Health professionals' attitude toward euthanasia: a cross-sectional study from Turkey

There is an ongoing debate on the definition of euthanasia and attempts to change laws about euthanasia and its practice in many countries. It is the medical doctors and the other health professionals who will elucidate the issue. Therefore, we performed this study to reveal attitude of Turkish health professionals toward euthanasia. This is an observational and cross-sectional study and data were collected with a questionnaire. The questionnaire was distributed to 545 health professionals in Samsun, a city in the Black Sea Region in Turkey. Data were analyzed with SPSS package programs. Of all health professionals included in the study, 43.5% were medical doctors and 45.5% auxiliary health professionals. Of all participants, 33.6% did not object to euthanasia and 7.9% were asked to perform euthanasia. Eighty point seven percent of the participants noted that euthanasia could be abused even if a euthanasia law were passed. It can be concluded that the health professionals should have a chance to discuss euthanasia and that their attitude toward and their expectations and worries about euthanasia should be taken into account when a euthanasia law is drafted.     

“管理学”断想

什么是管理学?具体到中国的环境下,"管理"是不是"学"?此问题同科学、知识、学科这3个词汇紧密相关。严格意义上的学科之"学"后缀为-o logy,此意义的管理学,不论中外并未形成,且很可能无法形成;科学意义上的管理学,已经形成或正在形成,在成熟程度上学界判断有差别;知识意义上的管理学,古代就有丰富积淀,学界公认现在已经形成。管理学界的讨论,需要对这种区别进行辨析,才能进一步讨论管理区域性和管理哲学等问题。     

中国市场化进程报告:现状分析与未来预测

本文通过对市场化进程的分析 ,指出当前中国总体市场化、行业市场化与地区市场化离目标市场化还有多远 ,并通过问卷调查及计量分析 ,对未来5～10年的市场化进程进行了预测。文章认为 ,未来市场化的最主要障碍是政府与市场的关系以及法制建设。正是在这个意义上 ,中国未来改革的中心任务将是政府职能转换。而想真正做到对政府行为的约束 ,处理好政府与市场的关系 ,就需有制度监督与保障 ,即法律制度环境的完善     

How to fire a physician

How does one fire a physician? In a word, carefully! Most of the legal protections for other employees apply just as well to physicians. And physicians have access to an expanded realm of protections because of the nature of their profession and because of its role in the health care delivery system. The ordinary employee cannot raise antitrust; the fired physician may very well raise just that issue. And yet the need to terminate a physician will sometimes, even though rarely, occur. How can the organization be certain that it has treated the physician fairly, has documented any and all offenses in a defensible fashion, and has generally followed accepted practices in all aspects of dealing with the physician? The author provides some guidelines for dealing with the problem or the incompetent physician.     

Dispensing death,desiring death: an exploration of medical roles and patient motivation during the period of legalized euthanasia in Australia

A qualitative case study was conducted to explore the clinical decision making processes that underpinned the practice of euthanasia under the Rights of the Terminally Ill (ROTI) Act. The key informant for this research was Philip Nitschke, the general practitioner responsible for the legal cases of euthanasia. His information was supported by extensive document analysis based on the public texts created by patients in the form of letters and documentaries. Further collaborating sources were those texts generated by the media, rights groups, politicians, the coroner's cort, and the literature on euthanasia and assisted suicide. A key study finding was that the ROTI legislation did not adequately provide for the specific medical situation in the Northern Territory, Australia. The medical roles, as proscribed by the legislation, carried many inherent assumptions about the health care context and the availability of appropriately qualified medical staff committed to providing euthanasia. These assumptions translated into difficulties in establishing clinical practices for the provision of euthanasia. A further finding concerned the motivations of those who requested euthanasia. This article addresses the medical roles and the motivations of those seeking euthanasia.     

Attitudes toward and desire for assisted suicide among persons with amyotrophic lateral sclerosis

This study aimed at investigating attitudes toward assisted suicide among individuals with amyotrophic lateral sclerosis, and the differences in health status (illness severity and functional disability) and psychosocial adjustment (depression, perceived stress, social support, and coping) between those in favor of and those against assisted suicide. This study also aimed at describing the characteristics of terminally-ill individuals who acknowledge contemplating assisted suicide. Forty-four individuals diagnosed with amyotrophic lateral sclerosis were surveyed about their attitudes and the circumstances that would make them contemplate assisted suicide and filled out standardized measures of mood, stress, social support, coping, and illness status. Seventy percent of the sample found assisted suicide morally acceptable and 60% thought it should be legalized. In addition, 60% of patients agreed they could foresee circumstances that would make them contemplate assisted suicide, but only three (7%) indicated they would have requested it already if it had been legal. Willingness to contemplate assisted suicide was associated with reports of elevated levels of depressive symptoms and reports of hopelessness. Results highlight the need to assess psychological status carefully when terminally ill individuals begin contemplating assisted suicide or voice a request for it.     

Medical staff handling of concerns with physicians' performance

Medical staff organizations and their leaders are frequently confronted with concerns about physician knowledge, performance, or behavior. Dealing with these concerns is a serious and time-consuming task. Poorly handled issues may result in serious legal consequences. In highly structured organizations, authority for responsibilities, income, and employment rests with individuals who must manage these problems, but medical staff structures do not always lend themselves to dealing with these issues. Introduction of quality improvement processes into medicine has been received as a panacea for physician problems. Certainly the majority of physicians understand quality improvement and work toward common goals to improve patient care. Unfortunately, a small minority remain problem physicians. Steps that can be taken to deal with problem physicians, particularly for issues of quality management, are described in this article.     

Sometimes we're our own worst enemies

There is a sense of frustration among physicians involved in the decision and policy making processes within health care institutions. Because the endpoint is reached at glacial speed, too much time, money, and opportunity is lost. The decision making process can be repetitious and tedious because of unnecessary steps. By eliminating certain tactics and strategies employed by upper-level management in many health care institutions, the decision making process becomes more effective. This article focuses on the medical staff's role in the decision making process; explains why tactics to involve the medical staff are ineffective and why eliminating the medical staff from certain aspects of the process does not jeopardize the institution; and concludes that the hospital board and its delegates should be autonomous in the decision making process.     

Associations between stress at work and attitudes towards retirement in hospital physicians

There is a need to understand the associations between attitudes towards retirement in specific occupations and various psychosocial and work-related factors. This study identified correlates of retirement thoughts and retirement preference in hospital physicians. The sample comprised 447 (251 male and 196 female) physicians from three hospital districts in Finland. After adjustment for gender, age and salary, minor psychiatric morbidity increased likelihood of retirement thoughts and retirement preference. Retirement thoughts and retirement preference were more common in doctors reporting low job control, poor teamwork and unjust supervision than in doctors perceiving their working conditions more favorably. Work preference was associated with high overwork. The associations of work characteristics with retirement thoughts and retirement preference largely persisted after control for indicators of health and social circumstances. In conclusion, in addition to demographic and financial factors and health, retirement attitudes in hospital physicians seem to be related to organizational and managerial factors that are potentially amendable to intervention. This has implications for retaining hospital physicians who might otherwise retire.     

Associations between stress at work and attitudes towards retirement in hospital physicians

Abstract

There is a need to understand the associations between attitudes towards retirement in specific occupations and various psychosocial and work-related factors. This study identified correlates of retirement thoughts and retirement preference in hospital physicians. The sample comprised 447 (251 male and 196 female) physicians from three hospital districts in Finland. After adjustment for gender, age and salary, minor psychiatric morbidity increased likelihood of retirement thoughts and retirement preference. Retirement thoughts and retirement preference were more common in doctors reporting low job control, poor teamwork and unjust supervision than in doctors perceiving their working conditions more favorably. Work preference was associated with high overwork. The associations of work characteristics with retirement thoughts and retirement preference largely persisted after control for indicators of health and social circumstances. In conclusion, in addition to demographic and financial factors and health, retirement attitudes in hospital physicians seem to be related to organizational and managerial factors that are potentially amendable to intervention. This has implications for retaining hospital physicians who might otherwise retire.     

Turkish health professional's attitude toward euthanasia

The cross-sectional study was administrated between April and September 2006. Participants are doctors, nurses, and midwives. Between these dates we met only 750 health staff (doctor, nurse, and midwife). Six hundred thirty-two of them responded to our questionnaire, 122 of them were in Manisa city, and 510 of them in Erciyes. We sought to identify variables that contribute to euthanasia attitude, including demographics, in order to demonstrate Turkish doctors', nurses', and midwives' attitudes toward euthanasia and to compare their attitudes in this regard. The data was collected by a two-part questionnaire. The first part included questions about the health personnel; the second part comprised the euthanasia (Medical Staffs Attitude toward Euthanasia) scale. The scale was developed by the researcher to measure the attitude of healthy staff euthanasia. The SPSS was used to analyze the data. Student t-test, ANOVA, Mann Whitney U, and Kruskal Wallis were used to evaluate the data. Thep value 0.05 (95% confidence interval) was accepted as significant. In our study, professional groups are compared with all the factors but there is a significant difference only between social cost and professional groups.     

Entropy Principles in Decision Making Under Risk

This paper considers decision problems where: (1) The exact probability distribution over the states of nature is not precisely known, but certain prior information is available about the possibilities of these outcomes; (2) A prior distribution over the states of nature is known, but new constraint information about the probabilities becomes available. The maximum entropy principle asserts that the probability distribution with maximum entropy, satisfying the prior knowledge, should be used in the decision problem. The minimum cross-entropy principle says that the posterior distribution is the one which minimizes cross-entropy, subject to the new constraint information. The entropy principles have not gone uncriticized, and this literature, together with that justifying the principles, is surveyed. Both principles are illustrated in a number of situations where the distribution is either discrete or continuous. The discrete distribution case with prior interval estimates based on expert opinions is considered in detail.     

Of euphemisms and euthanasia: the language games of the Nazi doctors and some implications for the modern euthanasia movement

Euphemisms are place-holders for important concepts. They may disguise a practice which one might abhor if it were given another name. In Nazi Germany during World War II, euphemisms were used to desensitize physicians and society to the horrors of a program of euthanasia. This article examines some of the euphemisms used by the Nazi physicians to redefine medicalized killing, compares the Nazi language games with those of contemporary proponents of medicalized killing, and concludes that the consistent application of euphemisms for medicalized killing significantly weakens arguments against assisted killing.     

National Competitiveness: A Question of Cost Conditions or Institutional Circumstances?

The issue of national competitiveness is a matter of considerable importance to both managers and public policy makers alike. Business scholars reflect this importance by their annual production of international indices of country competitiveness. Nevertheless, the notion of national competitiveness is controversial and has both (i) a narrow, concise conception that relates primarily to cost conditions as determined by exchange rates, and (ii) a broader, more nebulous conception that comprises the institutional and systemic circumstances of an economy, such as legal, governmental, public policy and other factors framing countries' wider business environments. In practical managerial terms, national competitiveness is a combination of both these narrow and broad conceptions. However, exactly how important cost conditions as opposed to institutional circumstances are to national competitiveness from a practical business perspective has never been investigated and is not known. This study uses qualitative and quantitative data gathered from senior firm executives in a specimen economy to find out. Hierarchical regression analyses suggest that institutional circumstances are significantly more important than cost conditions to the competitiveness of an economy from a practical managerial viewpoint.     

Physician financial relationships in the new regulatory environment

In recent months, physicians have been under scrutiny by the federal government with respect to their financial relationships with both drug manufacturers and home care companies. This heightened scrutiny can be attributed, in part, to the attention that has been placed on health care fraud and abuse in this country as a major cause of rising health care costs. Federal investigators currently are examining physician financial relationships in light of the Medicare/Medicaid antikickback statute to determine whether certain payments made to physicians are intended as inducements to refer patients or to prescribe certain products. "Health Law" is a regular feature of Physician Executive contributed by Epstein Becker & Green. Mark Lutes of the law firm's Washington, D.C., offices serves as column editor.     

Hospital management's linchpin: the medical director.

The practice of medicine has become increasingly complex in this era of diagnosis-related groups (DRGs) and other direct government involvement in health care; complex and seemingly inappropriate legal decisions; liability chaos; and increasing competition from peers, entrepreneurs, and other health care organizations. In this new environment, an old player, the medical director (vice president of medical affairs) has been given new visibility and increased responsibilities to help physicians live with and overcome these environmental factors. In showing how the medical director can be of assistance in putting these factors into perspective, it is helpful to take a look at some aspects of the history of medicine, analyze the education process for physicians, point out where the profession began to be driven off course, and identify some of the overall problems of the profession and of the health care field. It is my intent here to project the position of medical director as a vital, frequently missing, link in the attempt to maximize communications, understanding, and achievement in health care organizations.     

Business and legal issues in enterprise collaborations: A German perspective

Virtual and Extended enterprises share a large amount of characteristics. Especially when it comes to the process of their foundation either one is well advised to base itself on a strong network of reliable partners. In this network each of the joining companies that form the Virtual enterprise can concentrate on their core competencies, giving the whole enterprise the chance to be extremely efficient. Bringing together the different partners and managing them is seen as being one of the biggest challenges of the Virtual enterprise. Therefore some partners will have to focus on those managing tasks. It might as well be their responsibility to ensure that no legal conflicts in regard to the foundation, dissolving, production and related topics emerge. This being especially difficult because the efficiency of a Virtual enterprise is strongly dependent on the looseness of its structure. What conflicts can appear in the described environment and how they might be solved is the focus of this article. It will be pointed out that the emergence of Virtual and Extended enterprises should be supported by general terms and conditions. This terms and conditions should be adjustable, offer the chance to establish a legal framework fitting just perfectly to the intended purpose to continuously create, adjust or dissolve Virtual enterprise. As a matter of fact a certain degree of commitment can positively expand the co-operation in a Virtual enterprise which is mainly based on trust.     

Self-managed Teams: Assessing the Benefits for Small Service-sector Firms

In recent years the concept of the self-managed team has gained in popularity as Western nations have struggled to remain competitive in world markets. Claims that autonomous working can contribute significantly to enhancing employee productivity, product innovation and quality management appear mainly based on anecdotal evidence extracted from single-firm case studies. In an attempt to close identified theoretical and empirical gaps about autonomous working, a larger-scale quantitative assessment of self-managed teams in small UK service-sector firms was undertaken. Although the results confirm that self-managed teams can contribute to improving certain aspects of performance, the scale of impact seems much less than that suggested in many articles. Furthermore, in certain circumstances it appears that a move to self-managed teams in small service-sector firms may have a somewhat negative impact on certain aspects of organizational capability. The question is raised, therefore, whether autonomous working should be strongly advocated as an important contributor to enhancing the competitiveness of small service-sector firms.     

The importance of taxes in entrepreneurial decisions: an analysis of practicing physicians’ behavior

An irrational strong importance of taxes in an individual’s decision-making behavior is one of the most popular assumptions about the behavioral effects of taxation. However, empirical research about this phenomenon is rare. In a study of German physicians, this paper analyzes whether tax aspects are over weighted in entrepreneurial decision-making. Furthermore, factors that may influence the irrational decision-making behavior of actors are analyzed. As research method, a conjoint analysis is used that permits measurement of the relative importance of tax aspects in decisions. The first result of the study is that the majority of the respondents (practicing physicians) misestimate their own marginal tax rate. The main result of the study is that––in comparison to the neoclassical model of rational maximization of consumption utility––most of the respondents overweight tax aspects. No evidence can be found for any relationship between indicators of a possible tax aversion (e.g., low satisfaction with the tax system) and attention to tax aspects in the decisions analyzed.