Social science & medicine
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Social science & medicine · Jan 1983
ReviewSex differences in human mortality: the role of genetic factors.
This paper reviews evidence concerning genetic factors that influence sex differences in human mortality, with attention to the interactions between genetic and environmental factors. Some widely quoted earlier conclusions, for example, that males have consistently higher fetal mortality than females, are not supported by current evidence. For example, for late fetal mortality, males had higher rates than females in earlier historical data, but not in recent data for several advanced industrial countries. ⋯ For both violent deaths and ischemic heart disease it appears that any genetic contributions to sex differences in mortality are strongly reinforced by the cultural influences that foster more risky behavior in males, including more use of weapons, employment in hazardous occupations, heavy alcohol consumption and cigarette smoking. It appears that these cultural influences on sex differences in behavior are widespread cross-culturally in part because of the effects of inherent sex differences in reproductive functions on the cultural evolution of sex roles. These examples illustrate the complexity and importance of interactions between genetic and environmental factors in determining sex differences in human mortality.
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Social science & medicine · Jan 1983
ReviewInformed consent and patient decision making: two decades of research.
Patient consent to medical treatment has been a subject of concern within the United States professional communities for over two decades. This paper traces the development of research literature on patient decision making and informed consent to medical treatment in three fields of research: medicine, law and the social sciences. A general model for stages in the development of scientific specialties is applied as a test for the development of informed consent as a specialty interest in each research field. ⋯ Research in the social science disciplines tend to lag behind in terms of cumulative number of publications. In addition, social science research which is potentially relevant to the ethical and policy issues of consent in medical treatment appears to lack a clear programmatic thrust, with little attention given to the policy implications of the work. In contrast, the medical and legal literatures indicate a direct concern with social policy and reflect attempts on the part of physicians and lawyers to influence the policy making process.
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Social science & medicine · Jan 1983
Tips, status and sacrifice: gift giving in the doctor-patient relationship.
This study examines the gifts physicians receive from their patients. Internists in a hospital-based group practice kept diaries of gifts received and were interviewed about their responses and the reasons which they ascribed to the patient's gift-giving. ⋯ Patient gifts are found to be reciprocations for some action on the part of the physician, which the patient, in turn, perceives as a gift. Three categories of gifts, according to their nature and timing, are: (1) gifts as 'tips', given to promote personalized service, to assure the continued interest and the tolerance of the physician; (2) gifts to address the status imbalance in the doctor-patient relationship, either by imposing a non-professional identity on the physician or by redeeming status lost in the sick role; (3) gifts as a sacrifice to the physician who exercises his power on the patient's behalf.