Social science & medicine
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Social science & medicine · Jan 1996
Medical futility decisions and physicians' legal defensiveness: the impact of anticipated conflict on thresholds for end-of-life treatment.
Does legal defensiveness significantly influence physicians' assessments of medical futility, in ways that may adversely affect the rights of patients and their family members to make their own health care decisions at the end of life? This exploratory study addresses that question with attitudinal data from a survey of 301 physicians practicing in academic medical centers in Texas. The majority of respondents indicated that the probability of success defining futile treatment should hypothetically be lower for patients with potential to benefit more from life-sustaining medical intervention (e.g. typically patients who are sentient), and higher for patients with less potential to benefit (e.g. patients in a persistent vegetative state). That is to say, physicians normally perceive longer odds to be worth pursuing for greater potential gain - a position that seems logically consonant with patients' rational self-interest. ⋯ Rather, they tended to define futility in a manner that would maximize the physician's latitude to justifiably oppose patient preferences for end-of-life treatment abatement. These findings suggest that some physicians assume an adversarial position in their consideration of medical futility issues - an attitude that anticipates conflict with terminally-ill patients or their surrogates. The analysis presented here is not definitive, but at least raises the question of whether some physicians may inappropriately use their prerogative over medical futility as a means to guard their professional autonomy against perceived threats.
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Social science & medicine · Jan 1996
Prostitutes, prostitution and STD/HIV transmission in mainland China.
China's opening to the world has enabled massive social and economic transformations and the liberalization of many policies, but also the rise of coincident social problems and diseases. A revival of wide-scale female prostitution since the 1980s has now accelerated to a nationwide dilemma. Prostitutes have long been considered to be reservoirs, if not 'vectors' for the transmission of sexual diseases. ⋯ However, given the type of clients serviced by prostitutes in China, a prostitute's own risk of HIV infection is discussed. Control measures by the Chinese government to curb prostitution are examined at both national and provincial levels. Questions are raised as to the effectiveness of present tactics as adjunctive strategies in reducing STD infection and HIV risk in the prostitution population.