Rethinking Suffering: Allowing for Suffering that is Intrinsic at End of Life

The dilemma so central to the work of providers of palliative and end-of-life care is the paradox of their professional and ethical duty to try to relieve suffering and the limitations of so doing. While the capacity to sit with suffering at the end of life is critical to clinical work, the idea that some intrinsic suffering cannot necessarily always be relieved may model for patients and families that suffering can be borne. Clinicians who encounter unrelievable suffering may feel a sense of failure, helplessness, moral distress, and compassion fatigue. While tolerating suffering runs counter to the aims of palliative care, acknowledging it, bearing it, and validating it may actually help patients and families to do the same. “Sitting with suffering” signals a paradigm shift within the discipline of palliative care, as it asks clinicians to rethink their role in being able to relieve some forms of psychosocial suffering intrinsic to dying.     

Professionals’ decision‐making in cases of physical punishment reported to child welfare authorities: does family poverty matter?

The influence of family poverty on professionals’ decision‐making in cases of physical punishment reported to child welfare agencies was examined. The sample was drawn from the Canadian Incidence Study of Reported Child Abuse and Neglect. The influence of five indicators of poverty on six investigation outcomes was assessed. In addition, a Poverty Index was constructed from these five variables to assess whether the family's overall poverty status influenced investigation outcomes. The outcome variables examined were case substantiation, provision of ongoing child welfare services, referrals to child and family support programmes, out‐of‐home placement, applications to child welfare court and police involvement. Together, the poverty indicators did not account for more than 6% of the explained variation in any of the outcome variables, nor did the magnitude of the Poverty Index affect the likelihood of any of the investigation outcomes. These findings suggest that family poverty does not influence professionals’ decision‐making in cases of physical punishment reported to child welfare agencies in Canada. The findings have implications for the ongoing development of policy aimed at reducing parental use of physical punishment.     

BUSINESS FAILURE AND SOCIAL INEQUALITY

The paper contrasts the characteristics of bankrupt proprietors with those of debtors using Part X of the Bankruptcy Act. The findings, which are based partly on a survey of official files on bankrupts and Part X debtors, reveal class-related differences between the two groups, with bankrupts coming from relatively underprivileged backgrounds. This finding is moderated by factors such as ethnicity, partnership arrangements and time in business. The data are interpreted sociologically, with special reference to ethnomethodological concepts like deviance and stigma which emphasise the denouncement and symbolic expulsion of debtors; and structuralist explanations which associate differential use of the Bankruptcy Act with social inequality.     

Incarcerated Dutch juvenile sex offenders compared with non-sex offenders

There is some debate about whether or not sex offenders are similar to non-sex offenders with regard to family background (parental characteristics), personality, and psychopathology. The central aim of this study focused on the comparison of juvenile sex offenders and non-sex offenders. The sample consisted of incarcerated juvenile male sex (n = 30) and non-sex (n = 368) offenders. It appeared that sex offenders resembled non-sex offenders with respect to most of the offender and parental characteristics. Results demonstrated some differences between both groups, while the majority of characteristics were similar. Limitations of the study are discussed, especially the low number of sex offenders, followed by suggestions for further research.     

Management of premature menopause

There has been some confusion among women and health professionals since the publication of the Women's Health Initiative and Million Women studies about the management of premature ovarian failure (POF). Both studies were undertaken in women aged 50 and over, and cannot be extrapolated to their younger counterparts, who would normally be producing their endogenous estrogen, since they have functioning ovaries. Estrogen-based replacement therapy is the main stay of treatment for women with POF and is recommended at least until the average age of natural menopause (52 years in the UK). This view is endorsed by regulatory bodies such as the Committee on Safety of Medicines (now the Commission on Human Medicines) in the UK. No evidence shows that estrogen replacement increases the risk of breast cancer to a level greater than that found in normally menstruating women, and women with POF do not need to start mammographic screening early unless other risk factors are present, such as family history.     

Exploring the Etiology of Perfectionism and Perceptions of Self‐worth in Young Athletes

This study assessed the main and interactive effects of perceived parental expectations and perceived parental criticism on 180 young talented athletes' perfectionistic tendencies and level and reported fluctuation in self‐esteem. A potential quadratic effect of perceived parental expectations on the targeted dependent variables was also tested. Moderated hierarchical regression analyses indicated that perceived parental criticism was the strongest predictor of concerns over mistakes and doubts about actions whereas perceived parental expectations were positively related to personal standards only. Self‐esteem was predicted by high perceived parental expectations and low perceived parental criticism. Children's reported fluctuation in self‐esteem was highest when perceived parental criticism was high and perceived parental expectations were deemed high or low. The results argue against a unidimensional and linear examination of factors relating to the etiology of perfectionism and perceptions of self‐worth.     

Gender Mainstreaming versus Diversity Mainstreaming: Methodology as Emancipatory Politics

This article examines the question of whether and how the intersectional oppression of sexism and racism can be challenged by government policy. It draws on a case study of an Indigenous policy strategy in Australia to argue that, in contrast to concerns expressed by feminist policymakers, gender equality is not inevitably neglected when the target for remedial action is institutional racism. Our study suggests that successful action on Indigenous emancipation necessarily mobilizes a methodology for moving past one‐dimensional category distinctions. Therefore, focusing on the task of translating declared policy goals into action can provide a way out of the impasse over whether ‘diversity’ or ‘gender’ is the better vehicle for mainstreaming equity policy. To develop its case, the article draws conclusions about the politics of methodology from gender mainstreaming debates, intersectionality theory and institutional ethnography, then uses our conclusions to analyze the political and methodological effectiveness of the Indigenous policy strategy.