main index

P00: frame around

P01: olicognography

P02: addictions




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Ethics Management

Basic Olicognograph: Humane Criteria

Ethics has the meaning of a "relative permanency" of criteria (the medium term of moral values of the time) to take into account in any human management, adaptations introduce variations. With addictions there are the 1) Rights of the addict to be treated as a human being; 2) Have access and receive care by appropriate structures; 3) Social rights, which are in the duties of addict people also to receive protection and care from non-addict people, people and structures in charge, concerning thus the public protection; structures including their rights for assuming their social and public services, even when for the police and legal control control and management of illicit drugs mechanisms. Of course repressive structures and services have also their rights to act, protect and prevent. As in processes for making good complex hierarchy, rights and duties should be intertwined and appropriatedly articulated to give good balance to applications of moral and ethical criteria. Rightfull techniques should then be conceived as the best for controlling criminality, understand policies and ways for safe reductions of harm, cost-beneficial and cost efficient problem(s) management and delivery of Justice for all.

Health plan, which is a frame that can be adapted to any level from indvidual-addict treatment to institutions in charge; especially detailing the relations between levels, actors and structure. Due consideration is given for each of the following five domains: 1) Contractual scope—whether the contract provides any coverage for certain procedures and treatments, such as preventive and maintenance treatments that are not necessary to restore a patient to “normal functioning.” This dimension preempts any other coverage decision. 2) Standards of practice—whether the treatment (as judged by the health plan) accords with professional standards of practice. 3) Patient (or main subjects considered) safety and setting—whether the treatment will be delivered in the safest and least intrusive manner. Be this subject the patient him-herself, his-her family, the agency or public serve and the society 4) Medical or professional services—whether the treatment is considered medical as opposed to social or nonmedical. 5) Cost—whether the treatment is considered cost-effective by the insurer. Costs and economics considerations once; but this interest any sort of management involved, out any dogmatic, and too narrow sense of social interest is of the best kind of methods for smoothing, making possible, articulate relations, consider the present and the best that could be done, care the future and anticipate for controlling probable future waste of ressources.

If a referral is made by primary care givers and primary clinician for a substance abuse assessment or to a specialized treatment program, written permission of the patient is required before any information or records can be disclosed in which the patient’s identity is revealed, except in cases of medical emergency or reporting suspected child abuse to the proper authorities. Nonetheless, records containing information about substance use disorders, should always be handled with discretion. Legal ground of substitutive treatment, for example is for: 1) Attract addict soon in care network; 2) Obtain better retention by sanitary system; 3) Prevent somatic and psychosocial harm; 4) Lead to abstain of drug.

A history of childhood physical abuse is associated with psychological distress such as anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. Adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders. Women with histories of substance abuse, withholding access to basic needs, positive affiliations, and normal social roles does not reduce the propensity to relapse. In support to that treating people in stigmatizing and punitive manners may actually increase their propensity to continue with substance-abusing and illegal behaviors. The findings suggest the need to replace punitive policies (e.g., withholding financial assistance) toward women who have histories of substance abuse with policies that allow these women to assume roles of responsibility such as work, education, and parenting. Strategies that support individuals seeking to develop or resume pro-social lives have potential positive implications for both individuals and society. At a minimum, policymakers should consider other factors besides past substance abuse and criminal behaviors when making decisions about how to treat women with histories of substance abuse..

Legal frame pay special attention to: 1) kind of drugs so as to target efforts to more noxious risks; 2) kind of use where individual rights intertwins with abuse and disorders; 3) kind of management like prevention of cure (in a health or non health sense, at a patient or social level); 4) amounts of drugs managed making often the border between private and trade borders, tolerance and what is possible (as a probabilistic professional we would often sort of scalable formulas); 5) way of management (which often help the discrimination between intention: caring some flowerpots or the raw material for a clandestin lab could make a difference, but this difference can vary its meaning from region to region). Anything should define its characteristics: time, place, quantities, qualities, procedures special situations, special cases; according in effect the sort of legal system prevailing. Like for patients rights: medical secret ; professional secret; private life confidentiality ; positive exceptions; duty to public interest information; well informed consent; family rights; places of care protection licenses; specificity and sensibility of individual pathway; vulnerability care; targeted groups priority efficiency; treatment matching; patient progress mood driven; human needs approach; fairness (despite patient behaviors).

Overview, control and report, legal or organizational, professional or sanitary are elements parts of system of information, knowledge and communication thus a essential to any "system of truth". At the fringe of formality and normality, complications and illegality this is essential to consistency of public protection. For an exemple of system of central information agency: the Cochrane Collaboration is a structured organisation including: 50 Groups and subgroups of Collaboratives Review Groups, CRG): 10 Methods Groups, 11 Fields, 21 Cochrane Centres), one Cochrane Collaboration Steering Group, CCSG), one Consumer Network. Convergent issue is in 1) Central CCTR Group: 2) Cochrane Library Users' Group 3) Cochrane Manual Group 4) Colloquim policy Group 5) Critisism Management Group 6) Executive Group 7) Handbook Group; 8) Monitoring and Registration Group 9) Publishing Policy Group 10) Software Development Group all core function of the system. "System of truth" may not be free from manipulation of complex issues but is important in every stage: addicts will be harder to approach if all procedure, approach or services, whatever patients own critical situation, are not based on evident truth, clues and fairness and harder it will be to design efficient policies if since the beginning biased by prejudgment, confusion and fake strong effects of demagogy.

Any executive process, organization, disposal, policy should receive the benefit of assessment as on: 1) Format—that is, whether they are fully structured or semi-structured; 2) The particular targeted; individual, clinical, non clinical, social, family preventon or research objectives they can serve; 3) Reliability and validity for selected uses (see “Reliability and Validity”); 4) Convenience features, such as modularity and availability in computer-based formats; and 5) Training requirements. Briefly reliability question is: will users of the instrument consistently reach the same diagnostic conclusions ? Validity's question is: Does the instrument truly and unambiguously assess the condition it is designed to evaluate? This question has more dimensions than the estimation of reliability; accordingly, validity is estimated with a number of methods.

Our guiding frame for any social sustainable criteria is made of four: 1) Freedom (but somehow like the extent of tolerance one's receve from his/her society, caring the good social intention of his/her experiments). Adapt to addictions should be extended, not just by the "abuser" but also by his/her society, inclusive criteria, ethical, as well as moral, and feasible). 2) Unity, in the common shared social and complex sense, especially on the essential values that could make sustainable social unit (community, social group, whole national culture) while not affecting others actors rights to humanity); 3) Solidarity as in the practical means deployed in caring other criteria; 4) Diversity also as the practical means for caring other criteria and empowering operational groups for coping with complex realities or issues problems.

The nuance or shade of given rigorous frame often proceed from deriving another intermediate frame of confused terms and set more details in upper or lower levels of scale for smoother detail. Say for example sensible to addiction, could be the system of: 1) Empathy (taken like in a complex way); 2) Rigourness (taken like in a simplifying way of doing); 3) Tolerance (eventually there in a paradoxic way to let efficient arbitration care locally, what is too difficult to fix by the law; this like for allowing the application of harmreduction program as breaches in illicit consumption of drugs); 4) Consistancy (not being the purpose of empathy and tolerance to let the field to things that ethics and moral as a democratic "consensus of truth" have set the core social value "for the period". No idealism there: it can be more for best concrete results like in opiates substitution; controlled consumptions (only if good social integration, systematic relapse, no psychopathology), complete abstain otherwise..

Empathy is a concept central to psychiatry, psychotherapy and clinical psychology. The construct of empathy involves not only the affective experience of the other person's actual or inferred emotional state but also some minimal recognition and understanding of another's emotional state. 4 major functional components dynamically interact to produce the experience of empathy: 1) Affective sharing between the self and the other, based on the automatic perception-action coupling and resulting shared representations; 2) Self-awareness. Even when there is some temporary identification between the observer and its target, there is no confusion between self and other; 3) Mental flexibility to adopt the subjective perspective of the other. 4) Regulatory processes that modulate the subjective feelings associated with emotion.

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