Patient Rights: An Advocate's Perspective

Abstract

The current growing concern about patients' rights and the delivery of student health care precipitates an environment of fear, distrust, and uneasiness within university health services. This paper addresses several selected clinical, ethical, and legal issues which have come into conflict during recent years. Our examination surveys ethical and legal principles of confidentiality, defines areas in which breaches are most likely to occur, and suggests ways of preventing breaches of confidence between students and health services.

While the fundamental ethical principle underlying confidentiality is the individual's right of privacy, many issues of confidentiality are extremely difficult to resolve. University health services have expanded the concept of health care to encompass all the conditions — medical, emotional, social, economic and environmental — which affect the health of students. As a result, health service administrators should be fully aware of the laws and associated legal complexities in their own state which affect confidentiality. Furthermore, student health physicians, and particularly mental health therapists must be sensitive to needs for protecting the privacy of students.

Legal principles of confidentiality discussed in this paper with respect to specific problem situations which might arise in a student health center include: 1) right to privacy; 2) privileged communications; 3) releasing information from the medical record; 4) releasing information to the student; and 5) treating minors without parental consent. Finally, in addition to the responsibilities which must be assumed by the health professional, certain student responsibilities in the selection and utilization of health professionals are recommended.     

HIV Seroprevalence and Clinical Characteristics of Severe Inpatient Mentally III Homeless

Two related studies were carried out at a state psychiatric center unit designed for the long-term hospitalization of homeless mentally ill people removed from the streets of New York City and taken to hospitals for psychiatric treatment. The first study, a charl review of 102 patients, documented high rates of severe psychiatric illness, alcohol and other substance use, and untreated medical problems. Patient histories showed significant social disadvantages, including high rates of criminal activity and inability to complete high school or establish long-term relationships. Our second study anonymously tested 87 patients between the ages of 18 and 59 for the presence of HIV antibodies. An overall seroprevalence rate of 5.8% is reported. Men and women in this population are likely to have similar rates of HIV infection. Being young, and Black, or Hispanic appears to be associated with increased risk. This disenfranchised population urgently needs a broad array of social, medical and psychiatric selVices. Assertive community outreach programs are necessary to assure delivery of services to this population.     

Nun sag, wie hast du’s mit der Ethik? – Menschenbilder und Ethik im Coaching. Eine Feldstudie

The integration of theory and practice in combination with ethical standards has been clearly defined as a scheme in the field of coaching, but there is still a long way to go. Within the scope of a field study and challenged by numerous perceptions, terms like ‘ethics’ and ‘idea of man’ in the context of coaching have been closely analysed, edited in a structured way and evaluated. These steps were followed by the examination and investigation of the websites of a selected number of providers and trainers of coaching, concerning the extent to which these websites include information on the meta model as well as on the theoretical level according to A. Schreyögg. Based on the rather sobering findings, our study concludes by specifying the cornerstones of a ‘check list’. This tool may help to classify providers and trainers.     

Partnering with parents to prevent childhood sexual abuse

Although research demonstrates that child‐focused sexual abuse prevention programmes can teach children personal safety knowledge and skills, childhood sexual abuse (CSA) prevention programmes that involve parents have a number of distinct advantages. The more knowledge parents have about CSA, the greater likelihood they can create safer environments for their children and thus prevent the occurrence of sexual exploitation. Research has demonstrated that parents lack crucial information about CSA and can benefit from even brief educational efforts. This paper will identify potential barriers to participation and offer practical suggestions for enhancing both recruitment and retention rates. Recommendations for parent education programmes are offered, including improving parents' confidence and skills in educating their children about CSA, providing them with parent‐friendly materials to use and developing Internet applications. Copyright © 2010 John Wiley & Sons, Ltd.