MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Health Care Analysis' source. Thu, 09 Feb 2012 10:12:53 +0100 http://www.medworm.com/index.php?rid=5575583&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh5073g38r82g1455%2F Abstract  Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the pathways that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of a... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5575583 Fri, 06 Jan 2012 16:49:21 +0100 5575583 http://www.medworm.com/index.php?rid=5519598&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fnk4602n376811025%2F Abstract  An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to become involved in the caring process and informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care a... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5519598 Sat, 17 Dec 2011 16:42:27 +0100 5519598 http://www.medworm.com/index.php?rid=5453165&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fcl428723qr1u58h4%2F This article examines whether beneath the rhetoric any form of real choice is endorsed either in law or in NHS policy. I explore the case law on ‘consent’, look at choice within the NHS and highlight the dilemmas that a mismatch of language and practice poses for clinicians. Given the variance in interpretation and lack of consistency for the individual patient I argue for a semantic change that obviates the use of ‘choice’, focussing instead on the options for treatment that are available and accessible, with due acknowledgement of individual patient preferences, without raising unfettered and false expectations. Content Type Journal ArticleCategory Original ArticlePages 1-25DOI 10.1007/s10728-011-0198-4Authors Ingrid Whiteman, Bioethics and Medical Jurisprudence, CSEP/... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5453165 Tue, 22 Nov 2011 17:58:58 +0100 5453165 http://www.medworm.com/index.php?rid=5415769&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv58151w1rr7342u1%2F Abstract  According to HealthCare.gov, by improving access to quality health for all Americans, the Affordable Care Act (ACA) will reduce disparities in health insurance coverage. One way this will happen under the provisions of the ACA is by creating a new health insurance marketplace (a health insurance exchange) by 2014 in which “all people will have a choice for quality, affordable health insurance even if a job loss, job switch, move or illness occurs”. This does not mean that everyone will have whatever insurance coverage he or she wants. The provisions of the ACA require that each of the four benefit categories of plans (known as bronze, silver, gold and platinum) provides no less than the benefits available in an “essential health benefits package”. However,... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5415769 Wed, 09 Nov 2011 07:03:06 +0100 5415769 http://www.medworm.com/index.php?rid=5309550&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa414414g55006041%2F Abstract  This paper will offer an alternative paradigm to healthcare delivery by introducing the concept of mutuality and empowerment into the existing health-wealth model. The backdrop is provided by Better Health, Better Care (Scottish Government 2007), Section 1 of which is entitled ‘Towards a Mutual NHS’. In detail, the paper will: revisit what is meant by mutuality; advance the meaning of the `public interest’; explore empowerment and community empowerment and its relationship to health; and introduce a model, which tries to link these concepts and terms together. It is hoped that this analysis will help researchers and practitioners alike further appreciate the important concept of mutuality and empowerment into the existing health-wealth model. Content... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5309550 Sat, 08 Oct 2011 15:42:11 +0100 5309550 http://www.medworm.com/index.php?rid=5256191&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7533406365m446w7%2F Abstract  In the UK, regulation of clinical services is being restructured. We consider two clinical procedures, abortion and IVF treatment, which have similar ethical and political sensitivities. We consider factors including the law, licensing, inspection, amount of paperwork and reporting requirements, the reception by practitioners and costs, to establish which field has the greater ‘regulatory burden’. We test them based on scientific, ethical, social, political factors that might explain differences. We find that regulatory burden borne by IVF services is greater than in abortion, but none of the explanatory theses can provide a justification of this phenomenon. We offer an alternative explanation based on regulatory ‘overspill’ from research regulation and po... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5256191 Sat, 24 Sep 2011 15:46:10 +0100 5256191 http://www.medworm.com/index.php?rid=5256192&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fmp33225406g05153%2F Abstract  The huge potential of biobanks/genetic databases for the research community has been recognised across jurisdictions in both publicly funded and commercial sectors. But although there is tremendous potential there are likewise potential difficulties. The long-term storage of personal health information and samples poses major challenges. This is an area is fraught with ethical and legal uncertainties. Biobanks raise many questions of the control of rights, of consent, of privacy and confidentiality and of property in human material. It is thus unsurprising then that there has been a lively debate as to how biobanks should operate, the boundaries of participation and what governance structure, if any they should adopt, a debate which has been engaged in across the ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5256192 Thu, 22 Sep 2011 05:53:31 +0100 5256192 http://www.medworm.com/index.php?rid=5231429&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fmm3l27q15w48t731%2F Abstract  It is generally assumed in research ethics that research participants have an unconditional right to withdraw from research without any detriment or reprisal. This paper analyses this right in the context of biobank research and argues that the traditional shape of the right in clinical research can be modified in biobank research without incurring significant ethical cost. The paper falls in three parts. The first part is a brief explication of the philosophical justification of the right to withdraw. The second part presents a number of extant criticisms of the right. And the third and final part argues that although a right to withdraw is crucial in relation to biobank research, such a right has to be specified in a different way to the similar right in relatio... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5231429 Thu, 15 Sep 2011 05:49:38 +0100 5231429 http://www.medworm.com/index.php?rid=5231430&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fxp859j257380613v%2F Abstract  Modern biobanks typically rely on the public to freely donate genetic data, undergo physical measurements and tests, allow access to medical records and give other personal information by questionnaire or interview. Given the demands on participants it is not surprising that there has been extensive public consultation even before biobanks in the UK and elsewhere began to recruit. This paper considers the different ways in which biobanks have attempted to engage and appeal to their publics and the reaction of potential and actual donors. Whilst those organising biobanks presumably want to be as close to their publics as they need to be in order to successfully recruit and sustain participation in sufficient numbers, the closer the relationship the more obligations... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5231430 Wed, 14 Sep 2011 05:52:41 +0100 5231430 http://www.medworm.com/index.php?rid=5231431&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F460279k358534k72%2F Abstract  This paper argues that the demands of respect for autonomy in the context of biobanking are fewer and more limited than is often supposed. It discusses the difficulties of agreeing a concept of autonomy from which duties can easily be derived, and suggests an alternative way to determine what respect for autonomy in a biobanking context requires. These requirements, it argues, are limited to provision of adequate information and non-coercion. While neither of these is in itself negligible, this is a smaller set of demands than is often suggested. In particular, it is argued here that securing ‘one time consent’ is consistent with respect for autonomy. Finally, the paper notes that while the demands of respect for autonomy may be less than some suppose, respect... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5231431 Tue, 13 Sep 2011 05:48:48 +0100 5231431 http://www.medworm.com/index.php?rid=5231432&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk852366735248640%2F This article presents the goals of CES as perceived by board members and members of ethics support staff. This is part of a Dutch national research using a mixed methods design with questionnaires, focus groups and interviews. Quantitative and qualitative data were analyzed and combined in an iterative process. Four main clusters of goals were found: 1) encouraging an ethical climate, 2) fostering an accountable and transparent organization, 3) developing professionalism and a final goal, overarching the previous three, 4) good care. Most important sub-goals of CES were: attention for ethical issues, raising awareness of ethical issues, fostering ethical reflection and supporting employees. The article ends with a discussion on the desirability to further operationalize the general g... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5231432 Tue, 13 Sep 2011 05:48:47 +0100 5231432 http://www.medworm.com/index.php?rid=5216676&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Feg647798j8215651%2F This article examines the moral reasonableness of arguments advanced for positive discounting in cost-effectiveness analysis both from an intergenerational and an intrapersonal perspective and assesses if arguments are equally applicable to health and monetary outcomes. The article concludes that behavioral effects related to time preferences give little or no reason for why society at large should favour the present over the future when making intergenerational choices regarding health. The strongest argument for discounting stems from the combined argument of diminishing marginal utility in the presence of growth. However, this hinges on the assumption of actual growth in the relevant good. Moreover, current modern democracy may be insufficiently sensitive to the concerns of future... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5216676 Fri, 09 Sep 2011 16:45:46 +0100 5216676 http://www.medworm.com/index.php?rid=5216677&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fjx06v872851u829g%2F Abstract  Guidelines provided by the Director of Public Prosecutions suggest that anyone assisting another to commit suicide in England and Wales, or elsewhere, will not be prosecuted provided there are no self-seeking motives and no active encouragement. This reflects the position in Switzerland. There, however, no difference is made between assistance and inducement. In addition, the Swiss approach makes it possible to establish organisations to assist the suicides of both their citizens and foreign visitors. It should not be assumed that this approach is without controversy in Switzerland. Proposals for reform continue to be debated there, not least because of the concern about some of the actual practices of certain end-of-life organisations. It is likely that a few Eng... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5216677 Thu, 08 Sep 2011 05:53:00 +0100 5216677 http://www.medworm.com/index.php?rid=5189842&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft311l55845078hkt%2F This article demonstrates moral learning by examining the case of an integrated social service network. The network’s development and implementation were supported by responsive evaluation, enriched by insights of care ethics and hermeneutic ethics. Content Type Journal ArticleCategory Original ArticlePages 1-16DOI 10.1007/s10728-011-0187-7Authors Merel Visse, Department of Medical Humanities, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorstraat 7, 1081 BT Amsterdam, The NetherlandsGuy A. M. Widdershoven, Department of Medical Humanities, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorstraat 7, 1081 BT Amsterdam, The NetherlandsTineke A. Abma, Department of Medical Humanities, EMGO+ Institut... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5189842 Tue, 30 Aug 2011 15:58:43 +0100 5189842 http://www.medworm.com/index.php?rid=5136826&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm1kr46814204761l%2F Abstract  This paper argues that a certain way of thinking about the function of the biobank—about what it does and is constructed for as a social institution aimed at ‘some good’—can and should play a substantial role in an effective biobanking ethic. It first exemplifies an ‘institution shaped gap’ in the current field of biobanking ethics. Next the biobank is conceptualized as a social institution that is apt for a certain kind of purposive functional definition such that we know it by what it does and what it is designed to do. This purpose is then characterized further as essentially incorporating the human goods the institution is designed to serve, such that it plays a useful and indispensible role in how it should operate, i.e. in the ethics and governanc... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5136826 Sat, 13 Aug 2011 06:13:47 +0100 5136826 http://www.medworm.com/index.php?rid=5101801&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F64qp1628m7t57821%2F Abstract  Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5101801 Tue, 02 Aug 2011 05:55:37 +0100 5101801 http://www.medworm.com/index.php?rid=5067612&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fhp3415430t56118p%2F Abstract  This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective. Content Type Journal ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5067612 Sat, 23 Jul 2011 15:48:09 +0100 5067612 http://www.medworm.com/index.php?rid=5060946&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F74325rt54357410l%2F Content Type Journal ArticlePages 1-13DOI 10.1007/s10728-011-0184-xAuthors Heather Widdows, Birmingham, UKSean Cordell, Birmingham, UK Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5060946 Thu, 21 Jul 2011 17:55:47 +0100 5060946 http://www.medworm.com/index.php?rid=5060947&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn1430q34mng16813%2F Abstract  This paper considers proposals for developing ‘co-productive’ medical partnerships, within the UK National Health Service (NHS), concentrating in particular on the potential problem involved in combining professional and lay conceptions of health. Much of the literature that advocates the introduction of co-productive healthcare partnerships assumes that medical professionals and patients share, or can easily come to share, a common set of beliefs about what is valuable with regard to health interventions and outcomes. However, a substantial literature documents the contestability of the concept of health, particular across professional and lay divides. We suggest that this potential disagreement ought to be taken seriously, and suggest that the prospect of a ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5060947 Wed, 20 Jul 2011 12:28:11 +0100 5060947 http://www.medworm.com/index.php?rid=5046652&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F74q8657532711u14%2F We present five illustrative cases that how empowerment is ‘done’ in the practice of vocational rehabilitation and its unintended effects. Our analysis demonstrates that activation strategies seem to be caught in a paradox: instead of including people in society, they have excluding consequences. Vocational rehabilitation professionals can go beyond this paradox by learning from the ways in which empowerment is ‘done’ by clients in vocational rehabilitation programmes. Content Type Journal ArticlePages 1-18DOI 10.1007/s10728-011-0182-zAuthors Lineke B. E. van Hal, Research School CAPHRI, Department of Health Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The NetherlandsAgnes Meershoek, Research ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5046652 Thu, 14 Jul 2011 06:00:03 +0100 5046652 http://www.medworm.com/index.php?rid=5034649&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa313441668714844%2F Abstract  On 19 December 2008 the Official Journal of Belgium published the ‘Law regarding the procurement and use of human body material destined for human medical applications or for scientific research purposes’. This paper will comment on various aspects of the Law: its scope of application (what is understood by ‘body material’?); its concept of ‘residual human body material’ (with far-reaching implications for the type of consent required for research); the nature of actions with and uses of human body material that are explicitly prohibited; the right of donors to be informed of relevant information revealed by the use of their body material; and the special responsibilities placed on hospital ethics committees. As will be argued in this paper, several of... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5034649 Wed, 13 Jul 2011 06:03:14 +0100 5034649 http://www.medworm.com/index.php?rid=5025794&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd7l60355u0331073%2F Abstract  The world is suffering from a dearth of health care workers, and sub-Saharan Africa, an area of great need, is experiencing the worst shortage. Developed countries are making the problem worse by luring health care workers away from the countries that need them most, while developing countries do not have the resources to stem the flow or even replace those lost. Postmodern philosopher Emmanuel Levinas offers a unique ethical framework that is helpful in assessing both the irresponsibility inherent in the current global health care situation and the responsibility and obligation held by the stakeholders involved in this global crisis. Drawing on Levinas’ exploration of individual freedom and self-pursuit, infinite responsibility for the Other, and the potential ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=5025794 Sun, 10 Jul 2011 05:52:52 +0100 5025794 http://www.medworm.com/index.php?rid=4996767&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy7867354357l3574%2F Abstract  Health care organizations are constantly seeking ways to improve quality of care and one of the often-posed solutions to deliver ‘good care’ is reflexivity. Several authors stress that enhancing the organizations’ and caregivers’ reflexivity allows for more situated, and therefore better care. Within quality improvement initiatives, devices that guarantee quality are also seen as key to the delivery of good care. These devices do not solely aim at standardizing work practices, but are also of importance in facilitating reflexivity. In this article, we study how quality improvement devices position the relationship between situated reflection and standardization of work processes. By exploring the work of Michel Callon, Michael Lynch, and Lucy Suchman on re... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4996767 Thu, 30 Jun 2011 17:47:52 +0100 4996767 http://www.medworm.com/index.php?rid=4919031&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv5hj12t4206w1p87%2F This study critically examines the implementation of one country’s Milk Code within the framework of the International Code of Marketing of Breast-Milk Substitutes, and the efficacy of the judicial process in balancing corporate marketing and state regulatory objectives. Drawing upon the Philippine experience with its own Milk Code, it evaluates the capacities of courts to determine policy costs and risks against the benefits of delineating and containing corporate marketing strategies for milk substitutes and supplements. The study finds that the methodological and information-based challenges faced by courts in resolving multi-dimensional health issues may not be overcome without serious questions concerning the legitimacy of the judicial process itself. Despite the deficiencies ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4919031 Wed, 08 Jun 2011 15:45:17 +0100 4919031 http://www.medworm.com/index.php?rid=4900199&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F92h385x75k144401%2F Abstract  In this article, we focus at a key concept of today’s healthcare, namely responsibility. Personal responsibility is so important today because it is obvious that the way society is organized, many people are facing a lot of difficulties to live their lives in a responsible way. We explicitly obtain an analysis of responsibility from a view which avoids the binary thinking which is so remarkably present in today’s health care discourse. The aim of this pilot study is therefore to open up the horizon of the use of responsibility in today’s healthcare. We develop the notion of ‘co-responsibility’ to understand how individuals, despite the fact they are responsible for their own agency, are always also affected by an ought which contaminates their efforts to... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4900199 Wed, 25 May 2011 06:22:42 +0100 4900199 http://www.medworm.com/index.php?rid=4851694&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3263l473520m2607%2F Abstract  The aim of this study is to describe how hermeneutic photography and one application of hermeneutic photography in particular, namely the photo-instrument, can be used as a health care intervention that fosters meaning (re-)construction of mental illness experiences. Studies into the ways how patients construct meaning in illness narratives indicate that aesthetic expressions of experiences may play an important role in meaning making and sharing. The study is part of a larger research project devoted to understanding the photostories that result from groups of psychiatric patients using the photo-instrument. Within a focused ethnography approach we employed a qualitative design of a single case study. Text analysis of photostories was combined with observational ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4851694 Thu, 19 May 2011 16:33:37 +0100 4851694 http://www.medworm.com/index.php?rid=4838236&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fql57712456l6874w%2F Abstract  When seeing immoral actions, criminal or not, we sometimes deem the people who perform them unhealthy. This is especially so if the actions are of a serious nature, e.g. involving murder, assault, or rape. We turn our moral evaluation into an evaluation about health and illness. This tendency is partly supported by some diagnoses found in the DMS-IV, such as Antisocial personality disorder, and the ICD-10, such as Dissocial personality disorder. The aim of the paper is to answer the question: How analytically sound is the inclusion of morality into a theory of health? The holistic theory of Lennart Nordenfelt is used as a starting point, and it is used as an example of a theory where morality and health are conceptually distinct categories. Several versions of a p... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4838236 Fri, 13 May 2011 05:43:07 +0100 4838236 http://www.medworm.com/index.php?rid=4810997&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb041612j04111456%2F Abstract  In this paper I investigate the web-rhetoric of companies offering home-based personal health monitoring to patients and elderly people. Two main rhetorical methods are found, namely a reference to practical benefits and a use of prestige words like “quality of life” and “independence”. I interpret the practical benefits in terms of instrumental values and the prestige words in terms of final values. I also reconstruct the arguments on the websites in terms of six different types of argument. Finally, I articulate a general critique of the arguments, namely that the websites neglect the context of use of personal health monitoring technologies. Whether or not a technology is good depends on the use of the technology by a particular individual in a particula... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4810997 Fri, 06 May 2011 16:19:42 +0100 4810997 http://www.medworm.com/index.php?rid=4744522&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fdx406p5v104g33h3%2F Abstract  Health technology assessment (HTA) was developed in the 1970s and 1980s to facilitate decision making on the desirability of new biomedical technologies. Since then, many of the standard tools and methods of HTA have been criticized for their implicit normativity. At the same time research into the character of technology in practice has motivated philosophers, sociologists and anthropologists to criticize the traditional view of technology as a neutral instrument designed to perform a specific function. Such research suggests that the tools and methods of more traditional forms of HTA are often inspired by an ‘instrumentalist’ conception of technology that does not fit the way technology actually works. This paper explores this hypothesis for a specific case:... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4744522 Sat, 16 Apr 2011 05:51:39 +0100 4744522 http://www.medworm.com/index.php?rid=4730869&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd4152294q7h71162%2F Abstract  In the US, stem cell research is at a moral impasse—many see this research as ethically mandated due to its potential for ameliorating major diseases, while others see this research as ethically impermissible because it typically involves the destruction of embryos and use of ova from women. Because their creation does not require embryos or ova, induced pluripotent stem cells offer the most promising path for addressing the main ethical objections to stem cell research; however, this technology is still in development. In order for scientists to advance induced pluripotent stem cell research to a point of translational readiness, they must continue to use ova and embryos in the interim. How then are we to ethically move forward with stem cell research? We argue... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4730869 Tue, 12 Apr 2011 06:54:34 +0100 4730869 http://www.medworm.com/index.php?rid=4599325&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fhj4vh513p0619t49%2F This article questions the applicability of such a concept in the context of Chile. Here, conflicting interests between the Mapuche and the Chilean state are related to aspects of economic development, modernity processes, integration, intercultural relations, and indigenous rights and are deeply reflected also in projects for an intercultural health system. By analysing the experience of the intercultural practice of Makewe Hospital, this article argues that effective and equitable intercultural health practices will not take place unless there will be an integral valorisation of the Mapuche culture from a broader perspective. Content Type Journal ArticlePages 1-19DOI 10.1007/s10728-011-0170-3Authors Maria Costanza Torri, Department of Social Sciences, University of Toronto Sc... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4599325 Mon, 14 Mar 2011 16:56:12 +0100 4599325 http://www.medworm.com/index.php?rid=4469582&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd7w0381j0670x07u%2F Abstract  Neurodiversity has remained a controversial concept over the last decade. In its broadest sense the concept of neurodiversity regards atypical neurological development as a normal human difference. The neurodiversity claim contains at least two different aspects. The first aspect is that autism, among other neurological conditions, is first and foremost a natural variation. The other aspect is about conferring rights and in particular value to the neurodiversity condition, demanding recognition and acceptance. Autism can be seen as a natural variation on par with for example homosexuality. The broad version of the neurodiversity claim, covering low-functioning as well as high-functioning autism, is problematic. Only a narrow conception of neurodiversity, referring... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4469582 Thu, 10 Feb 2011 19:58:28 +0100 4469582 http://www.medworm.com/index.php?rid=4427980&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F305h5636mx04250w%2F Content Type Journal ArticlePages 1-2DOI 10.1007/s10728-011-0168-xAuthors Per Nortvedt, Center for Medical Ethics, Institute of Health and Society, The Medical Faculty, University of Oslo, Oslo, Norway Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4427980 Fri, 28 Jan 2011 06:55:05 +0100 4427980 http://www.medworm.com/index.php?rid=4410527&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F76n58612077l5237%2F Abstract  To explore whether market reforms in a health care system affect medical professional ethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2–3 years after a major overhaul of the Dutch health care system involving several market reforms. Surgeons now regularly advertise their work (while this was forbidden in the past) and pay more attention to patients with relatively minor afflictions, thus deviating from codes of ethics that oblige physicians to treat each other as brothers and to treat patients according to medical need. Dutch GPs have abandoned their traditional reticence and their fear of medicalization. They n... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4410527 Tue, 25 Jan 2011 23:53:30 +0100 4410527 http://www.medworm.com/index.php?rid=4404370&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd033556x21445j74%2F Abstract  The idea behind this article is to discuss the importance and to develop the concept of reciprocity in asymmetric professional relationships. As an empirical starting point for an examination of the possible forms of reciprocity between patients and nurses in psychiatry, we chose two qualitative in-depth interviews with two different patients. The manners in which these two patients relate to medical personnel—one is dependent, the other is independent—show that this presents challenges to nurses. The theoretical context is provided by the notion of mature care as it has been developed by feminist-oriented ethics of care, in contrast to the notion of altruistic care. In relation to the concept of mature care, we discuss how nursing can be perceived in demandin... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4404370 Fri, 21 Jan 2011 15:35:38 +0100 4404370 http://www.medworm.com/index.php?rid=4317264&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw0l42n70p21p85v4%2F Abstract  In this article I argue that the ethics of care provides us with a novel reading of human relations, and therefore makes possible a fresh approach to several empirical challenges. In order to explore this connection, I discuss some specific normative features of the ethics of care—primarily the comprehension of the moral agent and the concept of care—as these two key elements contribute substantially to a new ethical outlook. Subsequently, I argue that the relational and reciprocal mode of thinking with regard to the moral agent must be extended to our understanding of care. I term this comprehension “mature care”. Citing conflicts of interests as examples, I demonstrate how this conceptualization of care may further advance the ethics of care’s ability ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4317264 Tue, 04 Jan 2011 17:54:15 +0100 4317264 http://www.medworm.com/index.php?rid=4317265&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm4m14nrn48779038%2F Abstract  In moral case deliberation (MCD), healthcare professionals meet to reflect upon their moral questions supported by a structured conversation method and non-directive conversation facilitator. An increasing number of Dutch healthcare institutions work with MCD to (1) deal with moral questions, (2) improve reflection skills, interdisciplinary cooperation and decision-making, and (3) develop policy. Despite positive evaluations of MCD, organization and implementation of MCD appears difficult, depending on individuals or external experts. Studies on MCD implementation processes have not yet been published. The aim of this study is to describe MCD implementation processes from the perspective of nurses who co-organize MCD meetings, so called ‘local coordinators’. Va... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4317265 Tue, 04 Jan 2011 17:54:14 +0100 4317265 http://www.medworm.com/index.php?rid=4312842&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F84m4m554375l1781%2F Abstract  Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference to the interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiali... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4312842 Mon, 03 Jan 2011 18:04:47 +0100 4312842 http://www.medworm.com/index.php?rid=4250644&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fat1m5950n20n34x8%2F Abstract  If ethics of care deals with the nature of relationships, attentiveness, and understanding particular others, narrativity ought to play a central part. Sometimes, caring simply amounts to working with narratives. In the article I claim that narrativity can even be said to be native to an ethics of care. Through an example, I demonstrate how a narrative ethics of care can discern and grasp some moral problems better than the standard theoretical outlooks. Content Type Journal ArticlePages 1-13DOI 10.1007/s10728-010-0162-8Authors Jens Erik Paulsen, Section for Medical Ethics, Department of General Practice and Community Medicine, University of Oslo, PO Box 1130, Blindern, 0318 Oslo, Norway Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4250644 Thu, 09 Dec 2010 07:52:03 +0100 4250644 http://www.medworm.com/index.php?rid=4240716&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv648512202024204%2F Abstract  In this paper I introduce a theoretical framework on care developed by the Norwegian nurse and philosopher Kari Martinsen, and I argue that this approach has relevance not only within nursing, but also within clinical medicine. I try to substantiate this claim by analysing some of the key concepts in this approach, and I illustrate the potential clinical relevance of this approach by applying it in relation to two care scenarios. Finally, I discuss some of the concerns that have been raised in relation to the aim of highlighting care in medicine. Content Type Journal ArticleDOI 10.1007/s10728-010-0161-9Authors Elin Håkonsen Martinsen, Section for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, PO BOX 1130 Blindern, 0... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4240716 Mon, 06 Dec 2010 18:48:50 +0100 4240716 http://www.medworm.com/index.php?rid=4207014&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F95xh350613u46770%2F Abstract  This paper aims at addressing some questions considering the conflicting normative claims of partiality, i.e. to provide for the caring needs of the particular patient, and impartial claims of treating all patients with a relevant need equally. This ethical conflict between different conceptions of moral responsibilities within professional ethics relates to debates between an ethics of care and an ethics of justice. An ethics of care is a particularistic position that endorses some form of partiality, i.e. favouring persons to whom one stands in particular relationships. This paper argues that also a professional ethics must endorse some kind of partiality at the clinical level of health care. In fact, consideration of care for particular patients is a prerequisi... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4207014 Wed, 24 Nov 2010 20:21:21 +0100 4207014 http://www.medworm.com/index.php?rid=4207015&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F135h4r6806273743%2F Abstract  The focus of the study is the conflict between care and concern for particular patients, versus considerations that take impartial considerations of justice to be central to moral deliberations. To examine these questions we have conducted qualitative interviews with health professionals in Norwegian hospitals. We found a value norm that implicitly seemed to overrule all others, the norm of ‘making a difference for the patients’. We will examine what such a statement implies, aiming to shed some light over moral dilemmas interwoven in bedside rationing. Content Type Journal ArticleDOI 10.1007/s10728-010-0160-xAuthors Helge Skirbekk, Medical Faculty, Institute of Health and Society, Centre For Medical Ethics, University of Oslo, P.O. Box 1130, Blindern, 03... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4207015 Wed, 24 Nov 2010 20:21:20 +0100 4207015 http://www.medworm.com/index.php?rid=4181864&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fkl65725526768200%2F Abstract  Departing from theories of distributive justice and their relation with the distribution of health care within society, especially egalitarianism and libertarianism, this paper aims at demonstrating that the approach taken by the European Court of Justice regarding the application of the Internal Market principles (or the market freedoms) to the field of health care services has introduced new values which are more concerned with a libertarian view of health care. Moreover, the paper also addresses the question of how these new values introduced by the Court may affect common principles of European health systems, such as equity and accessibility. Content Type Journal ArticleDOI 10.1007/s10728-010-0158-4Authors Danielle da Costa Leite Borges, European Univer... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4181864 Tue, 16 Nov 2010 19:29:34 +0100 4181864 http://www.medworm.com/index.php?rid=4142147&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp636157231n40775%2F Abstract  The theory and practise of care is defined and enacted differently in different national as well as cultural contexts, illuminating how differently constructed the personal and societal structures in Europe are. A common trait is however that care work paid or non-paid, private or public is identified with women. To navigate in the landscape of care and ethics requires taking into account the constitutive relation between one’s identity, embodiment and position. The author suggests conceiving care as an existential condition of life demanded from all human beings. This will free care from the identification with women and pave a way towards a more gender equal and just society with less gender segregation in the labour market and at the arena of education. ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4142147 Fri, 05 Nov 2010 11:03:46 +0100 4142147 http://www.medworm.com/index.php?rid=4142148&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx78th54028p228l3%2F Abstract  The lack of economic sustainability of most healthcare systems and a higher demand for quality and safety has contributed to the development of regulation as a decisive factor for modernisation, innovation and competitiveness in the health sector. The aim of this paper is to determine the importance of the principle of public accountability in healthcare regulation, stressing the fact that sunshine regulation—as a direct and transparent control over health activities—is vital for an effective regulatory activity, for an appropriate supervision of the different agents, to avoid quality shading problems and for healthy competition in this sector. Methodologically, the authors depart from Kieran Walshe’s regulatory theory that foresees healthcare regulation as ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=4142148 Fri, 05 Nov 2010 11:03:44 +0100 4142148 http://www.medworm.com/index.php?rid=3912844&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fhkr7253374263818%2F Abstract  Patient organizations increasingly play an important role in health care decision-making in Western countries. The Netherlands is one of the countries where this trend has gone furthest. In the literature some problems are identified, such as instrumental use of patient organizations by care providers, health insurers and the pharmaceutical industry. To strengthen the position of patient organizations government funding is often recommended as a solution. In this paper we analyze the ties between Dutch government and Dutch patient organizations to learn more about the effects of such a relationship between government and this part of civil society. Our study is based on official government documents and existing empirical research on patient organizations. We foun... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3912844 Fri, 27 Aug 2010 17:17:16 +0100 3912844 http://www.medworm.com/index.php?rid=3775431&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp7013w7r47534p05%2F Abstract  Evaluation of quality of life, psychic and bodily well-being is becoming increasingly important in oncology aftercare. This type of assessment is mainly carried out by medical psychologists. In this paper I will seek to show that body experience valuation has, besides its psychological usefulness, a normative and practical dimension. Body experience evaluation aims at establishing the way a person experiences and appreciates his or her physical appearance, intactness and competence. This valuation constitutes one’s ‘body image’. While, first, interpreting the meaning of body image and, second, indicating the limitations of current psychological body image assessment, I argue that the normative aspect of body image is related to the experience of bodily whole... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3775431 Sat, 17 Jul 2010 21:12:58 +0100 3775431 http://www.medworm.com/index.php?rid=3775432&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx304261672n15278%2F Abstract  The study is designed to provide an informal summary of what is known about consumer switching of health insurance plans and to contribute to knowledge about what motivates consumers who choose to switch health plans. Do consumers switch plans largely on the basis of critical reflection and assessment of information about the quality, and price? The literature suggests that switching is complicated, not always possible, and often overwhelming to consumers. Price does not always determine choice. Quality is very hard for consumers to understand. Results from a random sample survey (n = 2791) of the Alkmaar region of the Netherlands are reported here. They suggest that rather than embracing the opportunity to be active critical consumers, individuals are mo... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3775432 Sat, 17 Jul 2010 21:12:56 +0100 3775432 http://www.medworm.com/index.php?rid=3736112&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F303870505t14488m%2F Abstract  Although there is a long-standing international debate concerning the privatization and corporatization of health services, there has been relatively little systematic analysis of the ways these types of reform manifest. We examine the impact of privatization and corporatization on public hospitals, and in particular on hospitals’ autonomy and accountability, with two aims: to uncover the key themes in the literature, and to consider implementation issues. The review of 2,319 articles was conducted using content analysis and a discussion of selected key issues. Several major themes appear in the privatization and corporatization literature, including their use as tools in health systems reform, and the role of governments in sponsoring the processes. We show tha... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3736112 Wed, 07 Jul 2010 05:59:55 +0100 3736112 http://www.medworm.com/index.php?rid=3736113&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy13558302687t26q%2F Abstract  Consumer-operated services organizations (COSOs) are independent, non-profit organizations that provide peer support and other non-clinical services to seriously mentally ill people. Mental health consumers provide many of these services and make up at least a majority of the organization’s leadership. Although the dominant conception of the COSO is as an adjunct to clinical care in the public mental health system, this paper reconceives the organization as a civic association and thereby a locus of citizenship. Drawing on empirical research on COSOs in one state and the citizenship and civic democracy literatures, COSOs are analyzed here as membership organizations with democratic norms and strong ties to local communities. The suggestion is made that by embrac... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3736113 Tue, 06 Jul 2010 17:04:47 +0100 3736113 http://www.medworm.com/index.php?rid=3479047&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx582q74h7458w457%2F In conclusion, the notion of invasiveness may best be eliminated from medical terminology, replacing it with a detailed understanding of the notion of harm. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-010-0149-5Authors Abraham Rudnick, University of Western Ontario Departments of Psychiatry and Philosophy 850 Highbury Avenue London ON N6A 4H1 Canada Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3479047 Tue, 13 Apr 2010 18:19:56 +0100 3479047 http://www.medworm.com/index.php?rid=3479048&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv025x64160366018%2F This study aims to compare and contrast how specific information health technologies (IHTs) have been debated, how they have proliferated, and what they have enabled in Germany’s and England’s healthcare systems. For this a discourse analysis was undertaken that specifically focussed on future-scenarios articulated in policy documents and strategy papers released by relevant actors from both healthcare systems. The study reveals that the way IHTs have been debated and how they have proliferated depends on country-specific regulatory structures, their respective values, actors’ and institutions’ organized interests, and the status of health professionals. These conditions have enabled IHTs to promote a new and similar concept of patienthood in both countries, although they ten... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3479048 Tue, 13 Apr 2010 18:19:54 +0100 3479048 http://www.medworm.com/index.php?rid=3432063&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F783570l13717k130%2F Abstract  In a severe influenza pandemic, hospitals will likely experience serious and widespread shortages of patient pulmonary ventilators and of staff qualified to operate them. Deciding who will receive access to mechanical ventilation will often determine who lives and who dies. This prospect raises an important question whether pandemic preparedness plans should include some process by which individuals affected by ventilator rationing would have the opportunity to appeal adverse decisions. However, the issue of appeals processes to ventilator rationing decisions has been largely neglected in state pandemic planning efforts. If we are to devise just and effective plans for coping with a severe influenza pandemic, more attention to the issue of appeals processes for pa... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3432063 Wed, 31 Mar 2010 05:46:23 +0100 3432063 http://www.medworm.com/index.php?rid=3432062&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp120x527782t7047%2F Abstract  This paper argues that there is a need to move yet further than has already been suggested by some from the individual to the collective as a base for public health. A communitarian approach is one way to achieve this. This has the advantage of allowing not only the community’s voice to have a say in setting the values for public health but also more formally the development of a constitution on which public health might then be built. It also sees public health as a social institution which can be valued in its own right. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-010-0147-7Authors John E. Ataguba, University of Cape Town Health Economics Unit, School of Public Health and Family Medicine Falmouth Annex, Medical Campus Observato... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3432062 Wed, 31 Mar 2010 05:46:23 +0100 3432062 http://www.medworm.com/index.php?rid=3361726&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg7j76p51483l4111%2F Abstract  Empirical evidence suggests that some health professionals believe consent procedures for the emerging technology of non-invasive prenatal diagnosis (NIPD) should become less rigorous than those currently used for invasive prenatal testing. In this paper, we consider the importance of informed consent and informed choice procedures for protecting autonomy in those prenatal tests which will give rise to a definitive result. We consider whether there is anything special about NIPD that could sanction a change to consent procedures for prenatal diagnosis or otherwise render informed decision-making less important. We accept the claim that the absence of risk of miscarriage to some extent lessens the gravity of the decision to test compared with invasive methods of te... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3361726 Wed, 10 Mar 2010 18:32:42 +0100 3361726 http://www.medworm.com/index.php?rid=3361727&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp2n1832w2phg3460%2F Abstract  Moral distress is a concept used to date in clinical literature to describe the experience of staff in circumstances in which they are prevented from delivering the kind of bedside care they believe is expected of them, professionally and ethically. Our research objective was to determine if this concept has relevance in terms of key health care managerial functions, such as priority setting and resource allocation. We conducted interviews and focus groups with mid- and senior-level managers in two British Columbia (Canada) health authorities. Transcripts were analyzed qualitatively using constant comparison to identify key themes related to moral distress. Both mid- and senior-level managers appear to experience moral distress, with both similarities and differen... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3361727 Wed, 10 Mar 2010 18:32:40 +0100 3361727 http://www.medworm.com/index.php?rid=3248408&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fllg0166636n370t0%2F Abstract  Abstracts are written to summarise documents and to whet the reader’s interest. Alas, many readers just use them as a substitute for reading the whole paper, which given the brevity of abstracts can give a somewhat distorted impression. I hope that having read this abstract, you will read on. If you do, you will find that I offer a little personal history and a little impersonal history on the development of interest in the issue of health inequalities in England. I then summarise the policy response of recent Labour administrations, briefly detail the effects of this response, and finally offer my own three-pronged policy attack on our thus far really quite stubborn inequalities in health. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s1072... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3248408 Thu, 04 Feb 2010 18:14:32 +0100 3248408 http://www.medworm.com/index.php?rid=3170438&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu4hh5724728872q4%2F This study aims to analyse whether these worries are warranted by analysing Dutch care practices using telemonitoring in care for chronic patients in the Netherlands. How do clinical practices of nursing change when telecare devices are introduced and what this means for notions and norms of good nursing? The paper concludes that at this point the practices studied do not warrant the fear of negligence and compromised relations. Quite the contrary; in the practices studied, telecare lead to more frequent and more specialised contacts between nurses and patients. The paper concludes by reflecting on the ethical implications of these changes. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-009-0140-1Authors Jeannette Pols, Academic Medical Centre (AMC) Amste... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3170438 Sun, 10 Jan 2010 06:48:52 +0100 3170438 http://www.medworm.com/index.php?rid=3170439&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3j22w21480356gv1%2F Abstract  In prevention and health promotion interventions, screening methods and risk profile assessments are often used as tools for establishing the interventions’ effectiveness, for the selection and determination of the health status of participants. The role these instruments fulfil in the creation of effectiveness and the effects these instruments have themselves remain unexplored. In this paper, we have analysed the role screening methods and risk profile assessments fulfil as part of prevention and health promotion programmes in the selection, enrolment and participation of participants. Our analysis showed, that screening methods and health risk assessments create effects as they objectify health risks and/or the health status of individuals, i.e., they select t... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3170439 Sun, 10 Jan 2010 06:48:51 +0100 3170439 http://www.medworm.com/index.php?rid=3170440&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj26l266472808575%2F Abstract  This paper considers the legal position of genetic test results in insurance law in England and Wales. The strict position is that this information is material to the decision of the insurer to offer insurance cover and should be disclosed by insurance applicants. However, the British Government and the Association of British Insurers have agreed to a moratorium on the use of genetic test results in insurance, which will run until 2014. The moratorium prohibits unfavourable treatment of insurance clients on their basis of their genetics, unless it can be justified. In this paper, I consider the notion of genetic discrimination and ask whether it is possible to justify the concept in such a way that its existence should be accepted. The paper suggests that the insu... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3170440 Sun, 10 Jan 2010 06:48:49 +0100 3170440 http://www.medworm.com/index.php?rid=3170441&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F2qh53m16v3861267%2F Abstract  This paper offers a panoramic assessment of the significant changes experienced by psychiatric care in Western Europe and North America in the course of the last decades of deinstitutionalization and reform. Drawing on different comparative studies and an own review of relevant data and reports, the main transformations in the mental health field are analyzed around seven major topics: the expanding scope of psychiatry; the decline and metamorphosis of the asylum; the introduction of alternative and diversified forms of care; the new challenges posed by chronic mental illness; the emergence of modern psychopharmacology; the deployment of subspecialization; and the new forms of coercion implemented with community mental health practices. Following a renewed diagnos... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3170441 Sun, 10 Jan 2010 06:48:48 +0100 3170441 http://www.medworm.com/index.php?rid=3170442&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fqxl1776603172r6p%2F Abstract  For the past several years patients have been expected to play a key role in their recovery. Self management and disease management have reached a hype status. Considering these recent trends what does this mean for the division of responsibilities between doctors and patients? What kind of role should healthcare providers play? With findings based on a qualitative research project of an innovative practice for people with Chronic Obstructive Pulmonary Disease (COPD) we reflect on these questions. In-depth interviews conducted with people with COPD, physiotherapists and a pulmonologist show that shifting responsibilities require a supportive attitude from healthcare providers and a dialogical communication between patients and professionals. Our findings show more... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3170442 Sun, 10 Jan 2010 06:48:43 +0100 3170442 http://www.medworm.com/index.php?rid=3155499&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3137kmh34734g716%2F Abstract  Many countries encourage immigration, yet almost without exception they impose medical conditions on the admissibility of prospective immigrants. This paper examines the ethical defensibility of this practice. It argues that the neighbourhood principle, which states that we owe a greater duty to neighbours than to strangers, when properly understood, extends to all human beings, that economic and safety considerations play only a limited role in ethically underwriting an exclusionary policy, and that medical immigration criteria should be harmonized with treatment eligibility criteria for citizens of the relevant countries themselves. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-009-0142-zAuthors Eike-Henner W. Kluge, University of V... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3155499 Tue, 05 Jan 2010 06:50:09 +0100 3155499 http://www.medworm.com/index.php?rid=3135015&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy1q763230718k04u%2F This article aims to challenge and expand notions of health, health care and health promotion, particularly in relation to smoking, via a consideration of the autobiographical literary work of the English playwright, Simon Gray. Gray died in 2008, having written a series of reflective autobiographical books, The Smoking Diaries. Gray was a lifelong smoker, perpetually trying to give up his habit. This article introduces Gray’s diaries and their reflections on life, death, health care and smoking. It then enquires what can be learned about contemporary health care practices and assumptions from Gray’s work. Finally, it reflects on the limits of views of health and health promotion when considered in the light of a fully lived life. In the life under consideration, health care risk... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3135015 Wed, 30 Dec 2009 16:47:13 +0100 3135015 http://www.medworm.com/index.php?rid=2930088&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff0g251n278226413%2F Abstract  Creativity has become an oft-used word in UK public policy, but perhaps it is also under-imagined. This paper contends that there is an instrumental tendency to narrowly frame creativity as innovation, implying a reproducible product, instead of more openly as improvisation, a situational, embodied and temporal process. This is not a simple dichotomy (innovation and improvisation, product and process, can be mutually informing concepts), nor is it specifically a question of definition; rather, it relates to an ontological orientation, and related to that are issues of epistemological implications. In particular the paper is concerned with the value of the arts in public policy, as situated in the social, and therefore human, spaces of health and care; and more gener... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2930088 Sat, 24 Oct 2009 07:53:41 +0100 2930088 http://www.medworm.com/index.php?rid=2919017&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm53r43k5180u1p4n%2F Abstract  There is currently a clarion call for the NHS to be more creative and innovative, as it moves into an increasingly quality focused agenda. But exactly how easy is it to do this when the NHS performance regime for the last 10 years has been more about delivering centrally driven, specific and detailed targets for improvement, such as reduction of waiting times, than promoting a culture that speaks of experimentation and possibilities rather than certainties. Can a workforce that may not have been all that prepared for creativity, be creative? And what does being prepared for creativity look like? This paper explores, briefly, the relationship the NHS has with creativity and the new agendas that are creating more fertile ground but then, drawing on practices an... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2919017 Wed, 21 Oct 2009 12:16:27 +0100 2919017 http://www.medworm.com/index.php?rid=2885559&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7311n67023456k1n%2F Abstract   Deconstructing the Toolkit explores the current desire for toolkits that promise failsafe structures to facilitate creative success. The paper examines this cultural phenomenon within the context of the risk-averse workplace—with particular focus on the NHS. The writers draw on Derrida and deconstructionism to reflect upon the principles of creativity and the possibilities for being creative within the workplace. Through reference to The Extra Mile project facilitated by Open Art, the paper examines the importance of engaging with an aesthetic of creativity and embracing a more holistic approach to the problems and potential of the creative process. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-009-0134-zAuthors Von Allen, Open Art... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2885559 Sat, 10 Oct 2009 07:30:53 +0100 2885559 http://www.medworm.com/index.php?rid=2878578&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh86164284m68v180%2F Abstract  The Creativity in Health and Care Workshops programme was a series of investigative workshops aimed at interrogating the subject of creativity with an over-arching objective of extending the understanding of the problems and possibilities of applying creativity within the health and care sector workforce. Included in the workshops was a concept analysis, which attempted to gain clearer understanding of creativity and innovation within this context. The analysis led to emergent theory regarding the central importance of aesthetics, emotion and empathetic imagination to the generation of creative and innovative outcomes that have the capacity to promote wellbeing in the health and social care workforce. Drawing on expertise in the field, this paper outlines the conc... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2878578 Thu, 08 Oct 2009 06:57:09 +0100 2878578 http://www.medworm.com/index.php?rid=2878579&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg7r61143652185l9%2F Abstract  A lot of interest has been generated by the possibility of deriving gametes from embryonic stem cells and bone marrow stem cells. These stem cell derived gametes may become useful for research and for the treatment of infertility. In this article we consider prospectively the ethical issues that will arise if stem cell derived gametes are used in the clinic, making a distinction between concerns that only apply to embryonic stem cell derived gametes and concerns that are also relevant for gametes derived from adult stem cells. At present, it appears preferable to use non-embryonic stem cells for the derivation of gametes. Adult stem cell derived gametes do not present any problems with regard to the moral status of the human embryo, bypass the safety risks linked ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2878579 Thu, 08 Oct 2009 06:57:07 +0100 2878579 http://www.medworm.com/index.php?rid=2864797&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F074q7476306047ju%2F Abstract  This paper offers a brief consideration of how narrative, in the form of people’s own stories, potentially figures in health and social care provision as part of the impulse towards patient-centred care. The rise of the epistemological legitimacy of patients’ stories is sketched here. The paper draws upon relevant literature and original writing to consider the ways in which stories can mislead as well as illuminate the process of making individual treatment care plans. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-009-0130-3Authors Hannah Bradby, University of Warwick Department of Sociology Coventry CV4 7AL UKJanet Hargreaves, University of Huddersfield School of Human and Health Sciences Queensgate HD1 3DH UKMary Robson, NESTA Lo... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2864797 Fri, 02 Oct 2009 05:50:06 +0100 2864797 http://www.medworm.com/index.php?rid=2850284&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1829j8432n1v3488%2F Abstract  The aim of this paper is to demonstrate that there are significant ethical problems with nonmedical sex selection, and that prohibitive legislation is justified. The central argument put forward is that nonmedical sex selection is a sexist practice which promotes socially restrictive conceptions of sex, gender and family. Several steps are taken to justify this position: background information on technology and legislation is provided, the neoliberal position that is supportive of nonmedical sex selection is described, and preliminary reasons for rejecting this approach are given. A detailed description of how a harm/benefit based analysis contributes to the argument against nonmedical sex selection, and how it successfully counters most criticism, is provided. Th... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2850284 Tue, 29 Sep 2009 07:37:29 +0100 2850284 http://www.medworm.com/index.php?rid=2850283&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fhk6xp17h1m07168g%2F Abstract  The article explores the communist ideology that has guided the formation of professional ethics of medicine in China. It first explores the constitutions of the People’s Republic of China and the Chinese Communist Party and codes of practice for medicine enforced since 1949, showing that the core of the ideology in relation to health provision and doctor–patient relationship has always been ‘serving the people wholeheartedly’. The ideological undertaking, however, has never been successfully exercised. In the pre-reform era, the bureaucratisation of health professionals led to the emergence of ‘bureaucratic medicine’ featuring negligence of patients’ interests. In the reform era, the prevailing commercialisation of health care is in fundamental confl... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2850283 Tue, 29 Sep 2009 07:37:29 +0100 2850283 http://www.medworm.com/index.php?rid=2850285&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu6080697w22gx232%2F Abstract  The Problem of Application investigates the multiple viewpoints in defining a critical aesthetic in applied arts practice. Amongst organisations, participants, and facilitators there are varying wants and needs in any creative project with an educational agenda. The product of arts based health initiatives often seek to inform and educate, whereby an aesthetic standard may seem contrary to this participatory approach. This research maintains that an aesthetic approach is a lively portion of the collaborative dialogue, which requires interrogation and consideration for a successful outcome. Through the analysis of a participatory arts project completed in West Africa addressing youth issues and HIV/AIDS, The Problem of Application seeks to uncover the multiple facet... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2850285 Tue, 29 Sep 2009 01:08:48 +0100 2850285 http://www.medworm.com/index.php?rid=2850286&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft120k1ukn300t0r7%2F Abstract  This paper is drafted as an overview of the process of the Creativity in Health and Care workshop programme the themes arising from the project. It is intended as an introduction to the special edition and the notion of creativity that is being explored. Content Type Journal ArticleCategory IntroductionDOI 10.1007/s10728-009-0128-xAuthors Emma Brodzinski, University of London Department of Drama and Theatre, Royal Holloway London UKDeborah Munt, Open Art Hudderfield UK Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2850286 Tue, 29 Sep 2009 01:08:46 +0100 2850286 http://www.medworm.com/index.php?rid=2835952&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F51l71084h6341tg2%2F Abstract  In spite of the growing interest in nursing ethics, few studies have focused on ethical dilemmas experienced by nurses working with clinical studies as ‘research nurses’. The aim of the present study was to describe and explore ethical dilemmas that Swedish research nurses experience in their day-to-day work. In a qualitative study a purposeful sample of six research nurses from five wards of differing disciplines in four Swedish hospitals was interviewed. The analysis displayed several examples of ethical dilemmas, primarily tensions between the nurses’ obligations to the study and to the patients involved. A guiding moral principle for the nurses was patient-centeredness, where the interest of research must not override the interest of the patient. In situ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2835952 Fri, 25 Sep 2009 05:49:07 +0100 2835952 http://www.medworm.com/index.php?rid=2833799&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm22k1631423r0014%2F Abstract  It appears that there are two distinct practices within public health, namely health promotion and disease prevention, leading to different goals. But does the distinction hold? Can we promote health without preventing disease, and vice versa? The aim of the paper is to answer these questions. First, the central concepts are defined and the logical relations between them are spelt out. A preliminary conclusion is that there is a logical difference between health and disease, which makes health promotion and disease prevention two distinct endeavours. However, since disease is defined in relation to health, as those kinds of internal processes and states that typically lead to ill health, the difference is smaller than it might appear. Second, in order to answer th... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2833799 Tue, 22 Sep 2009 15:42:51 +0100 2833799 http://www.medworm.com/index.php?rid=2812013&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv0528r7813j0846p%2F Abstract  The terms “health promotion” and “disease prevention” refer to professional activities. But a “health promoter” has also come to denote a profession, with an alternative agenda compared to that of traditional public health work, work that by some is seen to be too medically oriented, too reliant upon prevention, risk-elimination and health-care. But is there really a sharp distinction between these activities and professions? The main aim of the paper is to investigate if these concepts are logically different, or if they are just two extremes of one dimension. The central concepts, health promotion and disease prevention, are defined, and it is concluded that health promotion and disease prevention are logically distinct concepts, although they are co... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2812013 Thu, 17 Sep 2009 12:39:20 +0100 2812013 http://www.medworm.com/index.php?rid=2501040&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F22145v6648x05886%2F Abstract  Policies on reproduction have become an increasingly important tool for governments seeking to meet the so-called demographic ‘challenge’ created by the combination of low fertility and lengthening life expectancies. However, the tension between the state and the market in health care is present in all countries around the world due to the scare resources available and the understandable importance of the health issues. The field of assisted reproduction, as part of the health care system, is affected by this tension with both—the state’s and the market’s involvements—carrying important implications. Bulgaria and Israel share the same size of population, are markedly paternalistic and both have strong pro-natalist cultures by which large families are e... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2501040 Tue, 09 Jun 2009 15:48:04 +0100 2501040 http://www.medworm.com/index.php?rid=2501039&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj858025726qr0320%2F This article offers a logical analysis of Slippery Slope Arguments. Such arguments claim that adopting a certain act or policy would take us down a slippery slope to an undesirable bottom and infer from this that we should refrain from this act or policy. Even though a logical assessment of such arguments has not received much careful attention, it is of vital importance to their overall assessment because if the premises fail to support the conclusion an argument is worthless. I partition slippery slope reasoning by means of two dichotomies (reasoning under certainty vs. uncertainty and one-step vs. multiple-step reasoning) into four general categories and evaluate these in turn. The analysis reveals that slippery slope arguments are logically fallacious. Content Type Journal Art... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2501039 Tue, 09 Jun 2009 15:48:04 +0100 2501039 http://www.medworm.com/index.php?rid=2401994&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp316vp21nq882035%2F Abstract  In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. However, most citizens seem reluctant to adopt the practice; the number of patients who have an advance directive is low across most countries. The article discusses the key argument for seeing such documents as an instrument of self-interpretation and life-planning, which ultimately have to be interpreted by third parties as well. Interpretation by third parties and the process of self-reflection are conceptually linked by a qualitative concept of identity. Identity is conceived here as constructed in a processual dialogue between a personal and a cultural perspective. How the cultural dimension comes into play in unde... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2401994 Fri, 08 May 2009 06:07:21 +0100 2401994 http://www.medworm.com/index.php?rid=2401995&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh167vx0x025k86m0%2F Abstract  In the UK and elsewhere suicide presents a major cause of death. In 2008 in the UK the topic of suicide rarely left the news. Controversy surrounding Daniel James and Debbie Purdy ensured that the problem of assisted suicide received frequent media discussion. This was fuelled also by reports of a higher than usual number of suicides by young people in South Wales. Attention attracted by cases such as that of Daniel James and Debbie Purdy can lead to a neglect of the problem of how to respond to the vast majority of suicides, in which there is no obvious accompanying health problem. This paper seeks to redress that balance to some degree. Its focus is primarily on the provision of assisted suicide when the person seeking such assistance has no accompanying health ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2401995 Thu, 07 May 2009 06:03:45 +0100 2401995 http://www.medworm.com/index.php?rid=2401996&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe2j663735159w631%2F Abstract  Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed three characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entitie... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2401996 Wed, 06 May 2009 06:01:29 +0100 2401996 http://www.medworm.com/index.php?rid=2366881&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb2227687187331g6%2F Abstract  Using material from the Pfizer sponsored website providing health information on erectile dysfunction to potential Swedish Viagra customers (www.potenslinjen.se), this article explores the public image of masculinity in relation to sexual health and the cultural techniques for creating pharmaceutical appeal. We zoom in on the targeted ideal users of Viagra, and the nationalized, racialized and sexualized identities they are assigned. As part of Pfizer’s marketing strategy of adjustments to fit the local consumer base, the ways in which Viagra is promoted for the Swedish setting is telling of what concepts of masculinity are so stable and unassailable that they can withstand the association with a drug that is, in essence, an acknowledgement of ‘failed’ mascul... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2366881 Thu, 23 Apr 2009 08:16:31 +0100 2366881 http://www.medworm.com/index.php?rid=2363134&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F41twn83608k83270%2F Abstract  Face transplants have been performed, in a small number, since 2005. Popular concern over the morality of the face transplant has tended to focus on the role that one’s face plays in one’s sense of self or one’s personal identity. In order to address this concern, the current paper will explore the significance of face transplants in the light of a theory of the self that draws on symbolic interactionism, narrative theory, and accounts of embodiment. The paper will respond to certain presuppositions concerning personal identity made by Huxtable and Woodley. A theory of the self will be articulated that draws on the work of Merleau-Ponty and G. H. Mead, in order to place embodiment and social interaction centrally to an understanding of self-identity. This wi... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2363134 Wed, 22 Apr 2009 08:04:47 +0100 2363134 http://www.medworm.com/index.php?rid=2321127&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx84m02621x241n44%2F Abstract  There is great diversity in in vitro fertilization (IVF) funding and reimbursement policies and practice throughout Europe and the rest of the world. While many existing reimbursement and regulatory frameworks address safety and legal concerns, economic factors also assume a central role. However, there are several problems with the evidence that is available on the economics of IVF. This suggests there is a need for more robust cost-effectiveness studies. It also indicates the need for alternative rationales to justify the reimbursement of IVF, which might more fully account for the social, political, ethical, and philosophical considerations embedded in notions of infertility and technology-driven reproductive treatments. The merits and limitations of five alter... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2321127 Fri, 03 Apr 2009 06:58:32 +0100 2321127 http://www.medworm.com/index.php?rid=2321129&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw875121300517612%2F Abstract  The article’s aim is to explore human hand allograft recipients’ postoperative experience of disownership and their gradual experience of their new hand as theirs, with the aid of the work of the French phenomenologist Maurice Merleau-Ponty. Many have used a Merleau-Pontinian perspective in the analysis of embodiment. Far fewer have used it in medico-ethical analysis. Drew Leder’s phenomenologically based ethics of organ donation and organ sale is an exception to this tendency. The article’s second aim is to examine Leder’s phenomenologically based ethics of organ donation and organ sale. Though I find parts of Leder’s approach promising, I also elaborate a line of reasoning that draws on Merleau-Ponty, that does allow us to argue for certain kinds of ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2321129 Fri, 03 Apr 2009 06:58:31 +0100 2321129 http://www.medworm.com/index.php?rid=2321131&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F9k5304k71rn31747%2F Content Type Journal ArticleCategory EditorialDOI 10.1007/s10728-009-0120-5Authors Kristin Zeiler, Linköping University Division of Health and Society, Department of Medical and Health Sciences Linköping Sweden Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2321131 Tue, 31 Mar 2009 05:57:39 +0100 2321131 http://www.medworm.com/index.php?rid=2272180&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm646334v75875241%2F Abstract  Priority setting remains a big challenge for health managers and planners, yet there is paucity of literature on evaluating priority setting. The purpose of this paper is to present a framework for evaluating priority setting in low and middle income countries. We conducted a qualitative study involving a review of literature and Delphi interviews with respondents knowledgeable of priority setting in low and middle income countries. Respondents were asked to identify the measures of successful priority setting in low and middle income countries. Responses were grouped as: immediate internal or external/delayed internal or external. We also identified some pre-requisites for successful priority setting. The immediate internal measures included increased efficiency i... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2272180 Sat, 14 Mar 2009 12:15:49 +0100 2272180 http://www.medworm.com/index.php?rid=2272184&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd812r637r516333m%2F This study performed a secondary qualitative analysis of the data to identify the ethical issues of adult predictive genetic testing important to members of the general public. The identified issues were: (1) need for public education; (2) choice to undergo genetic counselling and testing; (3) access to genetic counselling and testing; and (4) obligations regarding the handling of genetic information. Audience members emphasized public education and access to information regarding potential choices, which was different from the emphasis on informed consent and other ethical issues prominent in the literature. Members of the general public emphasized ethical issues that were different than those identified by experts and patients. It is essential that members of the public be included... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2272184 Sat, 14 Mar 2009 12:15:48 +0100 2272184 http://www.medworm.com/index.php?rid=2209215&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl6435341073j1up3%2F Abstract  In this paper, I apply Michel Foucault’s analysis of normalization to the 2006 announcement by the US and European Endocrinological Societies that variations on the term “hermaphrodite” and “intersex” would be replaced by the term, “Disorders of Sex Development” or DSD. I argue that the change should be understood as normalizing in a positive sense; rather than fighting for the demedicalization of conditions that have significant consequences for individuals’ health, this change can promote the transformation of the conceptualization of intersex conditions from “disorders like no other” to “disorders like many others.” Understood in these terms, I conclude, medical attention to those with atypical anatomies should be recast from a preoccupat... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2209215 Sat, 21 Feb 2009 08:11:20 +0100 2209215 http://www.medworm.com/index.php?rid=2149258&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn64876l4x3038830%2F Abstract  Throughout the Western world people turn towards the health care system seeking help for a variety of psychosomatic/psychosocial health problems. They become “patients” and find themselves within a system of practises that conceptualizes their bodies as “objective” bodies, treats their ill health in terms of the malfunctioning machine, and compartmentalizes their lived experiences into medically interpreted symptoms and signs of underlying biological dysfunction. The aim of this article is to present an alternative way of describing ill health and rehabilitation using the philosophy of Maurice Merleau-Ponty in order to deepen our understanding of the rehabilitation process. I will explore how the experience of chronic pain ruptures the natural connection b... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2149258 Fri, 30 Jan 2009 09:26:27 +0100 2149258 http://www.medworm.com/index.php?rid=2149257&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx84324025184875k%2F Abstract  Kidney transplantation is the most efficacious and cost-effective treatment for end-stage renal disease. However, the treatment’s accessibility is limited by a chronic shortage of transplantable kidneys, resulting in the death of numerous patients worldwide as they wait for a kidney to become available. Despite the implementation of various measures the disparity between supply and needs continues to grow. This paper begins with a look at the current treatment options, including various sources of transplantable kidneys, for end-stage renal disease. We propose, in accordance with others, the introduction of compensated kidney donation as a means of addressing the current shortage. We briefly outline some of the advantages of this proposal, and then turn to exami... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2149257 Fri, 30 Jan 2009 09:26:27 +0100 2149257 http://www.medworm.com/index.php?rid=2149259&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm2r4lw5726hqq05k%2F Abstract  In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursue... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2149259 Fri, 30 Jan 2009 09:26:25 +0100 2149259 http://www.medworm.com/index.php?rid=2140796&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fxj51131030268638%2F Abstract  Canada is a leader in experimenting with alternative, non fee for service provider remuneration methods; all jurisdictions have implemented salaries and payment models that blend fee for service with salary or capitation components. A series of qualitative interviews were held with 27 stakeholders in the Canadian health care system to assess the reasons and expectations behind the implementation of these payment methods for family physicians, as well as the extent to which objectives have been achieved. Results indicate that the main reasons are a need to recruit and retain primary care physicians to rural and remote regions of the country, and the desire to increase collaboration, care continuity, prevention and health promotion. The general perception is that po... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2140796 Tue, 27 Jan 2009 07:52:29 +0100 2140796 http://www.medworm.com/index.php?rid=2103991&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fun588l877135183j%2F Abstract  Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and methodologies have emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2103991 Tue, 13 Jan 2009 08:40:31 +0100 2103991 http://www.medworm.com/index.php?rid=2094410&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa077735r60681785%2F Abstract  This paper explores one aspect of the social implications of new reproductive technologies, namely, the impact such technologies have on our understandings of family structures and our expectations of children. In particular it considers whether the possibilities afforded by such technologies result in a more contractual and commodified understanding of children. To do this the paper outlines the possibilities afforded by NRTs and their commodificatory tendencies; second, it explores the commodification debate using the somewhat parallel example of commodification of organs; and third, in light of these debates the link between the commodification of body parts and persons is addressed. It will argue that there is a prime facie connection between body parts and pe... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2094410 Fri, 09 Jan 2009 13:35:43 +0100 2094410 http://www.medworm.com/index.php?rid=2094411&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw6216024v2625jl8%2F Abstract  In central definitions of shared decision-making within medical consultations we find the concept of negotiation used to describe the interaction between patient and professional in case of conflict. It has been noted that the concept of negotiation is far from clear in this context and in other contexts it is used both in terms of rational deliberation and bargaining. The articles explores whether rational deliberation or bargaining accurately describes the negotiation in shared decision-making and finds that it fails to do so on both descriptive and normative grounds. At the end some notes on further analysis is given and it is suggested that the interaction is more accurately described in terms of an internal balancing of values like patient best interest, pati... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2094411 Thu, 08 Jan 2009 08:58:02 +0100 2094411 http://www.medworm.com/index.php?rid=2094412&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd51t116791413021%2F Abstract  Patients’ trust in their physicians improves their health outcomes because of better compliance, more disclosure, stronger placebo effect, and more physicians’ trustworthy behaviors. Patients’ autonomy may also impact on health outcomes and is increasingly being emphasized in health care. However, despite the critical role of trust and autonomy, patients that naïvely trust their physicians may become overly dependent and lack the motivation to participate in medical care. In this article, we argue that increased trust does not necessarily imply decreased autonomy. Furthermore, patients with high levels of trust and autonomy preferences are most likely to have the best health outcomes. We propose a framework for understanding simultaneous trust and autonomy ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2094412 Thu, 08 Jan 2009 08:58:01 +0100 2094412 http://www.medworm.com/index.php?rid=2094413&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fll4054v154851656%2F Abstract  Health policy frameworks usually construe environmental protection and human health as harmonious values. Policies that protect the environment, such as pollution control and pesticide regulation, also benefit human health. In recent years, however, it has become apparent that promoting human health sometimes undermines environmental protection. Some actions, policies, or technologies that reduce human morbidity, mortality, and disease can have detrimental effects on the environment. Since human health and environmental protection are sometimes at odds, political leaders, citizens, and government officials need a way to mediate and resolve conflicts between these values. Unfortunately, few approaches to applied bioethics have the conceptual tools to do accomplish ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2094413 Thu, 08 Jan 2009 08:58:00 +0100 2094413 http://www.medworm.com/index.php?rid=2059595&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe02p75450201456m%2F Abstract  Health care has become increasingly patient-centred and medical guidelines are considered to be one of the instruments that contribute towards making it so. We reviewed the literature to identify studies on this subject. Both normative and empirical studies were analysed. Many studies recommend active patient participation in the process of guideline development as the instrument to make guidelines more patient-centred. This is done on the assumption that active patient participation will enhance the quality of the guidelines. We found no empirical evidence, however, to support this assumption. Moreover, the studies show that patients experience several difficulties in the participation process, which cannot solely be traced back to flawed practices. Given this po... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=2059595 Sun, 21 Dec 2008 08:37:25 +0100 2059595 http://www.medworm.com/index.php?rid=1944822&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F16n1377553v87570%2F Abstract  In recent years UK government policy has been drawing private companies into the operation of the British National Health Service as providers of health care. Hitherto the National Health Service has been the main employer of health care practitioners, but this may change as a result of this development. There is an issue as to whether professional health care practitioners owe the same moral commitment to an employer in the private sector as they would owe to an employer that is part of the state-run National Health Service. I explore some arguments around this issue, focusing on ways of identifying organisational commitment to good health care. With regard to the practitioners commitment to the organisation I consider two strengths of commitment, normative and c... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1944822 Thu, 06 Nov 2008 00:41:45 +0100 1944822 http://www.medworm.com/index.php?rid=3099529&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft506246p03529104%2F The Nature of Vital Goals: Comment on Andrew Bloodworth’s Review of Rationality and Compulsion Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-008-0098-4Authors Lennart Nordenfelt, Linköping University Department of Medicine and Health 58183 Linköping Sweden Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 Journal Volume Volume 17 Journal Issue Volume 17, Number 1 / March, 2009 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=3099529 Sat, 04 Oct 2008 09:29:37 +0100 3099529 http://www.medworm.com/index.php?rid=1855488&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft506246p03529104%2F Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-008-0098-4Authors Lennart Nordenfelt, Linköping University Department of Medicine and Health 58183 Linköping Sweden Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1855488 Sat, 04 Oct 2008 09:29:37 +0100 1855488 http://www.medworm.com/index.php?rid=1840370&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx071386q03633gv2%2F Abstract  Though abortion is legal in Canada, policies currently in place at various levels of the health care system, and the individual actions of medical professionals, can inhibit access to abortion. This paper examines the various extra-legal barriers to abortion access that exist in Canada, and argues that these barriers are unjust because there are no good reasons for the restrictions on autonomy that they present. The paper then outlines the various policy measures that could be taken to improve access. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-008-0101-0Authors Chris Kaposy, Dalhousie University 1234 LeMarchant Street Halifax Canada NS B3H 3P7 Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Heal... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1840370 Sat, 27 Sep 2008 14:01:02 +0100 1840370 http://www.medworm.com/index.php?rid=1785570&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fvn86850783121736%2F Content Type Journal ArticleCategory Review EssayDOI 10.1007/s10728-008-0096-6Authors Andrew Bloodworth, Swansea University Department of Philosophy, History and Law, School of Health Science Singleton Park Swansea SA28PP UK Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1785570 Wed, 10 Sep 2008 08:41:31 +0100 1785570 http://www.medworm.com/index.php?rid=1749660&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm278522672260q17%2F Abstract  In applied health care research, an essentialised notion of culture is often used when studying ethnic disparities in health and health care access between the majority populations of Western countries and migrants, with ethnic backgrounds that differ from majority population. This notion of culture, however, is considered highly problematic in anthropology and ethnic studies. Therefore, in our research on Dutch illness certification practices, we employed a dynamic conceptualisation of culture. Our research shows that, in practice, when clients fail to meet the implicit norms of this practice, doctors ascribe this nonconformity differently when the client is a migrant than when he or she is a Dutch client. More specifically, when migrants fail to meet the norms, ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1749660 Sat, 30 Aug 2008 11:16:20 +0100 1749660 http://www.medworm.com/index.php?rid=1685745&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7076gg5k57131115%2F Abstract  This paper is a response to a paper by John Coggon ‘Best Interests, Public Interest, and the Power of the Medical Profession'. It argues that certain legal judgements in relation to best interests seek to change and curtail the role of the medical profession in this arena while simultaneously extending the jurisdiction of the courts. It also argues that we must guard against replacing one professional standard, that of the medical profession, with another, that of the judiciary in this area. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-008-0085-9Authors Muireann Quigley, University of Manchester Centre for Social Ethics and Policy/Institute of Science, Ethics and Innovation, School of Law Rm 2.07 Williamson Building, Oxford Rd Manche... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1685745 Tue, 05 Aug 2008 07:08:49 +0100 1685745 http://www.medworm.com/index.php?rid=1685746&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fxjn4j478058u671j%2F This article will examine the role of the rational decision-maker in medical law and argue that this role is limited. The paper concludes by suggesting how we view the relationship between ‘best interests’ and ‘pragmatism’. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-008-0089-5Authors Sheelagh McGuinness, University of Manchester Institute for Science, Ethics and Innovation, Centre for Social Ethics and Policy, School of Law Williamson Building, Oxford Road Manchester M20 4LZ UK Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1685746 Tue, 05 Aug 2008 07:08:46 +0100 1685746 http://www.medworm.com/index.php?rid=1678919&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fqt5774435u430027%2F This article comments briefly on three specific issues in Shazia Choudhry’s paper “‘Best Interests’ What can healthcare law learn from family law?” The three issues are: (1) the implications of ‘best interests’ and ‘welfare science’ for women within the family law and the health care law context, (2) the risk of capture by the ‘welfare science’ industry, and (3) the proposal that a committee of medical experts and medical ethicists should be set up to provide reports to the Court of Protection on cases brought under the Mental Capacity Act 2005 (MCA). I argue that the risk of capture by ‘welfare science’ is equally large in health care law and that a committee of the kind envisaged by Choudhry is unlikely to contribute significantly to conflict resolution un... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1678919 Sat, 02 Aug 2008 07:02:51 +0100 1678919 http://www.medworm.com/index.php?rid=1678918&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F17731q5kl39w5224%2F Content Type Journal ArticleCategory IntroductionDOI 10.1007/s10728-008-0091-yAuthors John Coggon, University of Manchester School of Law, Centre for Social Ethics and Policy, and Institute for Science, Ethics and Innovation Manchester UKSøren Holm, Cardiff University School of Law, Cardiff Centre for Ethics, Law and Society Cardiff UK Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1678918 Sat, 02 Aug 2008 07:02:51 +0100 1678918 http://www.medworm.com/index.php?rid=1678920&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg376u1341q8201wj%2F This article aims to provide a critical appraisal of how the standard has been applied within family law, to outline how the standard is to be applied within healthcare law and, finally, to assess the relevance of the family law experience of the best interests standard to the operation of the standards as envisaged by the MCA. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-008-0084-xAuthors Shazia Choudhry, University of London Queen Mary College Mile End Road London E14NS UK Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1678920 Sat, 02 Aug 2008 07:02:46 +0100 1678920 http://www.medworm.com/index.php?rid=1678921&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy61t566443l7vg50%2F Abstract  This paper considers the role of the concept of best interests in the treatment of mental disorder. It considers the Mental Capacity Act 2005 where treatment of an incapacitated person’s mental disorder is authorized if treatment is in the patient’s own best interests. It also examines the Mental Health Act 1983 as amended by the Mental Health Act 2007 where treatment without consent of a detained patient is allowed where necessary for the patient’s health or safety or for the protection of others. Under both statutory regimes treatment must be in the best interests of the patient. This paper argues that ‘best interests’ is open to interpretation to include treatment interventions carried out primarily to protect other people. Content Type Journal Arti... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1678921 Sat, 02 Aug 2008 07:02:45 +0100 1678921 http://www.medworm.com/index.php?rid=1642107&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F353674n070734107%2F Abstract  Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and se... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1642107 Sat, 19 Jul 2008 13:59:42 +0100 1642107 http://www.medworm.com/index.php?rid=1642106&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb7x845r5522n7233%2F Abstract  Simon Woods proposes that we ought to re-orientate clinical decisions at the end of life back towards the patient, so as to honour his or her account of their “global” interests. Woods condemns the current medico-legal approach for remaining too closely tethered to the views of doctors. In this response, I trace the story of Mrs Kelly Taylor, who sought to be sedated and have life-sustaining treatment withdrawn, and I do so in order to show not only why Woods is right to detect an asymmetry in the law but also why there is more to the legal landscape than first appears. I argue that patient choice is indeed bounded—most obviously by the views of the doctors (and the judges), but no less significantly by so-called “public interest” concerns. Woods’ prop... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1642106 Sat, 19 Jul 2008 13:59:42 +0100 1642106 http://www.medworm.com/index.php?rid=1642109&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj116410672710238%2F Abstract  This is a response to Professor Fennell's paper on the recent influence and impact of the best interests test on the treatment of patients detained under the Mental Health Act 1983 (MHA) for mental disorder. I discuss two points of general ethical significance raised by Professor Fennell. Firstly, I consider his argument on the breadth of the best interests test, incorporating as it does factors considerably wider than those of medical justifications and the risk of harm. Secondly, I discuss his contention that the apparent permeability of the line between the interests of the patient and the interests of society is something to be concerned about in itself. Since the overarching theme of the paper is the proper place of social and cultural values, my reponse cons... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1642109 Sat, 19 Jul 2008 13:59:41 +0100 1642109 http://www.medworm.com/index.php?rid=1642108&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft6363508255366x5%2F This article provides an understanding and defence of ‘best interests’. The analysis is performed in the context of, and is informed by, English law. The understanding that develops allows for differences in values, and is thus argued to be appropriate in a pluralist liberal system. When understood properly, it is argued, best interests provides the best means of decision-making for people deemed incompetent to decide for themselves. It is accepted that some commentators are cynical of best interests in practice. Following an assessment of some of their principal concerns, it is suggested that best interests in fact provides a construct that is both defensible and desirable. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-008-0087-7Authors John Coggon,... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1642108 Sat, 19 Jul 2008 13:59:41 +0100 1642108 http://www.medworm.com/index.php?rid=1642111&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F2233608650q50885%2F Abstract  On one conception of “best interest” there can only be one course of action in a given situation that is in a person’s best interest. In this paper we will first consider what theories of “best interest” and rational decision-making that can lead to this conclusion and explore some of the less commonly appreciated implications of these theories. We will then move on to consider what ethical theories that are compatible with such a view and explore their implications. In the second part of the paper we will explore a range of possible criticisms of these views. And in the third part we will criticise the view that a court is always or even often in a good position to decide what the patient’s best interest is. In the fourth and final part we will put fo... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1642111 Sat, 19 Jul 2008 13:59:39 +0100 1642111 http://www.medworm.com/index.php?rid=1642110&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa2113683386n2601%2F Abstract  In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by activel... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1642110 Sat, 19 Jul 2008 13:59:39 +0100 1642110 http://www.medworm.com/index.php?rid=1517948&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F85140274n8630848%2F In this study of trust within a Primary Care Partnership (PCP) in Australia the experiences of risk and uncertainty, and control, of participants in different structural positions, were explored in detail. The data used in this paper was qualitative, derived from 63 interviews with managers and service providers participating in committees of the PCP. This paper reports on the differences in the experience of risk and uncertainty, trust and control, of managers and service providers working as boundary spanners through the committees of a PCP. For managers there were significant risks and uncertainties, and trust and control were important. For service providers there were few risks and uncertainties, and trust and control were of much less importance. Some policy implications of the... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1517948 Thu, 12 Jun 2008 06:28:56 +0100 1517948 http://www.medworm.com/index.php?rid=1272252&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F6p02u37231842204%2F Abstract  This paper argues that the concept of best interests in the context of clinical decisions draws on concepts rooted in the philosophical discipline of axiology. Reflection on the philosophical origins enables a distinction to be drawn between those interests related to clinical goals and those global interests that are axiological in nature. The implication of this distinction is most clearly seen in the context of end of life decisions and it is argued here that greater weight ought to be given to the positive requests, and not merely competent refusals, of patients at the end of life. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-008-0083-yAuthors Simon Woods, Newcastle University Policy Ethics and Life Sciences Research Centre Cityga... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1272252 Sat, 01 Mar 2008 08:08:15 +0100 1272252 http://www.medworm.com/index.php?rid=1269364&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F8x07k002817r1938%2F Abstract  Progress in medicine and the subsequent extension of health coverage has meant that health expenditure has increased sharply in Western countries. In the United States, this rise was precipitated in the 1980s, compounded by an increase in drug consumption which prompted the government to re-examine its financial support to care delivery, most notably in hospital care and emergencies services. In California for example, 50 emergency service providers were closed between 1990 and 2000, and nine in 1999–2000 alone. In that State, only 355 hospitals (out of 568) have maintained emergency services departments (Darves, WebMB, 2001). Reforming hospital Emergency Department (ED) operations requires caution not only because the media pay a lot of attention to ED operatio... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1269364 Thu, 28 Feb 2008 15:39:50 +0100 1269364 http://www.medworm.com/index.php?rid=1184091&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fck64676351w41220%2F Abstract  Bioethics as an academic discipline comes into public discourse when real life “hard cases” receive media attention. Since cases of this sort increasingly often become the subject of litigation, the forum for debate can be a court of law, with judges as the final arbiters. Judges (unlike philosophers) are obliged to give final and definitive rulings in a constrained time period. Their training is in a type of discourse very different from moral philosophy, though still concerned with right and wrong. This paper explores the differences between the tools and methods used in public legal debate and private academic discourse, and the different nature of the answers they produce. It attempts to suggest some ways in which bioethicists can better understand lawyers... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1184091 Thu, 24 Jan 2008 16:57:16 +0100 1184091 http://www.medworm.com/index.php?rid=1149371&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh76685142r066817%2F Abstract  Health professionals increasingly face patients with complex health problems and this pressurizes them to cooperate. The authors have analyzed how the complexity of health care problems relates to two types of cooperation: consultation and multidisciplinary teamwork (MTW). Moreover, they have analyzed the impact of these two types of cooperation on perceived professional autonomy. Two teams were studied, one team dealing with geriatric patients and another treating oncology patients. The authors conducted semi-structured interviews, studied written documents, held informal discussions and observed the teams at work. Consultation was most likely to take place when a patient had multiple problems. However, if these problems were interrelated, i.e. the solution for o... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1149371 Sat, 12 Jan 2008 16:29:57 +0100 1149371 http://www.medworm.com/index.php?rid=1108212&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr202035w61257665%2F Abstract  Power, dominance, and hierarchy are prevalent analytical terms in social studies of health care. Power is often seen as residing in medical structures, institutions, discourses, or ideologies. While studies of medical power often draw on Michel Foucault, this understanding is quite different from his proposal to study in detail the “strategies, the networks, the mechanisms, all those techniques by which a decision is accepted” [Foucault, M. (1988). In Politics, philosophy, culture: Interviews and other writings 1977–84 (pp. 96–109). New York: Routledge]. This suggestion turns power into a topic worth investigating in its own right rather than a basic analytical resource. It also suggests that technologies form an integral part of the networks and mechanisms,... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1108212 Tue, 18 Dec 2007 15:50:30 +0100 1108212 http://www.medworm.com/index.php?rid=1103136&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fql1072g466p09821%2F Content Type Journal ArticleCategory EditorialDOI 10.1007/s10728-007-0077-1Authors Jonathan Ives, The University of Birmingham Department of Philosophy, Centre for the Study of Global Ethics Edgbaston Birmingham B25 2TT UK Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1103136 Sun, 16 Dec 2007 18:52:29 +0100 1103136 http://www.medworm.com/index.php?rid=1099798&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F06237424gtr13562%2F Abstract  The paper explores how several commissions of inquiry established in Quebec, Canada, have, over time, contributed in redefining the meaning of quality in health-care and its management. Adopting an interpretive analysis of commissions’ reports, the paper examines the particular ‘conceptual boxes’ used by their members to tackle quality and the embedded nature of their work. It is shown that although quality was always considered, this was generally done by bringing into focus specific quality domains and issues, some new, others not so new. In addition, the various management approaches to quality featured in the reports were informed by evolving templates; although this evolution was not as straight and unwavering as some retrospective studies of quality in... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1099798 Sat, 15 Dec 2007 19:39:11 +0100 1099798 http://www.medworm.com/index.php?rid=1099797&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy27564l376x94234%2F Content Type Journal ArticleCategory EditorialDOI 10.1007/s10728-007-0079-zAuthors Anna Smajdor, Imperial College London Medical Ethics Unit Charing Cross campus, Reynolds Building, St. Dunstan’s Road London W6 8RP UKJonathan Ives, The University of Birmingham Department of Philosophy, Centre for the Study of Global Ethics Edgbaston, Birmingham B25 2TT UKEmma Baldock, King’s College London Institute of Psychiatry De Crespigny Park, Denmark Hill London SE5 8AF UKAdele Langlois, The Open University Development Policy and Practice/Innogen Walton Hall Milton Keynes MK7 6AA UK Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1099797 Sat, 15 Dec 2007 19:39:11 +0100 1099797 http://www.medworm.com/index.php?rid=1032370&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F5190020t51h78615%2F Abstract  One way of evaluating health is in terms of its impact on well-being. It has been shown, however, that evaluating health this way runs into difficulties, since health and other aspects of well-being are not separable. At the same time, the practical implications of the inseparability problem remain unclear. This paper assesses these implications by considering the relations between theories, components, and indicators of well-being. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-007-0066-4Authors Greg Bognar, Harvard University Program in Ethics & Health 641 Huntington Ave Boston MA 02115 USA Journal Health Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1032370 Thu, 15 Nov 2007 20:48:23 +0100 1032370 http://www.medworm.com/index.php?rid=1012097&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1617287r4603701n%2F Abstract  The concept of ‘empowerment’ is used frequently in a number of professional areas, from psychotherapy to social work. But even if the same term is used, it is not always clear if the concept denotes the same goals or the same practice in these various fields. The purpose of this paper is to clarify the discussion and to find a plausible and useful definition of the concept that is suitable for work in various professions. Several suggestions are discussed in the paper, for example control over life or health, autonomy, ability, self-efficacy, self-esteem, and freedom, and it is concluded that there are two plausible complementary uses, one as a goal and one as a process or approach. Empowerment as a goal is to have control over the determinants of one’s qual... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1012097 Tue, 06 Nov 2007 15:48:03 +0100 1012097 http://www.medworm.com/index.php?rid=1002109&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fqp2l53u165754353%2F Abstract  Promoting patient autonomy has become a key imperative in health service encounters. We will examine the potential negative effects of over-promoting patient autonomy and consider the impact on patient access, their experience and the provision of equitable services by focusing on an extreme manifestation of this trend, i.e. calls for patient involvement in health care decision making to be mandatory. Advocates of mandatory autonomy hold that patients have a duty to themselves, to society and to the medical system to make decisions on their health care independently. Models of mandatory autonomy may be contrasted to those of optional autonomy that seek to ascertain patients’ decisional preferences and to understand wider limitations on their freedom to choose. Wh... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=1002109 Fri, 02 Nov 2007 14:39:01 +0100 1002109 http://www.medworm.com/index.php?rid=991337&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp66684x3j47517lr%2F Abstract  In Europe, a well-known problem is the coordination of interagency service delivery to independently living older persons, disabled persons or persons suffering from chronic illness. Coordination is necessary in order for the users to receive services at the appropriate time and place. Based on historical institutionalism, which focuses on the path dependency of the development of government policy and organizational and professional rules, it can be stated that coordination requires organizational models or other solutions that fit the characteristics of the context (‘configuration’) for which the solution is intended. The western European countries have different configurations. Remarkably, across these countries, we see the emergence of multidisciplinary te... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=991337 Sat, 27 Oct 2007 17:40:01 +0100 991337 http://www.medworm.com/index.php?rid=978758&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm823t3tu10488614%2F Abstract  This paper argues for the necessity of universal health care (as well as universal free education) using a different argument than most that have been made heretofore. It is not meant to conflict with but to strengthen the arguments previously made by others. Using the second paragraph of the Declaration of Independence and the Preamble to the Constitution we argue that universal health care in this day and age has become a necessary condition if the ideals of life, liberty and the pursuit of happiness are to be more than an empty promise and if the discussion of “promoting of general welfare” in the preamble is to have any meaning. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s10728-007-0063-7Authors Erich H. Loewy, University of Califor... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=978758 Wed, 24 Oct 2007 14:59:54 +0100 978758 http://www.medworm.com/index.php?rid=963987&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F97xl7476556388r0%2F Abstract  Today, health systems around the world are under pressure to create greater value for patients and society [81, p. 1, 119]; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating higher value in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=963987 Thu, 18 Oct 2007 16:17:37 +0100 963987 http://www.medworm.com/index.php?rid=963986&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1x4h4305071658h3%2F Abstract   Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethic... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=963986 Thu, 18 Oct 2007 16:17:37 +0100 963986 http://www.medworm.com/index.php?rid=946677&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fnt53984111762025%2F Abstract  There is continuing interest in action research in health care. This is despite action researchers facing major problems getting support for their projects from mainstream sources of R&D funds partly because its validity is disputed and partly because it is difficult to predict or evaluate and is therefore seen as risky. In contrast traditional health science dominates and relies on compliance with strictly defined scientific method and rules of accountability. Critics of scientific health care have highlighted many problems including a perpetual quality gap between what is publicly expected and what is deliverable in the face of rising costs and the cultural variability of scientific medicine. Political demand to close the quality gap led to what can be seen as a... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=946677 Thu, 11 Oct 2007 15:14:42 +0100 946677 http://www.medworm.com/index.php?rid=946676&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F75307783204q4070%2F Abstract  A possible explanation for policy implementation failure is that the views of the policy’s target groups are insufficiently taken into account during policy development. It has been argued that involving these groups in an interactive process of policy development could improve this. We analysed a project in which several target populations participated in workshops aimed to optimise the utilisation of an expensive novel drug (interferon beta) for patients with Multiple Sclerosis. All participants seemed to agree on the appropriateness of establishing a central registry of Multiple Sclerosis patients and developing guidelines. Nevertheless, these policy measures were not implemented. Possible explanations include (1) the subject no longer had high priority when ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=946676 Thu, 11 Oct 2007 15:14:42 +0100 946676 http://www.medworm.com/index.php?rid=944150&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3221002447x288v2%2F Abstract  In this article two inter-related issues concerning the ongoing commercialisation of biomedical research are analyzed. One aim is to explain how scientists and clinicians at Swedish public institutions can make profits, both commercially and scientifically, by controlling rare human biological material, like embryos and embryonic stem cell lines. This control in no way presupposes legal ownership or other property rights as an initial condition. We show how ethically sensitive material (embryos and stem cell lines) have been used in Sweden as a foundation for a commercial stem cell enterprise—despite all official Swedish strictures against commercialisation in this area. We also show how political decisions may amplify the value of controlling this kind of biolo... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=944150 Wed, 10 Oct 2007 16:23:05 +0100 944150 http://www.medworm.com/index.php?rid=938453&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fer2x7140w08501k6%2F Abstract  Consulting the public about the ethical approaches underlying health policies can seem an appealing means of addressing concerns about limited public participation in development of health policy. However ambiguity surrounds questions of whether, or how consultation can really contribute to more defensible decisions about ethical aspects of policy. This paper clarifies the role and limits of public consultation on ethics, beginning by separating different senses of defensibility in decisions on ethics. Defensibility of ethical decisions could be understood either in the sense of legitimacy in virtue of reflecting the opinions of the public whose interests are affected, or in the sense of being able to withstand and respond to challenges presented in ethical debate... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=938453 Sat, 06 Oct 2007 17:41:37 +0100 938453 http://www.medworm.com/index.php?rid=938452&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F6726222h70827j10%2F Abstract  This paper suggests the adoption of a ‘capability approach’ to key concepts in healthcare. Recent developments in theoretical approaches to concepts such as ‘health’ and ‘disease’ are discussed, and a trend identified of thinking of health as a matter of having the capability to cope with life’s demands. This approach is contrasted with the WHO definition of health and Boorse’s biostatistical account. We outline the ‘capability approach’, which has become standard in development ethics and economics, and show how existing work in those areas can profitably be adapted to healthcare. Cases are used to illustrate the value of adopting a capability approach. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10728-007-0070-8Autho... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=938452 Sat, 06 Oct 2007 17:41:37 +0100 938452 http://www.medworm.com/index.php?rid=807167&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F38671066063t5886%2F Abstract  Recent medical informatics and sociological literature has painted the image of a new type of patient—one that is reflexive and informed, with highly specified information needs and perceptions, as well as highly developed skills and tactics for acquiring information. Patients have been re-named “reflexive consumers.” At the same time, literature about the questionable reliability of web-based information has suggested the need to create both user tools that have pre-selected information and special guidelines for individuals to use to check the individual characteristics of the information they encounter. In this article, we examine suggestions that individuals must be assisted in developing skills for “reflexive consumerism” and what these particular s... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=807167 Sat, 18 Aug 2007 07:02:15 +0100 807167 http://www.medworm.com/index.php?rid=804264&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd6l1711843158122%2F Abstract  Autonomy is a concept that holds much appeal to social and legal philosophers. Within a medical context, it is often argued that it should be afforded supremacy over other concepts and interests. When respect for autonomy merely requires non-intervention, an adult’s right to refuse treatment is held at law to be absolute. This apparently simple statement of principle does not hold true in practice. This is in part because an individual must be found to be competent to make a valid refusal of consent to medical treatment, and capacity to decide is not an absolute concept. But further to this, I argue that there are three relevant understandings of autonomy within our society, and each can demand in differing cases that different courses of action be followed. Jud... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=804264 Thu, 16 Aug 2007 08:55:11 +0100 804264 http://www.medworm.com/index.php?rid=804263&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F5754r76802w23642%2F This article was written whilst under the influence of Nietzsche, and I hope that readers will not mistake the polemical style and the occasional nod towards humour for flippancy. This is a serious subject, and this article attempts to ask, inexplicitly, a serious question. If we do suspend our subjective value judgements about life, and strip away what might be considered the ‘dogma’ of value in life, what effect might this have on our feelings towards voluntary euthanasia, and what can our reaction to that thought experiment tell us? Content TypeJournal Article JournalHealth Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=804263 Thu, 16 Aug 2007 08:55:11 +0100 804263 http://www.medworm.com/index.php?rid=804262&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv387128615723130%2F Abstract  This paper forms part of the feminist critique of the regulatory consequences of biomedicine’s systematic exclusion of the role of women’s bodies in the development of reprogenetic technologies. I suggest that strategic use of notions of the sacred to decontextualise and delimit disagreement fosters this marginalisation. Here conceptions of the sacred and sacralisation afford a means by which pragmatic consensus over regulation may be achieved, through the deployment of a bricolage of dense images associated with cultural loyalties to solidify support or exclude contradictory elements. Hence an explicit renegotiation of the symbolic order structuring salient debates is necessary to disrupt and enrich the entrenched and exclusionary dominant discourse over repr... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=804262 Thu, 16 Aug 2007 08:55:10 +0100 804262 http://www.medworm.com/index.php?rid=802050&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff0w3v467v3842422%2F Abstract  Health care systems throughout the developed world face ‘crises’ of quality, financing and sustainability. These pressures have led governments to look for more efficient and equitable ways to allocate public resources. Prioritisation of health care services for public funding has been one of the strategies used by decision makers to reconcile growing health care demands with limited resources. Priority setting at the macro level has yet to demonstrate real successes. This paper describes international approaches to explicit prioritisation at the macro-governmental level in the six experiences most published in the English literature; analyzes the ways in which values, principles and other normative concepts were presented in these international priority setti... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=802050 Wed, 15 Aug 2007 06:43:26 +0100 802050 http://www.medworm.com/index.php?rid=793332&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F45x14718210646k7%2F Abstract  A considerable section of the population in India accesses the services of individual private medical practitioners (PMPs) for primary level care. In rural areas, these providers include MBBS doctors, practitioners of alternative systems of medicine, herbalists, indigenous and folk practitioners, compounders and others. This paper describes the profile, knowledge and some practices of the rural doctor in India and then discusses the reasons for lack of equity in health care access in rural areas and possible solutions to the problem. Content TypeJournal Article JournalHealth Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=793332 Fri, 10 Aug 2007 07:12:38 +0100 793332 http://www.medworm.com/index.php?rid=745320&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F8710024851274361%2F Content TypeJournal Article JournalHealth Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 Journal VolumeVolume 6 Journal IssueVolume 6, Number 4 / December, 1998 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=745320 Thu, 19 Jul 2007 07:22:00 +0100 745320 http://www.medworm.com/index.php?rid=745318&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg58m66p4792rv378%2F Abstract  In many countries health policy and health system reforms are giving primary health care (PHC) a more prominent role in the health system. As a result, policy towards PHC is becoming more contested and is posing bigger and more contradictory demands of PHC (e.g. that PHC should at once be more accessible and of higher quality and cheaper). International and professional bodies have responded to the debates about what the role of PHC should be partly by promulgating redefinitions of ‘primary health care’. However, such definitions tend simply to assert a policy standpoint of their own, thereby begging the policy questions noted above. This paper tests some better-known current definitions of ‘primary health care’ against various criteria of validity, includ... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=745318 Thu, 19 Jul 2007 07:22:00 +0100 745318 http://www.medworm.com/index.php?rid=745314&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1435382782027504%2F Content TypeJournal Article JournalHealth Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 Journal VolumeVolume 6 Journal IssueVolume 6, Number 4 / December, 1998 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=745314 Thu, 19 Jul 2007 07:22:00 +0100 745314 http://www.medworm.com/index.php?rid=745312&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq422u24g04812m66%2F Abstract  Since 1994, health policy in the UK has focused explicitly on making the NHS ‘primary care-led’. However, the meaning of primary is contested by different health professions and by policy-makers. This paper charts the major points of debate since the 1960s and suggests that there are limitations as to what general practice can be expected to deliver in respect of primary care. Content TypeJournal Article JournalHealth Care AnalysisOnline ISSN 1573-3394Print ISSN 1065-3058 Journal VolumeVolume 6 Journal IssueVolume 6, Number 4 / December, 1998 (Source: Health Care Analysis) Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=745312 Thu, 19 Jul 2007 07:22:00 +0100 745312 http://www.medworm.com/index.php?rid=745308&cid=s_33394_51_f&fid=33394&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk3k6537815210152%2F Abstract  Recent interpretations of citizenship are firmly rooted in the value of social membership and social participation. Citizens are described as having a moral right to draw upon the support of the community, but at the same time have a responsibility to contribute to the provision of social services such as health care. In contrast, contemporary health economics has been criticised for taking a narrow and individualistic view of human behaviour. This paper examines the extent to which economic theory and practice have been developed to accommodate a more ‘civic’ view, namely, the notions of mutual concern for community members, social participation and social rights. It is argued that because the provision of health care is often linked to feelings of compassion... Health Care Analysis journals http://www.medworm.com/rss/comments.php?id=745308 Thu, 19 Jul 2007 07:21:58 +0100 745308