Examining the Social Benefits Principle in Research with Human Participants
Abstract
The idea that research with human participants should benefit society has become firmly entrenched in various regulations, policies, and guidelines, but there has been little in-depth analysis of this ethical principle in the bioethics literature. In this paper, I distinguish between strong and weak versions and the social benefits principle and examine six arguments for it. I argue that while it is always ethically desirable for research with human subjects to offer important benefits to society (or the public), the reasonable expectation of substantial public benefit should be a necessary condi...
Source: Health Care Analysis - July 3, 2016 Category: Health Management Source Type: research
Medical Need: Evaluating a Conceptual Critique of Universal Health Coverage
Abstract
Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional (universal, comprehensive) rather than a residual (minimalist, safety net) system. They argue that the concept (a) contradicts the idea of comprehensiveness; (b) leads to unsustainable expenditures; (c) is too indeterminate for policy; and (d) supports only a prioritarian distribution (and therefore a residual system). I argue (a) that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as...
Source: Health Care Analysis - June 7, 2016 Category: Health Management Source Type: research
Addressing Deficits and Injustices: The Potential Epistemic Contributions of Patients to Research
Abstract
Patient or public involvement (PPI) in health research is increasingly expected as a matter of policy. In theory, PPI can contribute both to the epistemic aims intrinsic to research (generating knowledge), and to extrinsically valued features of research such as social inclusion and transparency. In practice, the aims of PPI have not always been clear, although there has been a tendency to encourage the involvement of so-called ordinary people who are regarded as representative of an assumed patient perspective. In this paper we focus on the epistemic potential of PPI, using theoretical work in e...
Source: Health Care Analysis - June 7, 2016 Category: Health Management Source Type: research
Concierge, Wellness, and Block Fee Models of Primary Care: Ethical and Regulatory Concerns at the Public–Private Boundary
Abstract
In bioethics and health policy, we often discuss the appropriate boundaries of public funding; how the interface of public and private purchasers and providers should be organized and regulated receives less attention. In this paper, I discuss ethical and regulatory issues raised at this interface by three medical practice models (concierge care, executive wellness clinics, and block fee charges) in which physicians provide insured services (whether publicly insured, privately insured, or privately insured by public mandate) while requiring or requesting that patients pay for services or for the...
Source: Health Care Analysis - June 2, 2016 Category: Health Management Source Type: research
Doctors on Values and Advocacy: A Qualitative and Evaluative Study
Abstract
Doctors are increasingly enjoined by their professional organisations to involve themselves in supraclinical advocacy, which embraces activities focused on changing practice and the system in order to address the social determinants of health. The moral basis for doctors’ decisions on whether or not to do so has been the subject of little empirical research. This opportunistic qualitative study of the values of medical graduates associated with the Sydney Medical School explores the processes that contribute to doctors’ decisions about taking up the advocate role. Our findings show that perso...
Source: Health Care Analysis - May 10, 2016 Category: Health Management Source Type: research
Dying is the Most Grown-Up Thing We Ever Do: But Do Health Care Professionals Prevent Us from Taking It Seriously?
Abstract
This paper takes a somewhat slant perspective on flourishing and care in the context of suffering, death and dying, arguing that care in this context consists principally of ‘acts of work and courage that enable flourishing’. Starting with the perception that individuals, society and health care professionals have become dulled to death and the process of dying in Western advanced health systems, it suggests that for flourishing to occur, both of these aspects of life need to be faced more directly. The last days of life need to be ‘undulled’. Reflections upon the experiences of the autho...
Source: Health Care Analysis - April 22, 2016 Category: Health Management Source Type: research
Flourishing and Posttraumatic Growth. An Empirical Take on Ancient Wisdoms
Abstract
Considerations of well-being or flourishing include Maslow’s and Rogers’ concepts of self-actualisation and actualising tendency. Recent empirical findings suggest that only a modest proportion of the population might be considered to be flourishing. Separate findings focused upon the nature and determinants of post-traumatic growth identify it as comparable to flourishing, and facilitated by supported accommodation to the trauma. This can be understood as reflecting self-actualisation. Empirical findings such as these provide ontological stability to a set of phenomena that share much with a...
Source: Health Care Analysis - March 24, 2016 Category: Health Management Source Type: research
“I am Your Mother and Your Father!” In Vitro Derived Gametes and the Ethics of Solo Reproduction
Abstract
In this paper, we will discuss the prospect of human reproduction achieved with gametes originating from only one person. According to statements by a minority of scientists working on the generation of gametes in vitro, it may become possible to create eggs from men’s non-reproductive cells and sperm from women’s. This would enable, at least in principle, the creation of an embryo from cells obtained from only one individual: ‘solo reproduction’. We will consider what might motivate people to reproduce in this way, and the implications that solo reproduction might have for ethics and pol...
Source: Health Care Analysis - March 11, 2016 Category: Health Management Source Type: research
Flourishing and Freedom: Exploring Their Tensions and Their Relevance to Chronic Disease
Abstract
In this paper I will briefly discuss flourishing and freedom, relating them to health and disease; discuss the tensions between flourishing and freedom; and exemplify how those discussions are relevant to chronic disease suffering. The concept of freedom has significant connections with the concepts of health, disability and disease. Understanding disease and disability in terms of the loss of aspects of freedom may help our understanding of the suffering that arises from chronic disease. On the other hand, flourishing may require a degree of adversity. Therefore disability and disease may be con...
Source: Health Care Analysis - February 29, 2016 Category: Health Management Source Type: research
Could Moral Enhancement Interventions be Medically Indicated?
Abstract
This paper explores the position that moral enhancement interventions could be medically indicated (and so considered therapeutic) in cases where they provide a remedy for a lack of empathy, when such a deficit is considered pathological. In order to argue this claim, the question as to whether a deficit of empathy could be considered to be pathological is examined, taking into account the difficulty of defining illness and disorder generally, and especially in the case of mental health. Following this, Psychopathy and a fictionalised mental disorder (Moral Deficiency Disorder) are explored with ...
Source: Health Care Analysis - February 24, 2016 Category: Health Management Source Type: research
Moving Perspectives on Patient Competence: A Naturalistic Case Study in Psychiatry
We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the thera...
Source: Health Care Analysis - February 16, 2016 Category: Health Management Source Type: research
Behavior Change or Empowerment: On the Ethics of Health-Promotion Goals
Abstract
One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate (instrumental) goals or aims, and to morally evaluate the strengths and weaknesses of these two goal models, in...
Source: Health Care Analysis - February 16, 2016 Category: Health Management Source Type: research
Professional Talk: How Middle Managers Frame Care Workers as Professionals
Abstract
This paper examines how middle managers in the long term care sector use the discourse of professionalism to create ‘appropriate’ work conduct of care workers. Using Watson’s concept of professional talk, we study how managers in their daily work talk about professionalism of vocationally skilled care workers. Based on observations and recordings of mundane conversations by middle managers, we found four different professional talks that co-exist: (1) appropriate looks and conduct, (2) reflectivity about personal values and ‘good’ care, (3) methodical work methods, (4) competencies. J...
Source: Health Care Analysis - February 16, 2016 Category: Health Management Source Type: research
Am I My Brother’s Keeper? Moral Dimensions of Informal Caregiving in a Neoliberal Society
Abstract
Within the current Dutch policy context the role of informal care is revalued. Formal care activities are reduced and family and friends are expected to fill this gap. Yet, there is little research on the moral ambivalences that informal care for loved ones who have severe and ongoing mental health problems entails, especially against the backdrop of neoliberal policies. Giving priority to one’s own life project or caring for a loved one with severe problems is not reconciled easily. Using a case study we illustrate the moral ambivalences that persons may experience when they try to shape their...
Source: Health Care Analysis - February 16, 2016 Category: Health Management Source Type: research
Prospects for Flourishing in Contemporary Health Care
Abstract
This special issue of Health Care Analysis originated in an conference, held in Birmingham in 2014, and organised by the group Think about Health. We introduce the issue by briefly reviewing the understandings of the concept of ‘flourishing’, and introducing the contributory papers, before offering some reflections on the remaining issues that reflection on flourishing poses for health care provision. (Source: Health Care Analysis)
Source: Health Care Analysis - February 8, 2016 Category: Health Management Source Type: research
