Social science & medicine
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Social science & medicine · Aug 1992
Review Case ReportsThe negotiation of death: clinical decision making at the end of life.
The ability of medical science to prolong biological life through the use of technology raises the question of how far physicians should go in treating the terminally ill patient. In clinical decision making involving the dying patient, physicians, patients and families bring various perceptions and interpretations to the situation. These different realities must be negotiated in order to define the meaning of the situation and the meaning of various medical technologies. ⋯ While ethicists view the withholding and withdrawing of life-supporting treatment as morally equivalent, physicians tend to make a distinction based on the perceived locus of moral responsibility for the patient's death. In the author's interpretation the moral responsibility for the patient's death by withdrawing treatment is shared with family members, while the moral responsibility for the patient's death by withholding treatment is displaced to the patient. The author suggests that an illusion of choice in medical decision making, as offered by the physician, begins a negotiation of meanings that allows a sharing of moral responsibility for medical failure and its eventual acceptance by patient, family and physician alike.
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Social science & medicine · Aug 1992
ReviewHealth care consequences of the European economic community in 1993 and beyond.
Generally, health services are not covered by the treaties of the European Community. However, to an increasing extent the EC has and will have an influence on national health systems. In particular the effects of regulations made for other sectors have repercussions for health. ⋯ This goes in particular for medical informatics, standardization, quality assurance systems and pharmaceuticals. Indirect effects of the single market will probably appear within the area of insurance, public purchasing and building and other types of construction works. Other areas that probably will be influenced are record security and occupational health benefits.
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Social science & medicine · Jun 1992
Planning health care in South Africa--is there a role for traditional healers?
Developing health policies for the 'post-apartheid' era has become an urgent task of the early 1990s in South Africa. A neglected policy issue thus far has been the question of whether traditional healers have a role to play in future health care, and if so what this should be. ⋯ Arguments for and against traditional healers in health care are presented, and alternatives which could be chosen are outlined. Options adopted by countries on South Africa's borders, Zimbabwe, Mozambique and Swaziland are briefly considered.
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Unfavorable economic conditions in most of Africa (in this paper Africa refers to Sub-Saharan Africa only) have meant public austerity and a deceleration in government health spending. Given the dominant role of government in providing health services in Africa there is a need to investigate the links between public spending and the provision of health care. Analyzing information from five Sub-Saharan African countries, namely Botswana, Burkina Faso, Cameroon, Ethiopia and Senegal, we investigate the impacts of shifting expenditure patterns and levels on the process of providing health services as well as on delivery of health care. ⋯ Given the input to public health care of local communities, as well as the provision of private health care, it would seem that government spending on health care should be counter-cyclical, i.e. government health spending should accelerate during periods of economic down turns. Such counter-cyclical spending would tend to offset the difficulties facing local communities and the declining ability of individuals to pay for private health care. Recommending counter-cyclical health spending may seem wishful, but it points up the necessity of understanding what is likely to happen to health care in African countries in the face of economic difficulties, and particularly in the face of fiscal austerity.
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A study of a random sample of adults dying in 1987 is compared with a similar study in 1969 examining peoples' experience of home nursing care during the last twelve months of life. Respondents were 639 relatives and others in the community who knew the circumstances of the people who had died and 92 community nurses (mostly district nurses) who provided care. Both nurses' and relatives' perceptions of the adequacy of care showed little change between the two time points, in spite of less frequent visiting. ⋯ Areas of tension in nurses' relationship with general practitioners were evident, particularly over the issue of late referral and control over the prescription of pain relieving drugs. Nurses' information needs at referral were also sometimes not met very fully. The stress involved in this type of work was substantial, and nurses expressed a strong desire to spend more time supporting families emotionally, which was often hampered by late referral, a problem that had increased significantly since 1969.