in their possession was their biological daughter. Serological tests were performed on liquid blood samples in an effort to determine if the couple could have been the biological parents of the child. Two genetic inconsistencies were discovered in the 15 blood marker systems analyzed.     

A Contractualist Defense of Democratic Authority

Abstract.  This paper provides a defense of the following thesis: When there is reasonable disagreement over the design of morally necessary collective action schemes, it would not be reasonable to reject the authority of a democratic decision procedure to settle these disputes. My first argument is a straightforward application of contractualist reasoning, and mirrors T. M. Scanlon's defense of a principle of fairness for the distribution of benefits produced by a cooperative scheme. My second argument develops and defends the intuition that treating others morally requires respecting their exercise of moral judgment, or a sense of justice. I conclude by addressing the problem of disagreement over the design of the democratic decision procedure itself, and rebutting Jeremy Waldron's claim that democratic authority is incompatible with judicial review.     

Policy networks and market opening: Telecommunications liberalization in Spain

Abstract.  For a broad range of policy sectors, liberalization was the predominant goal during the 1990s, and the policy change involved gave rise to a wide range of academic debates. In this article we analyze the consequences of these far-reaching policies for the policy process itself. We ask whether the policy changes significantly altered the characteristics of policy processes by considering the timing and extent of the changes in policy networks during those years. More concretely, we discuss the extent to which policy networks changed as a result of market opening, considering the case of the telecommunications policy network in Spain. Using data from two successive surveys, we compare the network structure before and after market opening. Our findings show that only slight changes occurred during this period, making the network denser but not more open. Thus, we suggest that a more successful liberalization probably would have required a network that was more open to new entrants and in which power was less centralized and so able to guarantee a competitive environment.     

Trade union behaviour and inter-regional variations in unemployment rates

An important problem in the political economy of the UK is that the disparity of unemployment rates across its regions is much more marked than the corresponding dispersion of wage rates. One possibility is that this is due to the attitude of trade unions to their members in different regions. If unions wish to preserve parity between members in different regions then they will value wage equality between regions over and above wage levels. This may then persuade them to overlook inter-regional productivity differences in setting wages. The price that low-efficiency regions will then pay for this desire for wage equality is higher unemployment rates.Much of the research for this paper was carried out while the author was visiting the Trade Union Economics Research Institute (FIEF), Stockholm in 1989. An earlier version of this paper was presented at a seminar there and the author is gratefully to Villy Bergstrom, Paul Chen, Douglas Hibbs, Eva Udden-Jondal and other institute members for several useful comments. Comments from Kevin Lee, John Spencer and an anonymous referee have also substantially improved the paper. The usual disclaimer applies.     

Mentally disordered offenders in Sweden.

This article reviews the laws in Sweden concerning mentally disordered offenders. It also contains some figures on the relationship between mentally disordered offenders and other offenders sentenced to prison. The rules in Sweden are very different from other countries in that the responsibility concept has been abolished and thus there is no acquittal on a psychiatric basis.     

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.     

Dissecting intramural haematoma of the coronary artery with intimal tears.

A dissecting intramural haematoma of the coronary artery is an infrequent cause of sudden and unexpected death. Most cases are women and in a significant number of these women, the haematoma occurred at term to 80 days postpartum. Because the intimal rupture and communication with the lumen were not found in most of the cases, the site of rupture has been considered to be a vasa vasorum. The authors report on a case of one woman who was at a later postpartum period (106 days). The microscopic finding of the dissected coronary artery revealed two intimal tears in a section. The case showed that the dissecting intramural haematoma of the coronary artery is caused not only by the rupture of the vasa vasorum but also by the rupture of the intima.