The Clinician's Voice and the Limits of Bioethics

The bioethics movement has long promulgated a model of ‘principled decision‐making’ in which ethical dilemmas and conflicts between various rights, interests, and ethical principles are central. In many respects this movement has had a laudatory impact on health care and on health professionals, but we will also argue that the bioethical model of ethical analysis has important limitations. The model's theoretical orientation is discontinuous with the training and skills of health professionals, the manner in which health professionals conceptualise and solve problems that arise in a clinical setting, and the time constraints inherent in most clinical situations. As such, the model is not readily applicable to much of the day‐to‐day work of clinicians and, in particular, to the routine ethical questions and situations that arise in caring for patients. What we suggest is that the bioethical model does not take into account that health care professionals, as part of their daily work, encounter and manage difficult, often conflictual situations and that they do so by bringing to bear conceptual frameworks and therapeutic techniques that have, embedded within them, the ethical values and goals of their own fields, as well as established ways of dealing with problems and addressing competing priorities. We further argue that from a systems perspective, the bioethical model and the pragmatic, problem‐focused ethical decision‐making of clinicians operate on different levels of complexity; whereas the former is especially appropriate for situations that resist consensus or that raise significant issues of public policy, the latter serves as an effective framework in less difficult or complex situations that can be moved effectively toward consensus and closure.     

‘The Worst Thing is the Screwing’ (1): Consumption and the Management of Identity in Sex Work

This paper reviews qualitative data from academic research into prostitution, accounts from prostitutes themselves in the UK and Australia, and data from one of the authors' own research in New South Wales to analyse the ways in which female sex workers negotiate and construct their sense of themselves. This analysis is informed by the suggestion that, in the act of commercial sex, the prostitute's own body is being consumed by the client, which can be seen to place certain pressures on the relationship between sex workers' professional and personal identities. Our review suggests that individual workers' tactics for managing the contradictions of working as a prostitute and preserving self‐esteem are both similar and different, even within two broadly culturally commensurable contexts, and, moreover, that not all prostitutes necessarily want to maintain a strict divide between work sex and non‐work sex in every encounter. Moreover, even for those who do, the trials of maintaining the divide are considerable, as is the permeability of boundaries between work and intimate sex.     

Nature,Society, History and Social Change

The Nature, Society and History theme is discussed in terms of the conceptual framework of 'biohistory'. Reference is made to its relevance to human health and well-being, societal metabolism and ecological sustainability. The power of human culture as an ecological force is emphasized. The Nature, Society and History paradigm is discussed in the context of the social changes that will be necessary for the achievement of ecological sustainability. It is suggested that it has an essential contribution to make not only in the academic world, but also in the general community.     

The Exploration of Role Induction as a Potential Method for Improving Men's Perceptions of Career Counseling

The authors explored the influence of role induction on men's perceptions of career counseling and attitudes toward seeking professional help. Two separate role inductions were presented to 268 male college students; the first discussed holistic career counseling, and the second integrated a discussion of male gender role socialization. Results demonstrated that participants who viewed the holistic role induction reported greater valuing of career counseling when compared with a control group. However, results indicated no difference in perceptions of career counseling between a holistic career counseling role induction and one that included socialized male perceptions of counseling.     

Street Youth Labour Market Experiences and Crime*

Dans le cadre de notre recherche, nous étudions la façon dont les expériences dans le marché du travail des jeunes sans‐abri et l'inter‐prétation qu'ils font du chômage sont liées à leur comportement criminel. À partir d'entretiens réalisés auprès d'un échantillon de 200 jeunes homines vivant dans la rue, les données recueillies indiquent que ces jeunes se sentent exclus du marché du travail du fait des expériences négatives qu'ils ont vécues. Ce phénomène est exacerbé par le chômage à long terme, qui détruit la motivation et conduit les jeunes à rechercher d'autres exutoires matériels. En outre, les jeunes en viennent à considérer le système social comme injuste et se sen‐tent inaptes à l'emploi, ce qui augmente le risque qu'ils participent à des activités criminelles. Les jeunes qui restent lies à la société tradi‐tionnelle et continuent de croire à l'idéologie dominante du mérite réagissent par la dépression ou la culpabilité menant à une fuite passive et favorisant le comportement criminel. En revanche, les jeunes qui refusent l'idéologie font étant d'un affect négatif minimal et met‐tent en valeur la supérioritý matérielle et sociale qu'ils accordent aux activités criminelles par rapport à l'emploi qu'ils ont pu occuper avant et qui leur était offert. Les conclusions de cet article s'appuient sur les théories de la contrainte, du contrôle et de la sous‐culture. The research explores how homeless street youths' labour market experiences and interpretations of unemployment are linked to criminal behavior. Using interviews with a sample of 200 male street youth, the data suggest that these youths become alienated from the labour market because of negative experiences in their jobs. This is exacerbated by long‐term unemployment that destroys motivation and leaves the youths looking for other material opportunities. Further, the youths come to see the social system as unfair and themselves as unemployable, making it more likely they will become involved in criminal activities. Those youths who remain bonded to the conventional society and continue to believe in the dominant meritocratic ideology respond with depression and guilt, which lead to a passive withdrawal and inhibit criminal behavior. In contrast, those youth who dismiss the ideology display minimal negative affect and reveal that criminal activities are superior both materially and socially to previous and available employment. Findings are discussed in terms of strain, control and subcultural theories.     

The nature, extent and determinants of violence against psychiatric personnel

Violence against psychiatric staff seems to be on the increase. Such abuse can lead to mental health consequences for the staff and a reluctance to be closely involved with patients. Few Swedish investigations have examined violence against mental nurses and psychiatrists, or undertaken comparative studies between them. In this study we examined the extent, nature and determinants (i.e. risk factors) of violence against psychiatric nurses (n = 731) and psychiatrists (n = 320) working in the eight health care districts of Stockholm. These caregivers were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. violence and work environment). The majority of the participants (85%) reported having been exposed to violence during their careers, with 57% being victimized in the past 12 months. Physical violence was common, and factors such as negative attitudes to work and diminished sense of autonomy were associated with an increased vulnerability to violence. Nurses and psychiatrists did not differ in violence variables. In spite of the weaknesses of the design (cross-sectional self-selecting sample), this study corroborates previous findings and identifies personal factors associated with violence that have received little attention in the literature (e.g. lack of respect for the organization of care).     

Bank Loan Officers' Perceptions of Business Owners: The Role of Gender

There is a widely held belief that banks may be discriminating against female business owners. This study was designed to explore the perceptions held by bank loan officers of male and female business owners, using Bourdieu's theory of practice and Kelly's personal construct methodology. The research literature might lead to an expectation that the characteristics of the business owners would be relatively homogenous but that men and women business owners would be construed differently (for example women might be seen to lack drive). However, the results demonstrate heterogeneity in the constructs held by bank loan officers, and a particular concern with the character of the business owner. Significant gender differences were observed in only 20 of the 325 constructs elicited from 35 bank loan officers. Female bank loan officers were as likely as male bank loan officers to draw gender distinctions between business owners. Detailed multivariate analyses confirmed no evidence of systematic gender differences in the constructs held by bank loan officers of business owners.