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3.2 Ethics and health care relationships

Activity 9: Acting ethically

0 hours 30 minutes

Write down a few sentences about what you think ‘acting ethically’ means.

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3.1 Introduction

This extract considers what it means to practise ethically; why ethics is so central to the health care relationship; and the responsibilities of practitioners, professional bodies, users and those making health care decisions for other people (for example, parents and carers of users who are unable to make their own decisions). This extract also explores the unique ethical issues raised by complementary and alternative medicine (CAM) and the extent to which ethical obligations and legal requ
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2.14 Extract 2 References

Armstrong, D. (1987) ‘Silence and truth in death and dying’, Social Science and Medicine, Vol. 24, No. 8, pp. 651–7.

Armstrong, D. (1993) ‘Public health spaces and the fabrication of identity’, Sociology, Vol. 27, No. 3, pp. 393–410.

Budd, S. and Sharma, U. (1994) The Healing Bond: The Patient-Practitioner Relationship and Therapeutic Responsibility, London, Routledge.

Busby, H. (1996) Alternative medicines/alternative knowledges: putting fle
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2.13 Conclusion

All therapeutic relationships can harm as well as heal. In orthodox medicine, the bulk of the responsibility is placed on the doctor, because healing is attributed to specific effects brought about through the doctor's diagnostic and technical expertise. In CAM relationships, where users are expected to exercise self-responsibility, it may be inappropriate to focus solely on the shortcomings of the therapist (even though the law is unlikely to recognise mutual responsibilities when therapy go
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2.12.1 Integration

One factor which is already influencing the nature of the therapeutic relationship is the move towards greater integration with orthodox medicine. Whether or not CAM practitioners welcome this development, it is inevitable. The impetus for this is partly about providing health care that gives patient satisfaction, and also stemming the tide of the spiralling costs of hi-tech, orthodox medicine and medical litigation. Stacey (1988) points out that, when the state funds parts of the nati
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2.9 The failure of CAM therapeutic relationships: creating dependency to satisfy practitioners' emot

Although a failed therapeutic relationship is often assumed to involve a patient not returning, the case of a patient who attends repeatedly can also be highly problematic. This phenomenon can be seen as a breach of boundaries in that an inappropriately extended therapeutic relationship changes from being a healing encounter into a dependency relationship or friendship. Unlike the timescale contracts that may be negotiated in counselling and psychotherapy, there are no fixed timescales for mo
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2.7 The failure of CAM therapeutic relationships: breach of boundaries

In this section, failures caused by breach of boundaries are discussed under the following headings:

  • ‘wounded healers’

  • creating dependency to satisfy practitioners’ emotional and financial needs

  • sexual abuse and exploitation.

To reiterate a point made earlier, breaches of the therapeutic relationship cover a spectrum. Some breaches invariably thwart a successful therapeutic outcome (for example, when
Author(s): The Open University

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2.4.3 How CAM therapists impose their views on users

As most people do not have a wide knowledge of complementary perspectives and philosophies, the therapeutic relationship can break down because of a mismatch between what the practitioner offers and what the user of the service wants. The practitioner's ideas about health, illness, mind and body may be at odds with the user's, which can lead the user to find another therapist who offers therapy that is more congruent with their beliefs.

The scholar Ursula Sharma argues that users of CAM
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2.4.2 Holism and ideas about the body

Reductionist medical approaches have been criticised for providing a fixed, mechanistic view of the body, which fails to capture the patient's experience. The power associated with biomedical diagnoses and expertise means that patients’ explanations for their illnesses are often overlooked or dismissed. Does holism, which seeks to treat the mind, body and spirit, fare any better in giving patients a sense of control or ownership of what their illness means? This question is often reframed i
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2.4.1 Reductionism and ‘ownership’ of the body

Social scientists interested in changing relationships between workers and users of health care often draw attention to what is termed the loss of ownership or loss of governance of the body. These terms mean that a person's body is treated in some health situations as more important than the person themselves. It is almost as if they are purely a case, an example of a type of disease, or a set of symptoms. Traditionally, such criticisms were levelled against biomedical approach
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2.4 Ownership, control and ideas about the body

This section focuses on the extent to which a person becomes invisible when a practitioner rigidly adheres to a specific view of health and disease, and fails to accept that others (specifically the person they are treating) may have different ideas about illness or, indeed, about their body. The imposition of a fixed view of illness and disease can be extremely disempowering for people seeking help.

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2.3.1 Patients and therapeutic responsibility

Activity 6: Therapeutic responsibility

0 hours 15 minutes

Based on your own experience, and using the evidence you have read about and heard, answer the following ques
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1.3 Components and origins of health beliefs

Health beliefs, like other personal beliefs, are learned. Knowledge about health and illness is built up from childhood onwards, from diverse sources including family, social networks, community and religion, and through ‘official’ government health messages. Individual health beliefs, while rarely ‘scientific’ in themselves, none the less are grounded in experience, modified over time in the light of that experience, and rational in the light of people's wider belief systems and worl
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1.6 Valuing diversity

Social workers need to recognise diversity: valuing and respecting service users – irrespective of, for example, their ethnicity, gender or age – is central to good practice. It is also about working in a way that counters the unfair or unequal treatment of individuals or groups on the basis of their race, gender, class, age, culture, religion, sexuality or ability. There is a growing body of law that seeks to prohibit and punish a range of discriminatory behaviours in various kinds of so
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The course treats: the discrete Fourier Transform (DFT), the Fast Fourier Transform (FFT), their application in OFDM and DSL; elements of estimation theory and their application in communications; linear prediction, parametric methods, the Yule-Walker equations, the Levinson algorithm, the Schur algorithm; detection and estimation filters; non-parametric estimation; selective filtering, application to beamforming.
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This course focuses on a systematic approach to the design of analog electronic circuits. The methodology presented in the course is based on the concepts of hierarchy, orthogonality and efficient modeling. It is applied to the design of negative-feedback amplifiers. It is shown that aspects such as ideal transfer; noise performance, distortion and bandwidth can be optimized independently. A systematic approach to biasing completes the discussion. Lectures are interactive and combined with weekl
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