The Model Physician-Assisted Suicide Act and the jurisprudence of death

A Model Statute to Authorize and Regulate Physician-Assisted Suicide was published in 1996. This article describes the Act and some of its background and effects in detail, showing that it goes further than at first appears. Specifically, the article discusses the background and basic effect of the Act, the principal provisions of the Act and their effects, the morality and jurisprudence of the Act, the argument from autonomy, and the argument from utility. The authors conclude that by ignoring the moral traditions of Western culture, and focusing only on the ethics and anthropology of autonomy and utility, the drafters of the Act justify the dehumanization of the very people the Act is supposed to benefit.     

The functional autonomy of psychotherapy.

Psychotherapy's initial function was to provide a service to troubled people who asked for help. Later evidence of its efficacy was unimpressive, but the method did not die out. "Psychotherapy had, it appeared, achieved functional autonomy." Various criticisms of the value of psychotherapy have been controverted. The efficacy of psychotherapy is not considered in the American Psychological Association ethical principles. Chapters on psychotherapy in the Annual Review of Psychology from 1955 to 1960 dismiss the question of efficacy. Experts are convinced that psychotherapy works. We "can be sure that the principle of functional autonomy will permit psychotherapy to survive long after it has outlived its usefulness as a personality laboratory." From Psyc Abstracts 36:02:2IE75A. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autonomy and gender: Some questions for therapists.

Discusses the nature of autonomy and explores how autonomy as a therapeutic goal relates to clinical practice and the conduct of psychotherapy. Autonomy has been defined as the power to determine one's own best interests, and it has been criticized for promoting selfishness and reflecting upper-class values and gender bias. It is suggested that issues of autonomy are involved in the process of psychotherapy as well as its aim. In therapy, there is a dynamic tension between the principle of autonomy, the right of clients to determine their own interests, and the principle of beneficence, the therapist's obligation to protect the client's welfare. Whether autonomy is an appropriate ideal in psychotherapy for women or for men is considered. Feminist theorists have criticized aspects of masculine autonomy, contrasting it with feminine relatedness; however, the idealization of relatedness is questioned. It is concluded that the present conceptualizations of autonomy do not fully encompass the complexity of human interaction. It is argued that (a) autonomy and relatedness are not essential aspects of male and female nature but depend on power and status and (b) without social change, autonomy may not be a realistic goal of therapy for women. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Letter to the editor.

Comments on articles by M. A. Yarhouse (see record 1998-11146-011) and M. A. Yarhouse and W. Throckmorton (see record 2002-13988-007). Amato argues that the articles serve to masquerade ideological positions regarding homosexuality as science. It is contended that although here are various reasons for individuals wanting "not to be gay," the scientific literature has repeatedly failed to demonstrate the legitimacy of the "desire for reorientation" or the possibility that sexual orientation is even open to change. To couch the legitimacy of the change therapies in the garb of the ethics of autonomy and self-determination is an attempt to have prejudice masquerade as science by co-opting the notion of autonomy. Yarhouse's articles have demonstrated his repeated attempt to find a home for a biblically, not scientifically, founded hatred of homosexuality within the scientific community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In defense of freedom.

Comments on B. Schwartz's (see record 2000-13324-008) discussion of excessive personal freedom, autonomy, self-determination, and life satisfaction and meaning. A positive psychology, according to Schwartz, must constrain "tyranny of choice" (p. 81), and psychologists should "deemphasize freedom" because "American society has created an excess of freedom" (p. 79). R. Solomon suggests that a positive psychology for the 21st century must enhance and facilitate the creation of freedom, not undo it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician recommendations and patient autonomy: finding a balance between physician power and patient choice

Medical care in the United States has rapidly moved away from a paternalistic approach to patients and toward an emphasis on patient autonomy. At one extreme end of this spectrum is the "independent choice" model of decision making, in which physicians objectively present patients with options and odds but withhold their own experience and recommendations to avoid overly influencing patients. This model confuses the concepts of independence and autonomy and assumes that the physician's exercise of power and influence inevitably diminishes the patient's ability to choose freely. It sacrifices competence for control, and it discourages active persuasion when differences of opinion exist between physician and patient. This paper proposes an "enhanced autonomy" model, which encourages patients and physicians to actively exchange ideas, explicitly negotiate differences, and share power and influence to serve the patient's best interests. Recommendations are offered that promote an intense collaboration between patient and physician so that patients can autonomously make choices that are informed by both the medical facts and the physician's experience.     

The association of parent behaviors, chronic pain, and psychological problems with venipuncture distress in infants: The Generation R study.

Objective: To examine the association of parent behavior with infant distress during a potentially painful medical procedure. A second aim was to investigate the association of parent chronic pain and psychological problems with parent behavior and infant distress during the procedure. Design: Population-based cohort study with both cross-sectional and prospective measurements. Main Outcome Measures: Video recordings of 275 parents and their 14-month-old infant undergoing venipuncture were coded with an observational instrument to yield measures of infant distress behaviors and parent behaviors, such as reassuring, showing empathy, praising, and distracting. Parent chronic pain and psychological problems were assessed through questionnaires. Results: Infants cried 58% of procedure duration. Parent reassuring occurred 34% of procedure duration, and parent distracting occurred 37% of procedure duration. Infant distress was positively related to parent reassuring and negatively related to parent praising. Parent chronic pain was related to increased parent distracting but not to parent reassuring. Parent psychological problems were not associated with parent behavior and infant distress. Conclusion: Parent behavior rather than psychological traits is related to increased venipuncture distress in young infants. This finding suggests that the focus should be on interventions based on behavior modification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The nonlinear effects of job complexity and autonomy on job satisfaction, turnover, and psychological well-being.

This study examines the interactive relationship between job complexity and job autonomy on job satisfaction, turnover intentions, and psychological well-being. It was hypothesized that the positive or motivating effects of job complexity are only realized when workers are given enough autonomy to effectively meet the challenges of complex jobs. Results show that not only do job complexity and job autonomy interact, but that the relationships to the outcome variables are curvilinear in form. Job complexity is shown to be both a motivator and a stressor when job autonomy is low. However, the most beneficial effects of job complexity occur when it is matched by a high level of job autonomy. Theoretical and practical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Americans with Disabilities Act: II. Implications and suggestions for compliance for medical schools

There is a need for more information about the Americans with Disabilities Act that is tailored to colleges of medicine so that faculty, staff, and administrators can understand and carry out their responsibilities under the Act. This report (Part II) and the previous one (Part I) in the same issue of Academic Medicine address this need. In Part I, key terms of the Act are defined; the present report focuses on the educational relationship between medical schools, applicants, and students in the context of the Act. A comprehensive array of the Act's implications are discussed in question-and-answer format. For example, what impact does the Act have on the application and admission process? Can a college of medicine ask students whether they have a disability? When does a school's duty to accommodate a disabled student begin? The report concludes with 15 recommended steps that colleges should take to comply with the Act, such as (1) colleges should develop policies and procedures for applicants and students who want to request accommodation for disabilities; (2) colleges should identify the essential abilities and skills required for admission and for participation in the degree program; and (3) colleges should consider instituting alternate dispute resolution procedures. Although following the recommended steps may seem overwhelming, medical schools are obligated by law to accommodate qualified disabled persons; failure to comply with the Act deprives academically qualified persons with disabilities of the opportunity to demonstrate their ability to fulfill degree requirements and become physicians. Medical educators must continue to adjust their understanding and knowledge of the Act's implications for medical schools, given that the interpretation of the Act will evolve as the courts amplify and implement it.     

Application of the Act Special Admissions in Psychiatric Hospitals; balance between respect for autonomy and acting in the patient's best interest

Three years after the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals an evaluation was made. It shows that the law has reinforced the patients' rights to self-determination, but that actual practice is not yet fully according to the law. For the latter the reporters blame the complexity of the law and the inadequate manner in which the law was introduced. An evaluation of the effects of a similar law in the USA puts this issue in a different light. It shows that caregivers and judges do not let the patient's rights to autonomy prevail if this is not in the patient's best interests. The right to self-determination, expected in the sixties and seventies to become a revolution in psychiatry appears to be merely 'a near-revolution'. The moral importance of caring for a psychiatric patient outweighs the respect for his or her right to self-determination.     

The Cartwright Report ten years on: the obligations and rights of health consumers and providers

It is ten years since the Cartwright report was published, three years since the code of health and disability services consumers' rights was promulgated and two years since the code came into force which makes it due for review next year. This paper reviews the issues identified by Cartwright and the effect that her investigation into the "Unfortunate Experiment" has had on the provision of health services. Issues of clinical freedom, peer supervision and informed consent are discussed in relation to the Health and Disability Commissioner Act, the Privacy Act and concepts of partnership in health care. Some comments on the present state of the relationships between consumers and providers in the health system are included.     

A self-determination theory perspective on parenting.

This article describes research on parenting that supports children's need for autonomy. First, the authors define parental autonomy support and distinguish it from permissiveness or independence promotion. The authors also define psychologically controlling parenting and distinguish it from behavioral control (structure). Second, the authors present studies examining how parental autonomy support promotes healthy development. Indeed, clear and consistent positive effects arise from different types of studies, conducted with children of various ages. Parent observation studies suggest that parental autonomy support is associated with infants' motivation and toddlers' internalization. Parent interview studies reveal that an autonomy-supportive parental attitude relates to children's adjustment at school. Children self-report studies demonstrate a clear link between perceptions of parental autonomy support and psychosocial functioning amongst adolescents. Third, the correlates and precursors of parental psychological control and autonomy support are presented, with a special focus on parents' trust in their children's ability to develop in an autonomous manner. Finally, ideas for future research are suggested. Although self-determination theory is not strictly a developmental theory, it seems highly pertinent to the socialization of children, their internalization and development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Psychotherapy's" Autonomy.

Comments on the article by A. Astin (see record 1962-03183-001) which examined the functional autonomy of psychotherapy. The current author was left with the vague suspicion that Astin had martialed a good deal of scholarly evidence to prove a point that needs no proof. Psychotherapy is autonomous and serious students of it are giving a good deal of thought, time, and energy to a consideration of its functional properties. Certainly many of the "practitioners" are as unhappy as Astin over the uncertainties involved, but fortunately, unlike Astin they have not washed their hands of the "bothersome business" of outcome or process. The first issue that needs attention is his opening sentence. Unfortunately, here he gives no reference to indicate how long we have been about the business of attempting to formulate rigorously any test hypotheses about the therapy relationship within that situation itself and in the laboratory as well. The second and final point the current author makes is that it is unnecessary to answer Astin's article point by point. It would be more fruitful to look at the term "psychotherapy" and see in what way he may not have attended to what is perhaps the most important part of the problem he raises. That is, what does it mean to condemn "psychotherapy" when there are so many meanings attached to it, all applied by men of general good will who do intend to "provide a service to troubled people." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High levels of anticardiolipin antibodies in patients with abnormal embryo morphology who attended an in vitro fertilization program

Although it is unlikely that the legislative endeavors of 1996 and 1997 relating to the health care industry will be matched in 1998, implementing regulations of the Balanced Budget Act and the Health Insurance Portability and Accountability Act will predicate the successes or shortcomings of these new laws in 1998. It is important that NPs stay in close contact with their state legislators and Medicaid officers responsible for implementing the SCHIP. NPs should also closely track efforts at the Federal level to ensure inclusion of non-physician providers in legislation that is important to NPs, such as bans on "gag" clauses--a protection that should include all health care providers.     

Scientific and regulatory aspects of nutraceutical products in the United States

Within the past decade, the so-called health food industry has experienced a tremendous growth such that these products are commonplace in most community pharmacies within the United States. These products have since been defined, by those in the industry, as nutraceuticals. Passage of the Nutrition Labeling and Education Act of 1990 and the Dietary Supplement Health and Education Act of 1994 has had a significant impact on the information available to the consumers to enable them to make educated decisions when "self-medicating" with this class of products. This paper is an attempt to summarize the current state of scientific and regulatory issues that are relevant to nutraceutical products.     

Federal recognition of psychology in rehabilitation programs.

Notes that because psychology is a relatively young profession, it has only recently begun to achieve express statutory recognition. However, throughout 2 landmark federal rehabilitation initiatives—the Rehabilitation Act of 1973 (as amended) and the Education of All Handicapped Children Act—psychology has been deemed a full partner. Programmatic initiatives under both acts that should be of direct interest to psychologists are outlined. It is clear that the congressional committees that drafted the rehabilitation legislation hold psychology in high esteem. Not only are psychological services viewed as being important to all handicapped persons, but the profession's active participation in the political process has ensured that the underlying legislation will be truly interdisciplinary and inclusive in nature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drinking water for the future

The Safe Drinking Water Act of 1974 represents an important step in improving the quality of public water supply in the United States. However, it fails to address two important problems: (1) The 1970 Public Health Service Community Water Supply Survey revealed that small public water supply systems often deliver poor quality water. The Act does not assure that these supplies will now receive appropriate attention; furthermore, the Act does not address the needs of the 50 million people not now served by public water systems; (2) About one-third of our population draws its drinking waters from polluted sources. The decisions to use these low cost sources were made generations ago when consumers could be protected from water-borne infectious disease. A new problem has now arisen--the presence of numerous synthetic organic chemicals of uncertain health consequence, not removed by conventional water treatment. The Act does not address this problem. Regionalization and the integration of water resource and water pollution control authorities are proposed as a reasonable solution to these problems. The development of dual water supply systems in order to conserve scarce pure water sources for human consumption appears to be a feasible way to avoid using polluted waters for drinking. The development of dual supplies would be enhanced by regionalization and integration of water authorities.     

Is science autonomous?

Considers the meaning of the "autonomy of science" with respect to the article by I. L. Horowitz (1966) that condemns Federal funding decisions as a supreme act of censorship. The absolute value of scientific autonomy is questioned and the dangers of moral insularity are noted in conjunction with the need for balance between human restriction and freedom. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testimony before the Senate Subcommittee on Government Research of the Committee on Government Operations: Full Opportunity and Social Accounting Act.

Discusses provisions of the Full Opportunity and Social Accounting Act of 1967 (S. 843) in terms of the comparability of its purposes and goals to those of the Employment Act. While goals in the economic and social fields are interrelated, there is a different emphasis in considering priorities, and social science has not developed conceptual and statistical tools for an accounting similar to those used in economic accounting. In the area of welfare goals and their evaluation, more work must be done before a procedure and organization like that of the Employment Act could be adopted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)