Professional Jurisdictions and Intraprofessional Identity Dynamics: Doctors of Osteopathic Medicine and the Doctors of General Medicine

Professional jurisdictional boundaries change throughout time due to a myriad of factors such as scientific advances, social changes, or governmental requirements. Research on the negotiation of these jurisdictional changes has primarily focused on the relational dynamics between professions that affect these boundaries. We examine two physician groups that considered jurisdictional changes which were initially antithetical to their core professional identity. The DOs grappled with whether or not to incorporate drug therapy into their practice, and generalist MDs had to decide whether or not to become a specialty. We find that jurisdictional negotiations also occur within a profession, not just between them. We argue that for a profession to pursue a change in scope, members must settle on an interpretation of their professional identity congruent with the potential jurisdictional change.

Boundary work: the Mensendieck system and physiotherapy education in Norway

The history of physiotherapy can be seen as a history of boundary conflict, as the profession sought to first establish, then maintain, its distinctive professional identity. Traditional approaches to the sociology of the professions support this, seeing professionalization as an ongoing process of enclosure, encroachment, and conflict. Recent work, however, has emphasized the fluidity and collaborative nature of professionalization projects, and placed more emphasis on inter-professional negotiations and disciplinary coexistence. In this paper, we draw on this work to analyze the harmonization of the independent Mensendieck System of medical gymnastics in Norway, and the emerging state-sponsored physiotherapy system. Our contention is that over the course of the middle decades of the 20th century, advocates of the Mensendieck System and providers of orthodox, biomedically informed physiotherapy, came together and found a way to work collaboratively in a shared space without compromising their distinctive professional identities. We argue that this approach both points to ways we might revisit traditional conflict-based analyses of the history of physiotherapy, while also suggesting new ways of imagining how the profession might change in the years to come.

Brain Death and Pregnancy: On the Legalities of Post-mortem Gestation

This column examines a 2020 decision of the Supreme Court of the Australian Capital Territory, Millard v Australian Capital Territory [2020] ACTSC 138, which dealt with a dispute concerning a brain dead pregnant woman and whether treatment to sustain her body should have been continued to save the life of her fetus. The column compares the case to other cases from overseas jurisdictions to examine the question of whether there is any jurisdiction which would authorise the continuation of care in such circumstances.

Deaths Associated With Hepatitis C Virus Infection Among Residents in 50 States and the District of Columbia, 2016-2017

BACKGROUND

Mortality associated with hepatitis C virus (HCV) has been well-documented nationally, but an examination across regions and jurisdictions may inform health-care planning.

METHODS

To document HCV-associated deaths sub-nationally, we calculated age-adjusted, HCV-associated death rates and compared death rate ratios (DRRs) for 10 US regions, 50 states, and Washington, D.C., using the national rate and described rate changes between 2016 and 2017 to determine variability. We examined the mean age at HCV-associated death, and rates and proportions by sex, race/ethnicity, and birth year.

RESULTS

In 2017, there were 17 253 HCV-associated deaths, representing 4.13 (95% confidence interval [CI], 4.07-4.20) deaths/100 000 standard population, in a significant, 6.56% rate decline from 4.42 in 2016. Age-adjusted death rates significantly surpassed the US rate for the following jurisdictions: Oklahoma; Washington, D.C.; Oregon; New Mexico; Louisiana; Texas; Colorado; California; Kentucky; Tennessee; Arizona; and Washington (DRRs, 2.87, 2.77, 2.24, 1.62, 1.57, 1.46, 1.36, 1.35, 1.35, 1.35, 1.32, and 1.32, respectively; P < .05). Death rates ranged from a low of 1.60 (95% CI, 1.07-2.29) in Maine to a high of 11.84 (95% CI, 10.82-12.85) in Oklahoma. Death rates were highest among non-Hispanic (non-H) American Indians/Alaska Natives and non-H Blacks, both nationally and regionally. The mean age at death was 61.4 years (range, 56.6 years in West Virginia to 64.1 years in Washington, D.C.), and 78.6% of those who died were born during 1945-1965.

CONCLUSIONS

In 2016-2017, the national HCV-associated mortality declined but rates remained high in the Western and Southern regions and Washington, D.C., and among non-H American Indians/Alaska Natives, non-H Blacks, and Baby Boomers. These data can inform local prevention and control programs to reduce the HCV mortality burden.

Jurisdiction of the Medical Ethics Committees

Ethical principles of assessing medical research are to the greatest extent defined by the Nuremberg Code, the Declarations of Geneva and Helsinki, and the Oviedo Convention. Pursuant to their directives various national Medical Ethics Committees (MECs) were established which assess the ethics of research according to the risk and benefit ratio of the persons involved. Following the example of other countries, medical ethics committees eventually appeared also in hospitals and some medical and educational institutions around Slovenia. Due to an increased number of ethical challenges, it is of great importance to define the jurisdiction of the Slovenian MECs in order to ensure their coordinated operation. Exclusive jurisdiction of the national MEC includes multicentre and multi-national research, drug research (phases 1–3), high-risk research and research related to doctoral theses. The jurisdiction of the sectoral MECs includes testing the conditions for research, monitoring the execution and overviewing the final reports. A more significant jurisdiction of the sectoral MEC is preserving an ethical environment in their institutions. A network of Slovenian MECs is to be organised in the form of a jurisdiction pyramid where each member has its own obligations and responsibilities and plays an important role in relation to the entire structure.

Across the high seas: abuse, desertion, and violence in transnational marriages in India

This article examines the issues and concerns faced by Indian women in transnational marriages or what are popularly known as NRI marriages in India. It discusses how the Indian laws, the courts, and women try to deal with the difficulties and problems relating to issues of abuse, abandonment, and violence. It also highlights the inadequacies in laws and policies relating to such marriages in India. This article is complimentary to the article by Ann Stewart that concentrates on the "receiving" end of transnational marriages in the United Kingdom, and focuses on the ways in which the socio-legal context of the receiving State (in this case, the United Kingdom) presents difficulties for South Asian women. This article, conversely, takes a "sending" perspective, that is, the response of the home state, India, to the difficulties faced by Indian women involved in transnational marriages.

Dilemma of concepts and strategies for the prevention of spread of HIV in relation to human behavior, law and human rights

The new prevalence data regarding the estimated global number of human immunodeficiency virus positive (HIV+) cases, i.e., including people who are either aware or unaware of their HIV infection in 2010, lead many to wonder why the increase in incidence has reached today's unprecedented level and escalated within such a short time. This, in spite of prevention campaigns in countries affected by HIV/acquired immune deficiency syndrome (AIDS) with their urgent messages aimed at preventing HIV transmission by promoting changes in individual's behavior. This article analyzes the background of the prevention strategies, in particular their political, social and legal concepts in terms of human rights, and reveals traits of human behavior not considered thus far. A radical reappraisal is necessary, at social and legislative levels, as well as options additional to current concepts. When ethical issues come up, they become blamed for outmoded moralistic positions. However, ignoring the reality has led to dire consequences from prioritizing individual human rights over society's collective need to prevent the spread of HIV.

The influence of practice standards on massage therapists' work experience: a phenomenological pilot study

This original research is framed in phenomenological methodology, based on interviews conducted and interpreted using qualitative research methods. The findings suggest that, because of both direct and indirect factors (such as the nebulous nature of the work, general isolation in work conditions, and physical concerns), massage therapists perform their work with multiple sources of ambiguity that are potentially anxiety-causing. Licensing offers potential relief for this anxiety, but also generates a new set of frustrations and work concerns. The new concerns include the potential that practice will change to adapt to non-relevant standards and the difficulty of defining a body of work that frequently defies a “one size fits all” categorization. This pilot study suggests several areas for further exploration and also demonstrates the generativity of phenomenological methodology for research related to massage therapy.

Addiction medicine and addiction psychiatry in America: Commonalities in the medical treatment of addiction

Two competing medical disciplines treat addiction in the United States: addiction medicine and addiction psychiatry. Addiction medicine seeks recognition from the American Board of Medical Specialties whereas addiction psychiatry holds this high-level medical status, a mission that suggests a substantive distinction between addiction medicine physicians and addiction psychiatrists that does not exist. As this article shows, leading addiction medicine physicians and addiction psychiatrists agree on the definition of addiction and that drug treatment is an "art" which requires a multimethod approach. Despite this extensive accord, addiction medicine physicians and addiction psychiatrists draw sharp distinctions between addiction medicine and addiction psychiatry to serve historical, economic, and professional interests, revealing the importance to both disciplines of recognition from the American Board of Medical Specialties and thus jurisdiction over the medical treatment of addiction.

A First Nations voice in the present creates healing in the future

This paper discusses the urgency for change and improvements in health policy determined by the exploding demographics and inequities in the health status of First Nation people. A historical overview of health services for First Nation clients was conducted as set out through government legislation and health and social policies. Until WWII ended, the federal government provided assistance to First Nations through Indian Affairs branches of several departments. This responsibility was gradually transferred to National Health and Welfare. In 1962, the federal government established a Medical Services Branch, later renamed First Nations and Inuit Health Branch, and mandated to provide services to First Nation clients, which fell outside the provincial jurisdiction of health care. Initially centered on public health priorities, services have expanded to include primary health care, dental, mental health, environmental health, home and continuing care, and Non-Insured Health Benefits. The Romanow Report substantiated the urgency for health policy improvements voiced by many First Nations. However, it generalized Aboriginal issues in health care on a national front. Furthermore, its recommendations were specific to health care providers and delivery models and did not address the social and spiritual determinants of health, which are fundamental to a First Nations' holistic approach. Health planners must think holistically, considering traditional and westernized medicine, First Nations' values, priorities and government systems, and present and evolving health systems. Universities, health authorities, provinces and the federal government are continually developing new research and health models, which will also need consideration. Further, the imperative of involving community-level input must be recognized.