No abstract

Personality and attitudinal variables were assessed prenatally and three months following the birth of the first child of 267 high-risk mothers. Four consistent factors emerged and, along with constructs rationally derived from sets of variables, were analyzed for discriminatory power. Level of Personal Integration yielded the strongest differentiation with respect to adequacy of maternal care, suggesting this as an area for exploration in interventions into mother-child disturbance.

It is time for the noon conference. Your job is to impart a career-changing experience in ethics to a group of students and interns gathered from four different schools with varying curriculums in ethics. They have just finished 1½ h of didactic sessions and lunch. One third of them were on call last night. Your first job is to keep them awake. The authors argue that this “tragic case” approach to ethics education is of limited value because it limits understanding of moral problems to dilemmas; negates the moral agency of the student; encourages solutions that are merely intellectual; and suggests that ethical encounters are a matter for experts. The authors propose an alternative that focuses on three issues: the provider-patient relationship, the relationships between providers in the everyday world of health work and, the social position of healthcare providers in society. In this approach, teachers are not experts but more like guides on a journey who help students to learn that much of ethical practice comprises living through difficult situations of caring for vulnerable others and who help students to navigate some of these difficulties.

This study examined parent and nurse perceptions of parent stressors in a pediatric intensive care unit using the Parental Stressor Scale: Pediatric Intensive Care Unit (PSS:PICU) and standardized interviews of parents. A total of 41 parents and 34 nurses participated. Nurses expected parents to be more stressed by every dimension of the PSS:PICU than parents rated their own stress. Parents felt most stressed by the dimension relating to their child's behavioral and emotional responses, although nurses expected parents to be most concerned about staff communication and parental role alteration issues. Implications for clinical practice are discussed.

"Moral hazard" is a term familiar in economics and business ethics that illuminates why rational parties sometimes choose decisions with bad moral outcomes without necessarily intending to behave selfishly or immorally. The term is not generally used in medical ethics. Decision makers such as parents and physicians generally do not use the concept or the word in evaluating ethical dilemmas. They may not even be aware of the precise nature of the moral hazard problem they are experiencing, beyond a general concern for the patient's seemingly excessive burden. This article brings the language and logic of moral hazard to pediatrics. The concept reminds us that decision makers in this context are often not the primary party affected by their decisions. It appraises the full scope of risk at issue when decision makers decide on behalf of others and leads us to separate, respect, and prioritize the interests of affected parties.