The rising popularity of unprotected anal sex (bareback sex) among men who have sex with men (MSM) is perplexing healthcare providers working in sexual health clinics. Epidemiological research on the topic overlooks several socio-cultural and psychological dimensions. Our research attempts to construct an appropriate theoretical edifice by which we can understand this sexual practice. In order to achieve this objective, a qualitative design was selected and 18 semiconductive in-depth interviews were carried out with barebackers from five European and North American cities. We then analyzed the data using two theoretical approaches that were sensitive to the issues of desire, transgression and pleasure. These theories are those of the late French psychoanalyst, Jacques Lacan, and those of poststructural thinkers, Gilles Deleuze and Felix Guattari. These theoretical frameworks helped shed light on the significance of bareback sex, and can potentially influence healthcare providers in gaining a better understanding not only of their clients, but also of their own role in the circuitry of desire at work within bareback. We found that while the exchange of semen constitutes a dangerous and irrational practice to healthcare professionals, it is nevertheless a significant variable in the sexual lives of barebackers that needs to be taken into consideration in the provision of healthcare services.
A conflict of interest occurs in a situation in which professional judgement regarding a primary interest, such as research, education or patient care, may be unduly influenced by a secondary interest, such as financial gain or personal prestige. Conflicts of interest exist in every walk of life, including medicine and science. There is nothing inherently unethical in finding oneself in a conflict of interest. Rather, the key questions are whether one recognizes the conflict and how one deals with it. Strategies include disclosing the conflict, establishing a system of review and authorization, and prohibiting the activities that lead to the conflict.
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Canada's Royal Commission on New Reproductive Technologies rejects all forms of surrogacy arrangement under the rubric of objecting to commercial surrogacy. Noncommercial surrogacy arrangements, however, can be defended against the commission's objections. They can be viewed as cases of giving a benefit or service to another in a way that expresses benevolence, and establishes a relationship between surrogates and prospective 'social' parents that allows mutual understanding and reciprocal personal interaction between them.
The British Columbian Members of the Canadian Guidance and Counselling Association were surveyed to explore their attitudes regarding dual relationships. Of 529 deliverable surveys, 206 usable returns yielded a response rate of 39%. The survey instrument collected data regarding respondents' characteristics and ethicality ratings of 39 dual relationship activity items. An exploratory principal components analysis was performed on responses, resulting in a 4-factor equation, which accounted for 44% of the total variance. The results suggest that, although conceptual considerations of dual relationship typology do underlay the resultant factors, the relative ethicality of each item is also influential.
There has been little research that has addressed the practices of nurses who go beyond the usual scope of practice to demonstrate caring. In this study, a grounded theory methodology was used to interview 18 nurses identified as exceptional caring nurses. The core process identified was giving and involved gifts (particularly of time), responsibility and choice, teaching, vulnerability, preserving dignity, caring with and for coworkers, being truly present, and always finding a way. Although the findings of this study are not necessarily generalizable, it is important to acknowledge that these practices occur and that they should not automatically be discredited. The research has implications for the new emerging field of boundaries in professional relationships.
To determine the attitudes, knowledge and practices of family medicine residents relating to the pharmaceutical industry and to assess the effectiveness of existing guidelines on appropriate interactions with the pharmaceutical industry.
Survey by mailed questionnaire.
All 262 second-year family medicine residents in Ontario (seven centres); 226 (86.3%) responded.
Fifty-two (23.0%) of the residents who responded stated that they had read the CMA policy statement on appropriate interactions between physicians and the pharmaceutical industry. A total of 124 (54.9%) stated that they would attend a private dinner paid for by a pharmaceutical representative; the proportion was not significantly reduced among those who had read the CMA guidelines, which prohibit the acceptance of personal gifts. In all, 186 (82.3%) reported that they would like the opportunity to interact with pharmaceutical representatives in an educational setting, even though several programs now discourage these interactions. Approximately three quarters (172/226 [76.1%]) of the residents indicated that they plan to see pharmaceutical representatives in their future practice. Residents at Centre 2 were significantly more critical of the pharmaceutical industry than those from the other centres. Overall, being aware of, and familiar with, departmental policy or CMA policy on interactions with the pharmaceutical industry did not affect the residents' attitudes or intended future practices.
The presence of guidelines concerning physicians' interactions with the pharmaceutical industry does not appear to have a significant impact on family medicine residents in Ontario.
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