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Mihailov E, Provoost V, Wangmo T. Acceptable objectives of empirical research in bioethics: a qualitative exploration of researchers' views. BMC Med Ethics 2022; 23:140. [PMID: 36575520 PMCID: PMC9794471 DOI: 10.1186/s12910-022-00845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This is the first qualitative study to investigate how researchers, who do empirical work in bioethics, relate to objectives of empirical research in bioethics (ERiB). We explore reasons that make some objectives more acceptable, while others are deemed less acceptable. METHODS Using qualitative exploratory study design, we interviewed bioethics researchers, who were selected to represent different types of scholars working in the field. The interview data of 25 participants were analyzed in this paper using thematic analysis. RESULTS From the eight objectives presented to the study participants, understanding the context of a bioethical issue and identifying ethical issues in practice received unanimous agreement. Participants also supported other objectives of ERiB but with varying degrees of agreement. The most contested objectives were striving to draw normative recommendations and developing and justifying moral principles. The is-ought gap was not considered an obstacle to ERiB, but rather a warning sign to critically reflect on the normative implications of empirical results. CONCLUSIONS Our results show that the most contested objectives are also the more ambitious ones, whereas the least contested ones focus on producing empirical results. The potential of empirical research to be useful for bioethics was mostly based on the reasoning pattern that empirical data can provide a testing ground for elements of normative theory. Even though empirical research can inform many parts of bioethical inquiry, normative expertise is recommended to guide ERiB. The acceptability of ambitious objectives for ERiB boils down to finding firm ground for the integration of empirical facts in normative inquiry.
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Affiliation(s)
- Emilian Mihailov
- grid.5100.40000 0001 2322 497XFaculty of Philosophy, University of Bucharest, Bucharest, Romania
| | - Veerle Provoost
- grid.5342.00000 0001 2069 7798Bioethics Institute Ghent, University of Ghent, Ghent, Belgium
| | - Tenzin Wangmo
- grid.6612.30000 0004 1937 0642Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Ditwiler RE, Swisher LL, Hardwick DD. Doing things you never imagined: Professional and ethical issues in the U.S. outpatient physical therapy setting during the COVID-19 pandemic. Musculoskelet Sci Pract 2022; 62:102684. [PMID: 36356408 PMCID: PMC9617680 DOI: 10.1016/j.msksp.2022.102684] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite being the most prevalent physical therapy practice setting in the United States, no literature to date has examined the professional and ethical issues faced by outpatient physical therapists during the COVID-19 pandemic. The purpose of this study was to explore professional and ethical issues experienced by outpatient physical therapists in the United States during the COVID-19 pandemic. DESIGN An explorative semi-structured interview study using reflexive thematic analysis METHODS: Virtual semi-structured interviews explored physical therapists' experiences during COVID-19 in the OP setting. Data was analyzed using reflexive thematic analysis as described by Braun and Clarke. RESULTS Respondents worked predominantly with patients with orthopaedic impairments. Six primary themes and associated subthemes were identified: 1) Disruption of routine professional and personal life. 2) Negative impacts on health and wellbeing (physical, mental, and social). 3) Barriers to relationships, communication, and providing quality care. 4) Telehealth as a safe option to increase access with opportunities and challenges. 5) Discomfort practicing in an environment of misinformation, mistrust, and divisiveness. 6) New & pre-existing ethical issues in the COVID-19 context. CONCLUSIONS Results of this study indicate that physical therapists in the outpatient setting wrestled with critical questions regarding outpatient physical therapy practice during the COVID-19 pandemic: the role of touch in professional identity, challenges to the therapeutic alliance, effect of productivity and fiscal expectations and whether outpatient physical therapy is essential during public emergencies.
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Affiliation(s)
- Rebecca Edgeworth Ditwiler
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, USF Health Morsani College of Medicine, Tampa, FL, USA.
| | - Laura Lee Swisher
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Dustin Dean Hardwick
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, USF Health Morsani College of Medicine, Tampa, FL, USA,School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
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Lee JS, Kim S, Do YK. Public Preferences for Allocation Principles for Scarce Medical Resources in the COVID-19 Pandemic in Korea: Comparisons With Ethicists' Recommendations. J Prev Med Public Health 2021; 54:360-369. [PMID: 34649398 PMCID: PMC8517370 DOI: 10.3961/jpmph.21.333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate public preferences regarding allocation principles for scarce medical resources in the coronavirus disease 2019 (COVID-19) pandemic, particularly in comparison with the recommendations of ethicists. METHODS An online survey was conducted with a nationally representative sample of 1509 adults residing in Korea, from November 2 to 5, 2020. The degree of agreement with resource allocation principles in the context of the medical resource constraints precipitated by the COVID-19 pandemic was examined. The results were then compared with ethicists' recommendations. We also examined whether the perceived severity of COVID-19 explained differences in individual preferences, and by doing so, whether perceived severity helps explain discrepancies between public preferences and ethicists' recommendations. RESULTS Overall, the public of Korea agreed strongly with the principles of "save the most lives," "Koreans first," and "sickest first," but less with "random selection," in contrast to the recommendations of ethicists. "Save the most lives" was given the highest priority by both the public and ethicists. Higher perceived severity of the pandemic was associated with a greater likelihood of agreeing with allocation principles based on utilitarianism, as well as those promoting and rewarding social usefulness, in line with the opinions of expert ethicists. CONCLUSIONS The general public of Korea preferred rationing scarce medical resources in the COVID-19 pandemic predominantly based on utilitarianism, identity and prioritarianism, rather than egalitarianism. Further research is needed to explore the reasons for discrepancies between public preferences and ethicists' recommendations.
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Affiliation(s)
- Ji-Su Lee
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Soyun Kim
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
| | - Young Kyung Do
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.,Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
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Hernández-Marrero P, Martins Pereira S, de Sá Brandão PJ, Araújo J, Carvalho AS. Toward a bioethical framework for antibiotic use, antimicrobial resistance and for empirically designing ethically robust strategies to protect human health: a research protocol. J Int Med Res 2017; 45:1787-1793. [PMID: 28459355 PMCID: PMC5805197 DOI: 10.1177/0300060517697595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/11/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a challenging global and public health issue, raising bioethical challenges, considerations and strategies. Objectives This research protocol presents a conceptual model leading to formulating an empirically based bioethics framework for antibiotic use, AMR and designing ethically robust strategies to protect human health. Methods Mixed methods research will be used and operationalized into five substudies. The bioethical framework will encompass and integrate two theoretical models: global bioethics and ethical decision-making. Results Being a study protocol, this article reports on planned and ongoing research. Conclusions Based on data collection, future findings and using a comprehensive, integrative, evidence-based approach, a step-by-step bioethical framework will be developed for (i) responsible use of antibiotics in healthcare and (ii) design of strategies to decrease AMR. This will entail the analysis and interpretation of approaches from several bioethical theories, including deontological and consequentialist approaches, and the implications of uncertainty to these approaches.
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Affiliation(s)
- Pablo Hernández-Marrero
- Instituto de Bioética, Universidade
Católica Portuguesa, Porto, Portugal
- UNESCO Chair in Bioethics, Institute of
Bioethics, Universidade Católica Portuguesa, Porto, Portugal
| | - Sandra Martins Pereira
- Instituto de Bioética, Universidade
Católica Portuguesa, Porto, Portugal
- UNESCO Chair in Bioethics, Institute of
Bioethics, Universidade Católica Portuguesa, Porto, Portugal
| | | | - Joana Araújo
- Instituto de Bioética, Universidade
Católica Portuguesa, Porto, Portugal
- UNESCO Chair in Bioethics, Institute of
Bioethics, Universidade Católica Portuguesa, Porto, Portugal
| | - Ana Sofia Carvalho
- Instituto de Bioética, Universidade
Católica Portuguesa, Porto, Portugal
- UNESCO Chair in Bioethics, Institute of
Bioethics, Universidade Católica Portuguesa, Porto, Portugal
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Abstract
In 2016, Keyes and Galea issued 9 foundational principles of population health science and invited further deliberations by specialists to advance the field. This article presents 7 foundational principles of population health policy whose intersection with health care, public health, preventive medicine, and now population health, presents unique challenges. These principles are in response to a number of overarching questions that have arisen in over a decade of the authors' collective practice in the public and private sectors, and having taught policy within programs of medicine, law, nursing, and public health at the graduate and executive levels. The principles address an audience of practitioners and policy makers, mindful of the pressing health care challenges of our time, including: rising health-related expenditures, an aging population, workforce shortages, health disparities, and a backdrop of inequities rooted in social determinants that have not been adequately translated into formal policies or practices among the key stakeholders in population health. These principles are meant to empower stakeholders—whether it is the planner or the practitioner, the decision maker or the dedicated caregiver—and inform the development of practical tools, research, and education.
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Affiliation(s)
- Dru Bhattacharya
- 1 Department of Population Health Sciences, University of San Francisco , San Francisco, California
| | - Jay Bhatt
- 2 Northwestern Memorial Hospital , Chicago, Illinois
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Knight R, Small W, Carson A, Shoveller J. Complex and Conflicting Social Norms: Implications for Implementation of Future HIV Pre-Exposure Prophylaxis (PrEP) Interventions in Vancouver, Canada. PLoS One 2016; 11:e0146513. [PMID: 26756474 PMCID: PMC4710521 DOI: 10.1371/journal.pone.0146513] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/19/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND HIV Pre-Exposure Prophylaxis (PrEP) has been found to be efficacious in preventing HIV acquisition among seronegative individuals in a variety of risk groups, including men who have sex with men and people who inject drugs. To date, however, it remains unclear how socio-cultural norms (e.g., attitudes towards HIV; social understandings regarding HIV risk practices) may influence the scalability of future PrEP interventions. The objective of this study is to assess how socio-cultural norms may influence the implementation and scalability of future HIV PrEP interventions in Vancouver, Canada. METHODS We conducted 50 interviews with young men (ages 18-24) with a variety of HIV risk behavioural profiles (e.g., young men who inject drugs; MSM). Interviews focused on participants' experiences and perceptions with various HIV interventions and policies, including PrEP. RESULTS While awareness of PrEP was generally low, perceptions about the potential personal and public health gains associated with PrEP were interconnected with expressions of complex and sometimes conflicting social norms. Some accounts characterized PrEP as a convenient form of reliable protection against HIV, likening it to the female birth control pill. Other accounts cast PrEP as a means to facilitate 'socially unacceptable' behaviour (e.g., promiscuity). Stigmatizing rhetoric was used to position PrEP as a tool that could promote some groups' proclivities to take 'risks'. CONCLUSION Stigma regarding 'risky' behaviour and PrEP should not be underestimated as a serious implementation challenge. Pre-implementation strategies that concomitantly aim to improve knowledge about PrEP, while addressing associated social prejudices, may be key to effective implementation and scale-up.
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Affiliation(s)
- Rod Knight
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Anna Carson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- * E-mail:
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Knight R, Small W, Shoveller J. How do 'Public' Values Influence Individual Health Behaviour? An Empirical-Normative Analysis of Young Men's Discourse Regarding HIV Testing Practices. Public Health Ethics 2015; 9:264-275. [PMID: 27790291 DOI: 10.1093/phe/phv031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Philosophical arguments stemming from the public health ethics arena suggest that public health interventions ought to be subject to normative inquiry that considers relational values, including concepts such as solidarity, reciprocity and health equity. As yet, however, the extent to which 'public' values influence the 'autonomous' decisions of the public remains largely unexplored. Drawing on interviews with 50 men in Vancouver, Canada, this study employs a critical discourse analysis to examine participants' decisions and motivations to voluntarily access HIV testing and/or to accept a routine HIV test offer. Within a sub-set of interviews, a transactional discourse emerged in which the decision to test features an arrangement of 'giving and receiving'. Discourses related to notions of solidarity emphasize considerations of justice and positions testing as a 'public' act. Lastly, 'individualistic' discourses focused on individual-level considerations, with less concern for the broader public 'good'. These findings underscore how normative dimensions pertaining to men's decisions to test are dialectically interrelated with the broader social and structural influences on individual and collective health-related behaviour, thereby suggesting a need to advance an explicit empirical-normative research agenda related to population and public health intervention research.
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Affiliation(s)
- Rod Knight
- Simon Fraser University, University of British Columbia, and British Columbia Centre for Excellence in HIV/AIDS
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University
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