Midwives’ experience of personal/professional risk when providing continuity of care to women who decline recommendations: A meta-synthesis of qualitative studies

ProblemWomen’s autonomous choices in pursuit of physiological childbirth are sometimes limited by the midwife’s willingness to support those choices, particularly when those choices are contrary to recommendations or outside of guidelines.BackgroundWomen’s reasons for making such choices have received some research attention, however there is a paucity of research examining this phenomenon from the perspective of caseloading midwives’ and their perception of personal/professional risk in such situations.AimTo synthesise qualitative research which includes the voices of midwives working in a continuity of carer model who perceive any kind of risk to themselves when caring for women who decline current established recommendations.MethodsSystematic literature search and meta-synthesis were carried out following a pre-determined search strategy. The search was executed in April 2021 and updated in July 2021. Studies were assessed for quality using JBI Critical Appraisal Checklist for Qualitative Research. Data extraction was assisted by JBI QARI Data Extraction Tool for Qualitative Research. GRADE-CERQual was applied to the findings.FindingsEight studies qualified for inclusion. Five main themes were synthesised as third order constructs and were incorporated into a line of argument: Women’s rights to bodily autonomy and choice in childbearing are violated, and their ability to access safe midwifery care in pursuit of physiological birth is restricted, when midwives practise within a maternity system which is adversarial towards midwives who provide the care which women require. Midwives who provide such care place themselves at risk of damaged reputation, collegial conflict, intimidating disciplinary processes, tensions of ‘being torn’, and a heavy psychological load. Despite these personal and professional risks, midwives who provide this care do so because it is the ethical and moral thing to do, because they recognise that women need them to, because it can be very rewarding, and because they are able to.ConclusionMaternity systems and colleagues can be key risk factors for caseloading midwives who facilitate women’s right to decline recommendations. These identified risks can make it unsustainable for midwives to continue providing woman-centred care and contribute to workforce attrition, reducing options/choices for women which paradoxically increases risk to women and babies.     

Current issues in clinical research and the development of new pharmaceuticals

As a normal part of the drug development process, U.S. pharmaceutical companies conduct many thousands of clinical trials each year. Only after a reasonable assurance of safety is made can the drug be given to patients who have the underlying medical condition that the drug is designed to treat. Patient welfare is assured by adhering to the Food and Drug Administration's interpretation of the “common rule”; if the data will be used to support a licensing application. 21 CFR Part 50 sets forth the regulations along with the principles of informed consent and the use of institutional review boards (IRBs) that assure patients’ rights are protected. Any potential conflict of interest on the part of a clinical investigator must be reported to the FDA. Pharmaceutical companies extensively monitor ongoing clinical trials for compliance with appropriate regulations. The recent revision of the Declaration of Helsinki governing placebo‐controlled clinical trials may adversely impact drug development     

Empirically supported ethical research practice: The costs and benefits of research from the participants’ view

Researchers and institutional review boards are routinely called upon to evaluate the cost‐benefit status of proposed research protocols that involve human participants. Often these assessments are based on subjective judgments in the absence of empirical data. This reliance on subjective judgments is of particular concern for studies involving clinical samples where unfounded assumptions may adversely affect research progress or clinical outcomes. The Reactions to Research Participation Questionnaire (RRPQ) was designed to address this shortcoming and to help promote ethical decision making about research practice. The present study describes development of the RRPQ and presents a series of exploratory and confirmatory analyses investigating its structure. Based on these findings, a revised version of the instrument and suggestions for future research are presented. This approach provides a foundation for scientifically informed protection of human subjects.     

A little too much of the buchenwald touch? Military radiation research at the university of Cincinnati, 1960–1972

From 1960 through 1972, Dr. Eugene Saenger oversaw the experimental administration of lethal and near‐lethal doses of radiation to hospital patients at the University of Cincinnati. These experiments were funded by the US Department of Defense, and were specifically designed to acquire military information on the effects of radiation in combat soldiers. Although Saenger's research was terminated after public exposure in 1971, a full and detailed account has not been available until now. The account provided by the President's Advisory Committee on Human Radiation Experiments (ACHRE) in their Final Report of 1995 was incomplete. Our account is based on a reanalysis of all the material available to ACHRE, including highly critical peer reviews by U.C. faculty members. We also present, for the first time, several case histories taken from the medical records of Dr. Saenger's subjects.     

Patients’ competence to consent to neurobiological research

Progress has been made defining the standards for determining subjects’ competence to consent to research: abilities to communicate a choice, understand relevant information, appreciate the nature of the situation and its consequences, and manipulate information rationally. Available data show clearly that persons with mental illness display a spectrum of decisionmaking abilities, with many performing well, but some doing quite poorly. More attention now is required to identifying the degree of capacity required for competent consent to projects with varying risk/benefit characteristics. Practical means are also required for screening for subjects with impaired capacities, attempting to improve their performance, and providing substituted consent when their deficiencies are intractable.     

同意的涵义、性质及其类别

在伦理学视野下,最一般意义的同意是同意者基于自己的意志自由,以某种作为或不作为的形式,对被同意者提出的要求、建议或意见等给予肯定或否定的意思表示。除了一般的同意概念之外,还有次一级的概念如明示同意与默示同意、假设同意与推定同意以及拒绝同意、撤销同意和非同意等关联概念也应当引起人们的注意。次一级的同意概念,应当在理解一般意义的同意概念基础上依据其所在特殊情境予以具体理解。     

协商互动在大学英语课堂中运用的可行性研究

"协商"在SLA研究中指学习者与其对话者为克服交际障碍而做出的各种会话调整或修饰,它直接影响目的语输入和输出的质量。本文在回顾协商互动的理论依据和国内外研究现状的基础上,从协商互动对学习者二语习得的作用的角度,分析其在大学英语课堂中运用的可行性及其在大学英语课堂教学中的运作模式。     

法院直接变更指控罪名问题辩析

在法院能否变更指控罪名以及如何变更问题上,一些国家和地区存在着立法上的差别和理论上的分野,我国目前在程序设计上对法院的罪名变更权缺乏制约。文章通过举例子、作比较等方法,对法院能否直接变更指控罪名以及如何变更问题作了回答,并对如何构建法院变更指控罪名制度提出了构想。     

Ableism,ambiguity, and the Anna Stubblefield case*

This article discusses the ongoing case of Anna Stubblefield, a former Rutgers University philosophy professor who was convicted of the sexual assault of an African American man with cerebral palsy. On appeal, the conviction was reversed, and as of this submission Stubblefield is awaiting news from the state of New Jersey Supreme Court as to whether there will be a retrial. This piece engages with Sherry’s article in this journal, and dissects the many layers of ableism at play in this case, arguing that justice will not be served until the alleged victim gets to be heard.     

Baby K's unlawful removal: practice issues in the emergency protection of children

This paper addresses the legal and practice issues raised by a particular case in the UK. In January 2008, less than three hours after his birth, Baby K was removed from his mother's care by hospital staff and placed in a separate ward. At a High Court hearing later that morning, it was ruled that the removal of Baby K was unlawful. Important practice issues are raised by this ruling. After setting out the circumstances under which Baby K was removed from his mother, this paper considers a number of issues raised by the case: (i) what constitutes lawful removal under domestic law; (ii) European jurisprudence and domestic law in relation to emergency removal at birth; (iii) parental consent to removal; (iv) professionals' liability for breaches of human rights; and (v) the role of child protection plans in safeguarding children. Copyright © 2010 John Wiley & Sons, Ltd.