Confidential Relationship Research Articles

ACOG Committee Statement No. 13: Self-Managed Abortion.

Self-managed abortion (SMA) refers to actions people take to end a pregnancy outside the formal health care system. There are a variety of reasons people choose to self-manage their abortions, and these reasons may vary based on regional contexts. For some people, medically delivered abortion care is no longer, or has never been, available in their community. Available options might be inaccessible or unacceptable, or the person might have a preference for self-managed care as a primary choice. The majority of SMAs are completed safely with misoprostol, either alone or with mifepristone. Rare medical complications should be managed as they would be in any case of spontaneous pregnancy loss. For many people, the greatest risk of harm related to SMA comes from the threat of criminalization. Many U.S. states have at least one law in place that could be misused to prosecute people attempting or assisting with SMA. Criminalization makes people less safe and harms the confidential patient-practitioner relationship. Obstetrician-gynecologists and other health care professionals should provide all people with compassionate, nonjudgmental medical care, including those presenting before, during, or after self-managing an abortion.

The Buddy Program: High school students inform the design of a school-based peer support program for concussion

ABSTRACT Prior research provides little guidance on how to support return to school post-concussion. Peer support may be one strategy to enable adolescents to return to school post-concussion. The purpose of this study was to explore what high school students preferred in a school-based peer support program post-concussion. We conducted a qualitative instrumental case study in one high school in Calgary, Canada. Seven semi-structured focus groups were conducted with 53 high school students (16 boys, 36 girls, 1 preferring not to disclose gender; median age = 16 years, range = 15-18 years). All adolescents were enrolled in a sport medicine course and had either a history of concussion (n = 20) or were interested in supporting peers who had sustained a concussion (n = 33). Focus group questions aimed to solicit which factors the adolescents believed should be considered in the development of a post-concussion peer support program. We analyzed the focus group transcriptions using content analysis. Adolescents preferred a one-on-one Buddy Program. A one-on-one environment would provide a trusting and confidential relationship between the student with a concussion and their buddy. Peer support could include social support, advocacy support for academic accommodations, tutoring support, and concussion education. In future, the Buddy Program should be piloted in high schools.

Bringing a justice lens to ocean access

Maritime spaces have transformed rapidly the last decades. Open waters and beaches have become restricted and sometimes privatized enclosures. Different forms of extractivism have led to biodiversity loss and in particular to declining fish populations. Additionally, large-scale coastal and marine infrastructure projects, such as deepening and widening of shipping channels, have destroyed important habitats. These profound socio-ecological transformations have had an impact on geographies of resource access and control and consequently on the ability of actors to access, use and benefit from coastal and marine space. Moreover, changes in the lending policies of local banks have posed additional and severe challenges for fishers’ ability to fish. Such processes effect in particular the livelihoods of coastal and small-scale fisher communities and consequently increase existing inequalities and injustices. We suggest to bring the literature on ocean justice and access and property into dialogue and develop a heuristic for analysing inequalities and justice claims. Based on qualitative case studies focussing on the Sicily (Italy), the Elbe estuary (Germany) and the Lofoten (Norway), we show that investigating access relations facilitates the identification of unequal societal relationships with nature. Our cases illustrate that power relations in which privatization processes and access relations are embedded, determine whether injustices can be translated into justice claims and how successful these claims are. Moreover, unequal socio-ecological relations are also influenced by what we call translocal justice. Translocal justice is often lost in processes of commodification, privatization and in the rescaling of political authority and power, as local ties and confidential relationships vanish.

Towards Theology of Parenthood: Mother Mary as the Role Model for Sensitive and Secure Christian Parenting

Mother Mary’s intimate and confidential relationship with God has inspired Christians around the world for the last two millennia. Her role in salvation history has already been discussed in detail in various church documents and scholarly literature. However, from an interdisciplinary point of view, her maternal role has not yet been fully evaluated from a psychological and child-rearing perspective. Therefore, in this article, we conduct a psychological analysis of the Gospel passages that talk about her maternal role and we evaluate these passages through the prism of the well-established attachment theory. Despite temporal and cultural differences, Mary’s maternal attitude is found to be highly consistent with the key findings in research on quality parenting and interpersonal relationships. As we show, her “maternal genius” is revealed through the following fundamental characteristics of attachment-focused parenting: unconditional acceptance, sensitive guidance, compassionate accompaniment and continuous emotional regulation. These characteristics of Mary’s motherhood come to the fore especially in the key moments of salvation history. The psychological analysis of Mary’s motherhood brings an important contribution to the “aggiornamento” of Mariology and enables some new opportunities for pastoral theology. With new scientifically supported insights, the Church will be better equipped to help parents to discover the beauty and depth of the mission of parenthood, following Mary’s example. The findings of our research therefore also represent an important foundation for the emerging theology of parenthood.

Equity's System of Open-Ended Wrongs and Limited Remedies

It is well-known that equity gives courts considerable discretion to override the normal operation of legal rules to prevent an injustice in a particular case. This Article shows equity combined this discretion with limited remedies (rescission, restitution, reformation, and estoppel), and that these limited remedies strike a balance between the value of doing justice in a particular case and the cost of destabilizing the law in a way that places a heavy thumb on the scale favoring stability over justice. Henry Smith has described equity as a “second-order safety valve.” Equity’s limited remedies make it a weak “second-order safety valve.” This Article also examines what became of this system in the United States after the merger of law and equity. The most interesting developments involve the doctrines of constructive fraud and abuse of a confidential relationship, which are treated as torts with compensatory and punitive damages. This has had a small effect because of two developments. Courts reject most claims seeking compensatory damages by imposing categorical restrictions on the doctrines, while courts ignore these restrictions when a plaintiff seeks an equitable remedy. Thus, courts generally continue to do equity much as it has always been done in cases that would be covered by these doctrines, albeit in an ad hoc and confusing way

Intimate relationships and hypnosis: insecure adult attachment affects emotions and absorption during hypnosis.

Hypnosis research indicates that subjects are not equally hypnotizable. Most studies on hypnotizability focused on the relationships with personality or cognitive variables. At the same time, only a few proposed the contribution of the attachment style, defined as the result of the childhood relationship with the caregivers and influencing the adult relations. In the present investigation, two studies were carried out to test the possible association between adult attachment and hypnotic responsivity. The adult attachment was assessed using the Experiences in Close Relationships-Revised (ECR-R) questionnaire, while hypnosis was assessed through the Harvard Group Scale of Hypnotic Susceptibility (HGSHS:A; Study 1) and the Phenomenology of Consciousness Inventory: Hypnotic Assessment Procedure (PCI-HAP; Study 2) in order to adopt a behavioral and a phenomenological approach, respectively. Analyses showed that attachment factors (anxiety and avoidance) were not associated with the level of hypnotizability, whereas it was associated with variations of consciousness during hypnosis, mainly internal dialogue, absorption and negative emotions. Overall, the insecure attachment styles yielded increased mind wandering and restlessness during hypnosis when compared to the secure style. The reason probably lies in the feeling of anxiety or danger of insecurely attached individuals when involved in intimate or confidential relationships. These findings clarify a still poorly investigated aspect concerning the influence of attachment style on hypnotic experience and further highlight the need to consider inter-individual differences and the phenomenological perspective when assessing hypnosis and hypnotizability.

도심융합특구제도 추진동향과 토지공법적 과제

Inner city areas have been served as central places for business, commercial and cultural activities for a long time in the major cities. Recently, inner city areas receive great public attention as an innovative space for attracting young people throughout new jobs and restructuring urban functions. Based on these circumstances, Korean government announced the establishment plan for Urban Innovation District System in the inner cities last September of 2020 in order to secure local base for the regional innovation system. The main purpose of the establishment of Urban Innovation District System in the inner cities is providing base space for innovative activities using the network system between entrepreneurial activity, research activities, cultural activities and daily activities in terms of time and physical connection. To cope with this purpose government and lawmakers are pushing for the legislation of Special Act for Urban Innovation District Systems in the inner cities. Previous researches about the successful innovation districts in abroad indicates that excellent accessibility is the key factor of the districts. That is, excellent accessibility enables liberal contact and meeting between the companies and research centers including administrative agents. And these activities establish the confidential relationship between the innovative partners and this relationship can cause the proliferation of knowledge exchanges and strengthen the role of the districts to lead regional development. But Daeduk Special Research and Development Zone considered as a precedence case of the Urban Innovation District Systems in the inner cities is reviewed as a case of failure despite of the enough research outcomes. One of the reasons why the Daeduk Special Research and Development Zone considered as a case of failure is that the Special Research and Development Zone has no certain connection with the surrounding areas in terms of geographical, spatial, social context. Based on these findings this study suggests that in order to accomplish the purpose of the establishment of Urban Innovation District System in the inner cities both of the institutional arrangements and changeover efforts to minimize shortcomings and maximize strength the system are essential. For this reason, the Inner City Special District Act pending at the National Assembly needs to modify to secure enough leadership and financial resources align with the local characteristics and industrial conditions of the region.

Misconceptions and beliefs around hormone replacement therapy after childhood hematopoietic stem cell transplantation: A qualitative study among women leukemia survivors.

After childhood leukemia and hematopoietic stem cell transplantation, hormone replacement therapy is often required to induce puberty because of premature ovarian insufficiency. Observance of this kind of treatment in adolescents and young women seems quite poor, and literature about its acceptance remains scarce; in order to learn about their experience and to better understand their attitude towards hormone replacement therapy, we used qualitative methods. 13 young women childhood cancer survivors completed an individual interview. We report that the negative experience of leukemia may cause rejection of the treatment, closely related to infertility unacceptance. Misconceptions and lack of adequate information of hormonal treatment effects are also major barriers to a good compliance. Observance of hormone replacement therapy for young women childhood cancer survivors can be improved with a confidential patient-physician relationship, patient education, choice of galenic formulation according to personal preference, and psychological support during the long-time follow up.

What’s Hidden Under the Gastric Intestinal Metaplasia? Diffuse-Type Adenocarcinoma Discovered by Targeted Biopsies: A Case-Report

Gastric corpus atrophy and intestinal metaplasia are two well established gastric precancerous conditions and scientific evidence shows a confidential relationship between this precancerous condition and intestinal type gastric cancer, according to Lauren classification. Differently, the background histological gastric mucosa characteristics from whom diffuse type gastric cancer may arise, need to be clarified. In this case, report we present a case of an 81-year-old female with corpus atrophic gastritis in whom we arrived at the diagnosis of diffuse type gastric cancer by following specific guidelines related to the characterization and the endoscopic-histological surveillance of gastric precancerous conditions.

Ethical aspects of psychological work in Ukraine: past, present, and future

ABSTRACT This article presents an attempt to analyze the specifics of ethical norms in the work of psychologists in Ukraine, with an analysis of historical preconditions, current challenges and cultural characteristics. Ukraine, as a modern developing country striving for integration into the European space, is intensively developing psychology and trying to overcome the problems that it has today. Having well-trained psychologists, psychology in Ukraine has many vulnerabilities, such as the lack of legislation in this field and licensing. Professional communities, by virtue of their competencies, strengthen psychology in Ukraine through an attempt to implement ethical standards and highlight problematic topics. The article contains a review of Ukrainian psychologists’ understandings of confidentiality, informed consent and multiple relationships. This paper is an analysis and attempt to explain to the reader potential areas of growth and the unique cultural formations that we have in our practical work today. This exploration includes factors such as the features of importance in the relationship between a psychologist and a client in the Ukrainian context, and the historical, social, economic, cultural, and political factors that influence the perception of ethical standards among Ukrainian psychologists.

Ethical codes in the Arab region: comparisons and differences

ABSTRACT Within the professional practice of psychology the code of ethics characterizes what is morally right or wrong, by means of a set of principles, values, and standards of conduct. While there are numerous international mental health organizations that incorporate ethical guidelines such as the APA and EFPA; these codes still fall short in providing guidelines for psychologists working in non-western cultures, especially when there are no universally adopted and valid cross-cultural ethics codes. This paper explores various challenges psychologists in the Arab region face when using a western code which does not reflect the values and traditions of their culture. A comparison of several ethical codes from different Arab countries is presented, with a focus on challenging areas of interest such as confidentiality, informed consent and multiple relationships.

DEFENSIVE MEDICINE AND MEDICAL MALPRACTICES IN INDIA: AN ECONOMIC ANALYSIS

Medical science claims to have developed several ways of controlling health risks, increasing safety standards and protocols related to medical practices and procedures but it cannot claim that it has eliminated all other kinds of risks associated with it. The recent spurt in the litigation against medical professionals for medical negligence and the claim for redressal or compensation has shaken the confidentiality and patient-doctor relationship to a new high level. The increasing cost of medical malpractice litigation has increased the practice of defensive medicine. It is a medical practice that can be said as an act of economic security against potential allegations of negligence. The present study on economic analysis of medical malpractices and practice of defensive medicine focuses on a pre-existing market relationship between medical negligence and the resultant defensive practices adversely affecting many aspects of human life. The present research is divided into five sections. The first section deals with the nature of the existing market and the economic analysis of the relationship between medical negligence liability and its potential impact on the practice of defensive medicine. The aforesaid market relationship is much more pronounced in the western countries. It is based on the understanding of cost of litigation, the expectation of liability in excess to actual damages and the benefits accruing out of practicing defensive medicine in response to the above situation. However, in the context of India the relationship is not that simple. Particularly, when medical malpractice litigations are not very common practice by the victims and the so-called existing healthcare industry is already running at kickbacks for referring patients, inflating bills and thereby promoting defensive medical practices. In order to promote efficient transactions, exchanges and economic efficiency in the above market, role of legal means cannot be denied. The second part of the study examines the role of the insurance industry in dealing with medical claims. In an inefficient insurance market, insured medical claims remain low and out-of-pocket medical expenditure remains very high. This unethical socio-economic malpractice is economically inefficient and thereby inducing loss of socio-economic welfare of the people. The third section delves upon the unintended socio-economic impacts of the medical malpractices and defensive practice. Particularly in a welfare state like India, it neither results in an activity reinforcing excellence in the medical profession nor helps in achieving the constitutional mandate of ‘Right to Health’. An individual’s sense of wellbeing is incomplete in the absence of his physical as well as mental wellbeing and both of them are responsible for country’s economic and social development. The fourth part examines the relationship of law with defensive medicine. The role of law in regulating the market and thereby reducing healthcare costs is very important. Although it is very difficult to have correct estimates of medical liability costs and various components of it, the growing concerns related to increasing practice of defensive medicine has to be adequately addressed by law. The fifth and the last section discusses the conclusions and recommendations. Today, when the entire world is going through a phase of health crisis, the concerted effort of citizens and government becomes indispensable. In a country like India accessibility and affordability of medical facilities and insurance has to be ensured. With the continuous increase in health care costs the very objective of fair distribution of available healthcare facilities has become a difficult and unachievable task. In order to deal with the above complex and perplexing problem we need greater involvement of economics, law and suitable public policies. India’s fragmented health infrastructure may result in economic inefficiency, reduction in social and economic welfare, wastage of scarce medical resources and high-cost treatment.

Children and Young People’s Participation in decision-making in Foster Care

Children’s participation in decisions about their lives is a crucial point of the UN Convention on the Rights of the Child, which is the basis of child welfare and protection worldwide. Despite these clear guidelines, there is evidence that children’s voices may be heard but often with little impact on the decisions made by professionals in the childcare system. This study seeks to ascertain whether the voice of children living in foster care is considered and respected when making decisions that concern them, whether the children effectively exercise it, and what factors impact their participation. A systematic scoping review was performed to clarify concepts and unveil research gaps, using eleven scientific databases and publishers that allowed us to identify twelve recent studies in critical journals. In the light of the Bouma et al., (2018) model, the findings showed that there is, in general, a lack of effective children’s participation, namely in terms of information, listening, and involvement. Children’s voices still have a minimum impact on the decisions made in the childcare system. It will be necessary to avoid the bureaucratic assumption that there is an age cut-off point to promote participation. More, it is stressed the importance of a trusting, sincere and confidential relationship between the child and the social worker and the need to ensure training for professionals who intervene in review/statutory meetings or judicial proceedings, namely in the court of law.

Ethical standards for psychological practice in the UAE: current status and aspirations

ABSTRACT There is a growing body of global research demonstrating the significance of mental health to individuals’ overall happiness and productivity. The research evidence has encouraged governmental agencies in the United Arab Emirates (UAE) to divert more attention toward the provision and development of mental health services. As the sector grows, one of the first issues of concern is the adherence to a unified set of ethics of practice. The purpose of this paper is to present and discuss the existing ethical codes of conduct relevant to the mental health profession in the unique context of the UAE. Specifically, this discussion will focus on the interaction of cultural factors with the ethical standards of confidentiality, informed consent, and multiple relationships. This paper provides an initial reference for researchers and practitioners to explore regional issues of ethical standards in mental health services.

Tajemnica adwokacka w polskim procesie karnym – w kierunku attorney-client privilege?

The article refers to the issue of attorney-client privilege in Polish criminal proceedings. The author critically evaluates the current solution based on the dichotomy of defence secret and advocacy secret, pointing to basic normative and axiological problems connected with weakening of confidential attorney-client relationship based on mutual trust. In the following part, he refers to the attorney-client privilege, which is, in his opinion, much more guaranteeing having in particular in mind the special relationship between the advocate and the client. The whole argument ends with conclusions in which the author points out the disproportionate nature of the existing solutions regarding the possibility of waiving attorney-client privilege and questioning an advocate as a witness.

Mental capacity including testamentary capacity.

Mental capacity including testamentary capacity.

Some evidences and applications of the randomized response crossed model in a survey of sensitive population behaviors

Surveying human behaviors, especially in demographic, social, medical and public health research, often involves sensitive issues. Posing direct inquiries about stigmatizing or threatening topics may lead survey participants to refuse to answer or to give untruthful responses. Nonresponse and misreporting denote measurement errors that are difficult to treat and are likely to yield unreliable analyses of the surveyed topics. This problem can be mitigated by adopting survey methods that enhance anonymity and respondent cooperation. One possibility is to create a trustful and confidential relationship between the interviewer and the survey participants. Alternatively, it is possible to fully protect privacy by adopting indirect questioning procedures that elicit information without posing sensitive questions directly. We consider both above-mentioned possibilities showing the results of a real study which explores the effectiveness of the randomized response crossed model proposed by Lee et al. (2013) to produce prevalence estimates for two sensitive traits, cannabis use and its legalization.

Facilitating Care of Children with Juvenile Idiopathic Arthritis, Orofacial Pain, and Dysfunction: An Interview Study of Specialized Health Professionals.

(1) To deepen knowledge on how specialized health care professionals (HCPs) reflect on encounters with children diagnosed with juvenile idiopathic arthritis (JIA) and (2) to outline a theory for orofacial care. Grounded theory was used to discover the psychosocial processes involved in communication between HCPs, children, and parents, and this information was used to develop a theory about these processes. Using classic grounded theory, a total of 20 interviews with HCPs were analyzed. One main concern, "secure health and biopsychosocial development," permeated all care. A core category was identified as "create a responsive interaction with the child and family." The data that supported this core category helped to explain how the HCP responded to a patient to promote orofacial health. Based on the dentist's responses to the child, eight subcategories were identified: (1) secure confidential relationships; (2) convey disease-specific knowledge; (3) communicate healthy findings and form mutual insights at examination; (4) encourage health-promoting behaviors; (5) ensure follow-up; (6) share perspectives; (7) guide parenting; and (8) improve knowledge and networks. How the dentist shall best understand the needs of a child diagnosed with JIA requires further evaluation. To promote oral health, the child must feel safe, confirmed, and supported with knowledge. Also, further studies are needed on the dentist's collaboration with the pediatrician and the physiotherapist for contributing to overall health.

HUNG OUT TO DRY? ATTORNEY-CLIENT CONFIDENTIALITY AND THE REPORTING DUTIES IMPOSED BY THE FINANCIAL INTELLIGENCE CENTRE ACT 38 OF 2001

According to the South African Law Reform Commission, money laundering is the manipulation of illegally acquired wealth in order to obscure its true source or nature. This is achieved by performing a series of transactions with the proceeds of criminal activities that, if successful, will leave the illegally derived proceeds appearing as a product of legitimate transactions or investments. Professional money laundering assists and strengthens organised crime and may contribute to the undermining of the civil society and the financial system of a country. Attorneys as professionals are no doubt in a precarious position. On the one hand there is the duty to keep in confidence private information pertaining to clients’ affairs which is no doubt essential to the attorney-client relationship and on the other hand there is the duty to the community to uphold the ethics of the profession. Attorneys may find that they are caught between these seemingly conflicting duties and the question is which duty is more important. This article weighs the newly-imposed duties on the legal profession pertaining to money laundering against the equally important principle of attorney-client privilege and asks whether it is possible to reconcile anti-money laundering obligations with legal professional privilege. The article considers the latter duty in light of the ethics of the legal profession in South Africa and the foundation of legal professional conduct. In addition, the position in the United Kingdom and in Canada is also considered. Against this background it is argued that there is no need to regulate the South African professional legal industry any further. Until FICA’s reporting provisions are formally challenged in the Constitutional Court, attorneys will continue to remain uncertain as totheir position, notwithstanding the fact that guidance notes have been issued to aid attorneys in this regard. In order to comply with FICA and simultaneously preserve the attorney-client relationship, attorneys need to educate clients on the provisions of FICA. Furthermore, legal practitioners should have a sound legal knowledge of FICA in order help the State combat organised crime and laundering activities. Finally, it is advisable to keep up to date with the latest guidelines which regarding the independence of the profession; possible infringements of the fundamental right to privacy and potential threats to the confidential attorney-client relationship. It is the awareness of this precarious balance that will ensure compliance with the FICA without causing the attorneys’ profession to lose its credibility.

Person-centred communication with cancer survivors: Exploring the meaning of follow-up coaching conversations.

The aim of this study was to explore the meaning of a coaching intervention for cancer survivors. Cancer survivors often experience existential concerns and worries after adjuvant treatment. A number of "care transition interventions" have been developed to improve person-centred care by empowering patients. Several of these interventions include a "care transition coach". A coaching approach to communication used in health care communication have among others shown to assists in establishing confidential relationships between health professionals, increase the patient's well-being and support the patient's experience of being met and viewed as a whole person. This is a qualitative study using semi-structured interviews to explore the meaning of a coaching intervention. In analyzing and interpreting the qualitative interviews Ricoeur's theory of interpretation was applied. The intervention consisted of two parts: (1) a two-day training program in coaching for nurses and (2) a specially developed communication intervention for cancer survivors. The analysis of the transcribed interview material led to the development of two themes: (1) Support in moving forward in life, and (2) An opportunity to talk about existential thoughts and worries. Our results show how the experience of cancer, even when cured, leaves the survivors with profound existential worries. The cancer survivors described how coaching conversations allowed them to express their current concerns and provided them with an opportunity to discuss wider issues than treatment, symptoms, and after-effects, which had been the main focus during treatment. The time immediately after the end of adjuvant treatment can be challenging, with many existential concerns and opposing emotions. We found that the follow-up coaching conversations performed helped the cancer survivors to process many of these difficult thoughts and feelings.