The therapeutic misconception,beneficence, and respect

In order to provide benefits to society, human medical trials must place subjects at risk of harm. This activity is thought to be justified in part by the consent of the subjects involved. But, studies have shown that most such consents are based on a therapeutic misconception (TM); the false belief of subjects that their researchers will act as their personal physicians (seeking their benefit and protecting them from harm), rather than placing them at risk of harm for the good of others. Toleration by researchers of the TM in their subjects is a form of "informational manipulation" that renders consent procedures disrespectful to subject autonomy. Consent obtained from subjects who labor under a TM is neither voluntary nor informed; as long as they have not been disabused of the TM, the action they take in enrolling in a trial is not the one they intend nor is it autonomously chosen. Changes in consent procedures should be adopted to ensure that all subjects are aware inter alia that (a) the health interests of future patients (as well as the researchers' and their sponsors' financial interests) may be more important to researchers than the interest of a subject in his or her health, and (b) normal subjects neither understand nor believe this when told. Close attention to the response of prospective subjects to this information should allow for the exclusion of all but the truly altruistic. However, the result of conscientious implementation of such policies would likely be that human medical research could no longer be conducted on more than a minimal level.     

Stites Festschrift: An Introduction

相似文献   

The psychosocial needs of the Chinese elderly

Changing Chinese family patterns caused by immigration have contributed to the breakdown of traditional community and familial control in Chinese-American families. As a result, the Chinese-American elderly are faced with unique psychosocial problems that workers must consider when providing services to this population.     

The Continuing Dominance of Traditional Gender Roles in Southern Elections*

Objective. Studies of the election of women to public office have been increasingly encouraging about their prospects of female candidates. The purpose of this study is to examine the extent to which gender roles continue to influence the election of women to local office and the pool of candidates for higher office. Methods. Utilizing data on the gender of officials, the nature of the office, and constituency demographics from county elections in eight Southern states, we construct logit models of the election of women. Results. Women hold few local offices involved in fighting crime or of an executive nature. On the other hand, women routinely win election to process‐oriented offices with less discretion. Our analysis of constituency demographics reinforces our conclusions. Women win election in areas where the public office is relatively undesirable compared to other opportunities and the ratio of high‐quality male to high‐quality female candidates is relatively low. Conclusions. Although the frequent election of women to county office provides an expanded pool of female candidates for higher offices, it seems unlikely that women will find it as easy to move up the electoral ladder into the more competitive arena of high‐profile statewide and federal leadership offices.     

Rabbits in the fields: Temporal, spatial, and behavioral explanations of dryland crop failure in the Great Basin, 1912–1920

Records of dryland homesteaders in three parts of the Great Basin between 1912 and 1920 show that crop failures were common occurrences, and that failure was more often attributed to jackrabbits than to drought. These records demonstrate that most failures caused by rabbits conformed to well-defined temporal and spatial patterns, but they also make it clear that some losses can be explained only by specific actions taken by the farmers, their families, and neighbors.     

Promoting leadership skills in field education:a university-community partnership to bring macro and micro together in gerontological field placements

Social workers are being called upon to utilize a wide range of skills in practice including not only skills of working directly with clients, but also skills related to practice in organizations such as program management, inter-organizational cooperation, research and evaluation. This article describes an innovative geriatric field education program that prepares social workers with leadership skills in both direct service and management, and engages community agencies as both sites for student learning and as beneficiaries of their professional development projects. Case examples are provided and benefits and challenges to the model are discussed.     

The SESS multisite collaborative research initiative: establishing common ground

Multidisciplinary intervention approaches are needed for meeting service needs for families in which substance abuse and mental health disorders may be interfering with child‐rearing. Experiences from the Starting Early Starting Smart (SESS) initiative, a 12‐site national collaborative investigation of integrating behavioural health services in early childhood and primary health care service settings for children aged 0–5 years and their families and caregivers, are described. This 4‐year applied research initiative was co‐funded by the Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services and Casey Family Programs, a private operating foundation. SESS, which was developed and implemented in 12 geographically and culturally diverse cities in the USA during 1997–2001, encouraged federal, state, and local public/private partnerships. Opportunities and challenges in using an inclusive, consensus‐based, stakeholder model to maximize study relevance and utility for researchers, practitioners, and fiscal sponsors are discussed, and lessons for multidisciplinary, multisite research collaborations are identified.