Can "presumed consent" justify the duty to treat infectious diseases? An analysis

<p>Abstract</p> <p>Background</p> <p>AIDS, SARS, and the recent epidemics of the avian-flu have all served to remind us the debate over the limits of the moral duty to care. It is important to first consider the question of whether or not the "duty to treat" might be subject to contextual constraints. The purpose of this study was to investigate the opinions and beliefs held by both physicians and dentists regarding the occupational risks of infectious diseases, and to analyze the argument that the notion of "presumed consent" on the part of professionals may be grounds for supporting the duty to treat.</p> <p>Methods</p> <p>For this cross-sectional survey, the study population was selected from among physicians and dentists in Ankara. All of the 373 participants were given a self-administered questionnaire.</p> <p>Results</p> <p>In total, 79.6% of the participants said that they either had some degree of knowledge about the risks when they chose their profession or that they learned of the risks later during their education and training. Of the participants, 5.2% said that they would not have chosen this profession if they had been informed of the risks. It was found that 57% of the participants believed that there is a standard level of risk, and 52% of the participants stated that certain diseases would exceed the level of acceptable risk unless specific protective measures were implemented.</p> <p>Conclusion</p> <p>If we use the presumed consent argument to establish the duty of the HCW to provide care, we are confronted with problems ranging over the difficulty of choosing a profession autonomously, the constant level of uncertainty present in the medical profession, the near-impossibility of being able to evaluate retrospectively whether every individual was informed, and the seemingly inescapable problem that this practice would legitimize, and perhaps even foster, discrimination against patients with certain diseases. Our findings suggest that another problem can be added to the list: one-fifth of the participants in this study either lacked adequate knowledge of the occupational risks when they chose the medical profession or were not sufficiently informed of these risks during their faculty education and training. Furthermore, in terms of the moral duty to provide care, it seems that most HCWs are more concerned about the availability of protective measures than about whether they had been informed of a particular risk beforehand. For all these reasons, the presumed consent argument is not persuasive enough, and cannot be used to justify the duty to provide care. It is therefore more useful to emphasize justifications other than presumed consent when defining the duty of HCWs to provide care, such as the social contract between society and the medical profession and the fact that HCWs have a greater ability to provide medical aid.</p

Chinese relationship management: a qualitative study of banking in New Zealand

This study investigates the relational factors and motivations of Chinese migrant consumers towards financial service providers in New Zealand. Using convergent interviews, a deeper understanding is developed of immigrants’ relational behaviour with service providers. These relationships with service providers are significantly influenced by traditional Chinese values and guanxi and relational embeddedness plays an important role in how they are developed. The research contributes a better understanding of the interplay between Eastern and Western cultures in service relationships among immigrant groups. A general theory of the Chinese perspective of customer relationship management is developed. The implications for how marketing practitioners manage their relationships with migrant customers are explored

BRIEF REPORT: Needlestick Injury and Inadequate Post-Exposure Practice in Medical Students

BACKGROUND: Medical students are at a particularly high risk for needlestick injury and its consequences because of their relative inexperience and lack of disability insurance. OBJECTIVE: To determine the risk of needlestick injury and the use of post-exposure prophylaxis among medical students. DESIGN: Internet-based survey. PARTICIPANTS: The 2003 graduating medical school class at the University of Toronto. MEASUREMENTS: Number of needlestick injuries, circumstances surrounding those incidents, and post-exposure actions. RESULTS: The response rate was 88% (157/178). Over one third (55/157) of respondents suffered at least 1 needlestick injury. In more than half the high-risk injuries, the students continued working and did not seek medical advice. Six students who suffered a needlestick injury began prophylactic human immunodeficiency virus medications. Of those students who suffered an injury, 15% had purchased disability insurance prior to the incident. CONCLUSIONS: Poor use of post-exposure procedures and a lack of disability insurance leave medical students at high risk for career and life-altering consequences from a needlestick injury