Screening for prostate cancer in asymptomatic men: clinical, legal, and ethical implications

PURPOSE/OBJECTIVES: To describe the opposing recommendations of the major medical organizations related to screening for prostate cancer and to explore the impact of these opposing recommendations on advanced practice nurses (APNs) who are in a position to decide who gets screened and when. DATA SOURCES: Published medical, legal, and economic articles, published legal verdicts and settlements, case law, and news reports. DATA SYNTHESIS: The national recommendations for screening for prostate cancer are conflicting and have legal, economic, and ethical implications for healthcare practitioners. Both the current early diagnostic tests, age- and race-based prostate specific antigen ranges, and the resultant treatment have significant problems and further contribute to the national controversy about whether to screen asymptomatic men. Lack of coverage for early detection of prostate cancer by many managed-care plans and Medicare also contribute to the dilemma practitioners face. However, electing not to screen "at-risk" men may subject APNs to charges of negligence or other legal theories. CONCLUSIONS: Present recommendations by the leading national medical, cancer, and policy organizations related to prostate cancer screening are contradictory. Adding to this national quagmire is the lack of financial support from Medicare and most health maintenance organization plans to pay for early detection of prostate cancer. These conflicting recommendations place APNs in a legally and ethically precarious position. APNs and nurses with patient education responsibilities should individualize decision-making and counsel their asymptomatic patients who may be at risk for prostate cancer about the benefits and complications of screening. IMPLICATIONS FOR NURSING PRACTICE: Considering the multiple implications of the decision to screen for prostate cancer, counseling patients who may be at risk for the disease and involving them and their spouses may be the best approach in deciding whether to screen for prostate cancer in asymptomatic men.     

On the use of clinical psychology software: Practical, legal, and ethical concerns.

Discusses the use of clinical psychology software with respect to fees, patient acceptability, conformity, legal status, and ethical guidelines. Potential areas of abuse are identified, including trivialization of assessment, use of software inappropriate to the patient, inadequate contribution of the clinician to the assessment process, and legal questions of software equivalence to the clinician. Recommendations include adopting guidelines to increase programmer and provider accountability for clinical software, training clinicians to understand the limits of artificial intelligence programming, and determining the legal and ethical status of software. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Keeping secrets: the ethical and legal challenges

Blatant examples of breeches of confidentiality are less common in comparison to the daily indiscretions that occur by members of the health care team or support staff. Yet such breeches of confidentiality are rarely identified as ethical or legal problems and therefore remain unaddressed. To uphold their moral and legal obligation to protect private information, nurses must examine the nature of their obligations and devise strategies to create and maintain a culture that holds health care professionals accountable for their actions.     

Human tissues: legal and ethical issues

Typically the association president and the editor of the association's publication find themselves in discussions over who is ultimately responsible for the publication's style and content. The first article in this set of two focused on the problem, this article describes strategies to use to prevent conflicts between the editor and association leaders.     

Historical, ethical, and legal aspects of assisted suicide

The focus of this study was to discover the experiences of Mexican Americans receiving professional nursing care. The purpose of this study was to explore the care experiences, views, patterns, and meanings of Mexican Americans who have received professional nursing care. The need for this study arises from nursing's lack of knowledge regarding the experiences and cultural values of Mexican Americans receiving professional nursing care and how these values influence the health and/or well being of Mexican Americans.     

Psychologists' ethical responsibilities in the Internet-based groups: Issues, strategies, and a call for dialogue.

How can psychologists participate ethically as facilitators, advisers, and peer members in Internet-based groups? The astonishing growth of Internet technology and on-line groups has outpaced the development of formal ethical guidelines for psychologists involved in on-line groups. This article provides an initial appraisal of psychologists' ethical responsibilities in discussion, support, and self-help groups that operate on the Internet and offers practical strategies for avoiding ethical problems. By presenting initial strategies and guidelines for ethical behavior in Internet-based groups, the authors hope to stimulate the field to further discuss and analyze these issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Safety, ethical, and legal standards for instrumentation in therapy and research.

Discusses ethical, legal, and safety standards for the manufacture and use of psychological devices and instrumentation. Provided are steps psychologists should take to ensure that their clients are protected from the potential hazards of psychological devices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A clinimetric approach to the components of the patient-physician relationship

Although patient-physician relationships have been expressed with diverse concepts and models, we have formulated a clinimetric classification derived from several years of observation and discussions at weekly house-staff conferences devoted to "difficult" patients. The observed phenomena are classified into the following components: (1) background factors intrinsic to patient and physician before they meet, (2) individual anticipations and hopes for what may happen, (3) extrinsic features of the setting, (4) individual reactions during the encounter, and (5) the consequences thereafter. These interacting components are usually too complex for characterizations based on single models for the relationship or single titles (such as "hateful" or "noncompliant") for the patient. The components can serve as a "review of systems" for identifying manifestations, sources, and solutions to such common problems as discordant hopes, the physician's unawareness of the patient's pertinent extramedical status, psychiatric and mental-status challenges, and cogent factors in chronic illness.     

Human research beyond the medical model: legal and ethical issues

The diagnosis and treatment of adnexal cancers continues to pose a challenge to a wide range of clinicians. The diseases are a diverse lot, owing to the wide range of skin structures and large surface area. Early recognition and treatment are key to improved outcomes. Education of the patients as to their role in their care, especially early detection, is also of crucial importance. Further study may yield information to improve diagnosis and treatment.     

Prisoners' access to HIV experimental trials: legal, ethical, and practical considerations

Much confusion exists about federal regulations governing the enrollment of prisoners in experimental clinical trials. Given the high prevalence of HIV infection in certain incarcerated populations, the issues surrounding clinical trials need clarification. A review of the history of prisoners as human subjects and current federal regulations regarding research on prisoners is provided. Experience at two New York State Designated AIDS Centers with inmates and experimental drug trials is described. Guidelines for enrollment of inmates in clinical trials are presented.     

Beyond the guidelines of ethical/legal standards: Update.

Ethical issues in practice are viewed as dynamic questions that evolve from changes occurring both outside and within the profession. New questions have arisen from (1) changes in public attitudes, (2) changes in economic circumstances, (3) increased diversity in styles and standards of professional practice, and (4) psychologist functioning in new settings such as the public media. Enforcement and proactive ethical action strategies are discussed in the contexts of clinical training facilities, placement or internship agencies, peer review committees, licensing boards, and ethics committees. The dilemmas of the individual practitioner in confrontation with other practitioners or in public advocacy roles are discussed. The need for openness to collegial consultation is stressed, and expanded roles for ethics committees are offered to fill this void. (French abstract) (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of attention deficit hyperactivity disorder and conduct disorder to juvenile delinquency: legal implications

Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are both disorders of childhood and adolescence that all too frequently extend into adulthood. But just what is the relationship between these two disorders? This study explores the overlap between these two disorders as they relate to juvenile delinquency; both are significant risk factors for the development of antisocial behavior. But there is more significance to the presence or absence of ADHD or CD in later antisocial behavior. Higher levels of defiant and/or aggressive behavior lead to antisocial acts as compared with lower levels of defiance and antisocial acts. Boys diagnosed with ADHD have higher felony rates than normal control boys, yet ADHD is not nearly as strong a predictor of offending behavior as is CD in study subjects. The presence of both CD and ADHD contributes to illegal behavior, and it is likely that early intervention in both disorders will reduce the prevalence of antisocial behavior.     

Psychologists' and physical interventions: Ethics, standards, and legal implications.

Reviews the American Psychological Association's (1981) Ethical Principles of Psychologists and its (1980) Specialty Guidelines for the Delivery of Services by Clinical Psychologists, highlighting the special concerns the documents raise for professionals using physical interventions (PIs). The legal and regulatory frameworks for the practice of psychology are reviewed with significant emphasis on professional negligence. The steps that a conscientious and cautious practitioner should take when using PIs are analyzed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intergenerational gamete donation: ethical and societal implications

The incidence of hemodynamic and airway complications associated with tracheal reintubation after an unplanned extubation has not been established. Patients whose tracheas were emergently intubated outside the operating room were reviewed over a 27-mo period via a quality improvement vehicle to evaluate hemodynamic and airway complications. Data from a subset of patients (n = 57) who underwent tracheal reintubation after unplanned (self-) extubation were collected for analysis. Of the reintubations, 93% took place within 2 h of self-extubation. Of the patients, 72% had hemodynamic alterations and/or airway-related complications, including hypotension (35%), tachycardia (30%), hypertension (14%), multiple laryngoscopic attempts (22%), difficult laryngoscopy (16%), difficult intubations (14%), hypoxemia (14%), and esophageal intubation (14%). In addition, one surgical airway and one case of "cannot ventilate, cannot intubate" leading to cardiac arrest and death were recorded. These findings suggest that patients requiring reintubation will likely do so soon after self-extubation and that reintubation can be fraught with significant hemodynamic and airway complications. Less than one third of patients undergo a mishap-free reintubation. Strategies to decrease the self-extubation rate in the intensive care unit are needed to improve patient safety and to lessen the potential impact of emergency airway management. Implications: Self-extubation by patients requiring mechanical ventilation can be life-threatening, and replacing the breathing tube often leads to hemodynamic and airway complications. Using this quality improvement audit, 57 self-extubating patients and the complications associated with replacing the breathing tube, which are numerous and can lead to significant morbidity and mortality, were analyzed.     

The minimum competence movement: Social, scientific, and legal implications.

Contends that educational policy on minimum competency testing should be based on its efficacy and on the need to redress functional illiteracy. Minimum competency testing places demands on students that increase time-on-task, which extensive research has shown is critical to academic success. In discussing the legal aspects of minimum competence requirements, the author observes that recent judicial decisions have usurped the right to set educational policy, which constitutionally belongs to local educators who are informed about their communities' needs. (87 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)