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Towards an environmentally sensitive healthcare ethics: ten tasks and one model. JOURNAL OF MEDICAL ETHICS 2024; 50:382-383. [PMID: 38443166 DOI: 10.1136/jme-2024-109875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
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Translational (Neuro)Ethics: A Call for Supporting Equitable Determinants of Academic Practical Ethics. AJOB Neurosci 2023; 14:416-418. [PMID: 37856349 DOI: 10.1080/21507740.2023.2257160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
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On the Anatomy of Health-related Actions for Which People Could Reasonably be Held Responsible: A Framework. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2023:7187286. [PMID: 37256826 DOI: 10.1093/jmp/jhad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities.
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Dual duties to patient and planet: time to revisit the ethical foundations of healthcare? JOURNAL OF MEDICAL ETHICS 2023; 49:102-103. [PMID: 36543530 DOI: 10.1136/jme-2022-108847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
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How do we decarbonise fairly? Emissions, inequities and the implications for net zero healthcare. J R Soc Med 2022; 115:337-340. [PMID: 35944580 DOI: 10.1177/01410768221113069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ethical Algorithmic Advice: Some Reasons to Pause and Think Twice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:26-28. [PMID: 35737486 DOI: 10.1080/15265161.2022.2075053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Pursuing impact in research: towards an ethical approach. BMC Med Ethics 2022; 23:37. [PMID: 35387625 PMCID: PMC8988365 DOI: 10.1186/s12910-022-00754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research proactively and deliberately aims to bring about specific changes to how societies function and individual lives fare. However, in the ever-expanding field of ethical regulations and guidance for researchers, one ethical consideration seems to have passed under the radar: How should researchers act when pursuing actual, societal changes based on their academic work? MAIN TEXT When researchers engage in the process of bringing about societal impact to tackle local or global challenges important concerns arise: cultural, social and political values and institutions can be put at risk, transformed or even hampered if researchers lack awareness of how their 'acting to impact' influences the social world. With today's strong focus on research impacts, addressing such ethical challenges has become urgent within in all fields of research involved in finding solutions to the challenges societies are facing. Due to the overall goal of doing something good that is often inherent in ethical approaches, boundaries to researchers' impact of something good is neither obvious, nor easy to detect. We suggest that it is time for the field of bioethics to explore normative boundaries for researchers' pursuit of impact and to consider, in detail, the ethical obligations that ought to shape this process, and we provide a four-step framework of fair conditions for such an approach. Our suggested approach within this field can be useful for other fields of research as well. CONCLUSION With this paper, we draw attention to how the transition from pursuing impact within the Academy to trying to initiate and achieve impact beyond the Academy ought to be configured, and the ethical challenges inherent in this transition. We suggest a stepwise strategy to identify, discuss and constitute consensus-based boundaries to this academic activity. This strategy calls for efforts from a multi-disciplinary team of researchers, advisors from the humanities and social sciences, as well as discussants from funding institutions, ethical committees, politics and the society in general. Such efforts should be able to offer new and useful assistance to researchers, as well as research funding agencies, in choosing ethically acceptable, impact-pursuing projects.
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The Future Ethics of Artificial Intelligence in Medicine: Making Sense of Collaborative Models. SCIENCE AND ENGINEERING ETHICS 2022; 28:17. [PMID: 35362822 PMCID: PMC8975759 DOI: 10.1007/s11948-022-00369-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/21/2022] [Indexed: 05/14/2023]
Abstract
This article examines the role of medical doctors, AI designers, and other stakeholders in making applied AI and machine learning ethically acceptable on the general premises of shared decision-making in medicine. Recent policy documents such as the EU strategy on trustworthy AI and the research literature have often suggested that AI could be made ethically acceptable by increased collaboration between developers and other stakeholders. The article articulates and examines four central alternative models of how AI can be designed and applied in patient care, which we call the ordinary evidence model, the ethical design model, the collaborative model, and the public deliberation model. We argue that the collaborative model is the most promising for covering most AI technology, while the public deliberation model is called for when the technology is recognized as fundamentally transforming the conditions for ethical shared decision-making.
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Can medical algorithms be fair? Three ethical quandaries and one dilemma. BMJ Health Care Inform 2022; 29:bmjhci-2021-100445. [PMID: 35396245 PMCID: PMC8996015 DOI: 10.1136/bmjhci-2021-100445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/10/2021] [Indexed: 11/12/2022] Open
Abstract
Objective To demonstrate what it takes to reconcile the idea of fairness in medical algorithms and machine learning (ML) with the broader discourse of fairness and health equality in health research. Method The methodological approach used in this paper is theoretical and ethical analysis. Result We show that the question of ensuring comprehensive ML fairness is interrelated to three quandaries and one dilemma. Discussion As fairness in ML depends on a nexus of inherent justice and fairness concerns embedded in health research, a comprehensive conceptualisation is called for to make the notion useful. Conclusion This paper demonstrates that more analytical work is needed to conceptualise fairness in ML so it adequately reflects the complexity of justice and fairness concerns within the field of health research.
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Climate change and health in Ethiopia: To what extent have the health dimensions of climate change been integrated into the Climate‐Resilient Green Economy? WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Machine Learning in Healthcare: Exceptional Technologies Require Exceptional Ethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:48-51. [PMID: 33103974 DOI: 10.1080/15265161.2020.1820103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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How to reach trustworthy decisions for caesarean sections on maternal request: a call for beneficial power. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106071. [PMID: 33055135 PMCID: PMC8639926 DOI: 10.1136/medethics-2020-106071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 05/08/2023]
Abstract
Caesarean delivery is a common and life-saving intervention. However, it involves an overall increased risk for short-term and long-term complications for both mother and child compared with vaginal delivery. From a medical point of view, healthcare professionals should, therefore, not recommend caesarean sections without any anticipated medical benefit. Consequently, caesarean sections requested by women for maternal reasons can cause conflict between professional recommendations and maternal autonomy. How can we assure ethically justified decisions in the case of caesarean sections on maternal request in healthcare systems that also respect patients' autonomy and aspire for shared decisions? In the maternal-professional relationship, which can be characterised in terms of reciprocal obligations and rights, women may not be entitled to demand a C-section. Nevertheless, women have a right to respect for their deliberative capacity in the decision-making process. How should we deal with a situation of non-agreement between a woman and healthcare professional when the woman requests a caesarean section in the absence of obvious medical indications? In this paper, we illustrate how the maternal-professional relationship is embedded in a nexus of power, trust and risk that reinforces a structural inferiority for women. To accommodate for beneficial use of power, these decision processes need to be trustworthy. We propose a framework, inspired by Lukes' three-dimensional notion of power, which serves to facilitate trust and allows for beneficial power in shared processes of decision-making about the delivery mode for women requesting planned C-sections.
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The need for empathetic healthcare systems. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105921. [PMID: 32709754 PMCID: PMC8639938 DOI: 10.1136/medethics-2019-105921] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/15/2020] [Accepted: 05/01/2020] [Indexed: 05/23/2023]
Abstract
Medicine is not merely a job that requires technical expertise, but a profession concerned with making the best decisions and recommendations with reference to, and in consultation with, the patient. This means that the skill set required for healthcare professionals in order to provide good care is a combination of scientific knowledge, technical aptitude, and affective qualities or virtues such as compassion and empathy.
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Tensions and interplay: A qualitative study of access to patient-centered birth counseling of maternal cesarean requests in Norway. Midwifery 2020; 88:102764. [PMID: 32534254 DOI: 10.1016/j.midw.2020.102764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/10/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to explore women's access to patient-centered counseling for concerns initiating cesarean requests in absence of obstetric indications in pregnancy, and to identify tensions, barriers and facilitators affecting such care. DESIGN, SETTING AND INFORMANTS This qualitative study (June 2016 to August 2017) obtained data through semi-structured in-depth interviews with 17 women requesting planned C-section during birth counseling at a university hospital in Norway and focus group discussions with 20 caregivers (9 midwives and 11 obstetricians) employed at the same hospital. Analysis was carried out by systematic text condensation, a method for thematic analysis in medical research, presented within the frames of Levesque and colleagues' conceptual framework of access to patient-centered care. FINDINGS The analysis revealed that there were considerable tensions in care seeking and provision of counseling for maternal requests for C-section. There was a prominent culture of vaginal delivery among caregivers and women. The appropriateness of CS on maternal request was debated and caregivers revealed diverging attitudes and practices when agreement with women was not reached. Women's views on their entitlement to choose were divided, but the majority of women did not support complete maternal choice. Midwife-led counseling were highly appreciated among woman as well as obstetricians. IMPLICATIONS FOR PRACTICE Tensions and barriers in care seeking and provision of counseling for women requesting C-section for non-obstetric reasons, call for standardized counseling in order for equal and adequate care to be provided across health care institutions and providers. Dialogue-based decision-making and midwife-led care may improve satisfaction of care, enhance spontaneous vaginal deliveries and avoid future conflicts.
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Translational Ethics and Challenges Involved in Putting Norms Into Practice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:71-73. [PMID: 32208072 DOI: 10.1080/15265161.2020.1730520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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How to achieve trustworthy artificial intelligence for health. Bull World Health Organ 2020; 98:257-262. [PMID: 32284649 PMCID: PMC7133476 DOI: 10.2471/blt.19.237289] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/01/2019] [Accepted: 01/10/2020] [Indexed: 11/27/2022] Open
Abstract
Artificial intelligence holds great promise in terms of beneficial, accurate and effective preventive and curative interventions. At the same time, there is also awareness of potential risks and harm that may be caused by unregulated developments of artificial intelligence. Guiding principles are being developed around the world to foster trustworthy development and application of artificial intelligence systems. These guidelines can support developers and governing authorities when making decisions about the use of artificial intelligence. The High-Level Expert Group on Artificial Intelligence set up by the European Commission launched the report Ethical guidelines for trustworthy artificial intelligence in2019. The report aims to contribute to reflections and the discussion on the ethics of artificial intelligence technologies also beyond the countries of the European Union (EU). In this paper, we use the global health sector as a case and argue that the EU’s guidance leaves too much room for local, contextualized discretion for it to foster trustworthy artificial intelligence globally. We point to the urgency of shared globalized efforts to safeguard against the potential harms of artificial intelligence technologies in health care.
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Incommensurable Processes of Reasoning and Implications for Empirical and Normative Bioethics. AJOB Empir Bioeth 2020; 11:2-4. [PMID: 32096726 DOI: 10.1080/23294515.2019.1707726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Can clinical ethics committees be legitimate actors in bedside rationing? BMC Med Ethics 2019; 20:97. [PMID: 31856803 PMCID: PMC6923892 DOI: 10.1186/s12910-019-0438-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/09/2019] [Indexed: 11/25/2022] Open
Abstract
Background Rationing and allocation decisions at the clinical level – bedside rationing – entail complex dilemmas that clinicians and managers often find difficult to handle. There is a lack of mechanisms and aids for promoting fair decisions, especially in hard cases. Reports indicate that clinical ethics committees (CECs) sometimes handle cases that involve bedside rationing dilemmas. Can CECs have a legitimate role to play in bedside rationing? Main text Aided by two frameworks for legitimate priority setting, we discuss how CECs can contribute to enhanced epistemic, procedural and political legitimacy in bedside rationing decisions. Drawing on previous work we present brief case vignettes and outline several potential roles that CECs may play, and then discuss whether these might contribute to rationing decisions becoming legitimate. In the process, key prerequisites for such legitimacy are identified. Legitimacy places demands on aspects such as the CEC’s deliberation process, the involvement of stakeholders, transparency of process, the opportunity to appeal decisions, and the competence of CEC members. On these conditions, CECs can help strengthen the legitimacy of some of the rationing decisions clinicians and managers have to make. Conclusions On specified conditions, CECs can have a well-justified advisory role to play in order to enhance the legitimacy of bedside rationing decisions.
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Social Impact Under Severe Uncertainty: The Role of Neuroethicists at the Intersection of Neuroscience, AI, Ethics, and Policymaking. AJOB Neurosci 2019; 10:117-119. [PMID: 31361198 DOI: 10.1080/21507740.2019.1632965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Maternal reasons for requesting planned cesarean section in Norway: a qualitative study. BMC Pregnancy Childbirth 2019; 19:102. [PMID: 30922267 PMCID: PMC6440101 DOI: 10.1186/s12884-019-2250-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Pregnant women who request a cesarean section in the absence of obstetric indication have become a highly debated issue in academic as well as popular literature. In order to find adequate, targeted treatment and preventive strategies, we need a better understanding of this phenomenon. The aim of this study is to provide a qualitative exploration of maternal requests for a planned cesarean section in Norway, in the absence of obstetric indications. Methods A descriptive qualitative study was conducted consisting of 17 semi-structured, in-depth interviews with women requesting cesarean section and six focus group discussions with 20 caregivers (nine midwives, 11 obstetricians) working at a university hospital in Norway. Data were analyzed with Systematic Text Condensation, a method for thematic cross-case analysis. Results Fear of birth emerged most commonly as a result of a previous traumatic birth experience that prompted a preference for a planned cesarean to avoid a repetition of the trauma. For some women in our study, postnatal care and the puerperal period were their crucial past experiences, and giving birth by planned cesarean was seen as a way to ensure mental rather than physical capability to care for the expected child after birth. Others were under the impression of being at high risk for an emergency C-section, and requesting a planned one was based on their perceived risk. Such perceptions included having a narrow pelvis, hereditary factors or previous birth outcomes. Some primiparas requested a planned cesarean based on a deep-seated fear since their early teens, accompanied by alienation towards the idea of giving birth. Some obstetricians participating in our study also experienced requests that lacked what they regarded as any well-grounded reason or significant fear. Conclusions Behind a maternal request for a planned cesarean section are various rationales and life experiences needing carefully targeted attention and health care. Previous births are an important driver; thus, maternally requested cesareans should be regarded partly as an iatrogenic problem. Electronic supplementary material The online version of this article (10.1186/s12884-019-2250-6) contains supplementary material, which is available to authorized users.
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Towards theoretically robust evidence on health equity: a systematic approach to contextualising equity-relevant randomised controlled trials. JOURNAL OF MEDICAL ETHICS 2019; 45:54-59. [PMID: 30072485 DOI: 10.1136/medethics-2017-104610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 06/16/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
Reducing inequalities in health and the determinants of health is a widely acknowledged health policy goal, and methods for measuring inequalities and inequities in health are well developed. Yet, the evidence base is weak for how to achieve these goals. There is a lack of high-quality randomised controlled trials (RCTs) reporting impact on the distribution of health and non-health benefits and lack of methodological rigour in how to design, power, measure, analyse and interpret distributional impact in RCTs. Our overarching aim in this paper is to contribute to the emerging effort to improve transparency and coherence in the theoretical and conceptual basis for RCTs on effective interventions to reduce health inequity. We endeavour to achieve this aim by pursuing two more specific objectives. First, we propose an overview of three broader health equity frameworks and clarify their implications for the measurement of health inequality in RCTs. Second, we seek to clarify the relationship between theory and translational challenges that researchers would need to attend to, in order to ensure that equity-relevant RCTs are coherently grounded in theory.
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Stakeholder Participation for Legitimate Priority Setting: A Checklist. Int J Health Policy Manag 2018; 7:973-976. [PMID: 30624870 PMCID: PMC6326635 DOI: 10.15171/ijhpm.2018.57] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/17/2018] [Indexed: 11/22/2022] Open
Abstract
Accountable decision-makers are required to legitimize their priority setting decisions in health to members of society. In this perspective we stress the point that fair, legitimate processes should reflect efforts of authorities to treat all stakeholders as moral equals in terms of providing all people with well-justified, reasonable reasons to endorse the decisions. We argue there is a special moral concern for being accountable to those who are potentially adversely affected by decisions. Health authorities need to operationalize this requirement into real world action. In this perspective, we operationalize five key steps in doing so, in terms of (i) proactively identifying potentially adversely affected stakeholders; (ii) comprehensively including them in the decision-making process; (iii) ensuring meaningful participation; (iv) communication of recommendations or decisions; and (v) the organization of evaluation and appeal mechanisms. Health authorities are advised to use a checklist in the form of 29 reflective questions, aligned with these five key steps, to assist them in the practical organization of legitimate priority setting in healthcare.
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On Fundamental Premises for Addressing "Context" and "Contextual Factors" Influencing Value Decisions in Healthcare Comment on "Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis". Int J Health Policy Manag 2018; 7:958-960. [PMID: 30316249 PMCID: PMC6186470 DOI: 10.15171/ijhpm.2018.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/20/2018] [Indexed: 11/12/2022] Open
Abstract
In this commentary on Williams and colleagues’ paper, I will address some essential issues related to research on contextual factors that influence value decision-making in healthcare. Based on the presumption that scientific work requires coherence in its ontological, epistemological and methodological approaches, I identify some challenges in their text and reflect on how those challenges might be addressed. I recommend that more normative work be done to make this a comprehensive area of research and suggest that the fundamental premises structuring investigations in this field be explicitly clarified.
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Styringstiltak og rettferdighet i helse- og omsorgstjenesten: samspill og spenninger. TIDSSKRIFT FOR OMSORGSFORSKNING 2018. [DOI: 10.18261/issn.2387-5984-2018-02-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Standards of practice in empirical bioethics research: towards a consensus. BMC Med Ethics 2018; 19:68. [PMID: 29986689 PMCID: PMC6038185 DOI: 10.1186/s12910-018-0304-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 05/29/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This paper reports the process and outcome of a consensus finding project, which began with a meeting at the Brocher Foundation in May 2015. The project sought to generate and reach consensus on standards of practice for Empirical Bioethics research. The project involved 16 academics from 5 different European Countries, with a range of disciplinary backgrounds. METHODS The consensus process used a modified Delphi approach. RESULTS Consensus was reached on 15 standards of practice, organised into 6 domains of research practice (Aims, Questions, Integration, Conduct of Empirical Work, Conduct of Normative Work; Training & Expertise). CONCLUSIONS Through articulating these standards we outline a position that encourages responses, and through those responses we will be able to identify points of agreement and contestation that will drive the conversation forward. In that vein, we would encourage researchers, funders and journals to engage with what we have proposed, and respond to us, so that our community of practice of empirical bioethics research can develop and evolve further.
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Could information about herd immunity help us achieve herd immunity? Evidence from a population representative survey experiment. Scand J Public Health 2018; 46:854-858. [PMID: 29741455 DOI: 10.1177/1403494818770298] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Immunisation causes dramatic reductions in morbidity and mortality from infectious diseases; however, resistance to vaccination is nonetheless widespread. An understudied issue - explored here - is whether appeals to collective as opposed to individual benefits of vaccination encourage people to vaccinate. Knowledge of this is important not least with respect to the design of public health campaigns, which often lack information about the collective benefits of vaccination. METHODS Using a between-subjects experimental survey design, we test whether information about the effects of herd immunity influences people's decision to vaccinate. A representative sample of Norwegians was confronted with a hypothetical scenario in which a new and infectious disease is on its way to Norway. The sample was split in three - a control group and two treatment groups. The one treatment group was provided information about collective benefits of vaccination; the other was provided information about the individual benefits of vaccination. RESULTS Both treatments positively affect people's decision to vaccinate; however, informing about the collective benefits has an even stronger effect than informing about the individual benefits. CONCLUSIONS Our results suggest that people's decision about whether to vaccinate and thus contribute to herd immunity is influenced by concern for others. Thus, stressing the collective benefits of vaccination could increase the effectiveness of health campaigns.
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Abstract
In 2014, the editorial board of BMC Medical Ethics came together to devise sections for the journal that would (a) give structure to the journal (b) help ensure that authors’ research is matched to the most appropriate editors and (c) help readers to find the research most relevant to them. The editorial board decided to take a practical approach to devising sections that dealt with the challenges of content management. After that, we started thinking more theoretically about how one could go about classifying the field of medical ethics. This editorial elaborates and reflects on the practical approach that we took at the journal, then considers an alternative theoretically derived approach, and reflects on the possibilities, challenges and value of classifying the field more broadly.
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Commentary to ‘Social Health Disparities in Clinical Care: A New Approach to Medical Fairness’ by Puschel, Furlan and Dekkers. Public Health Ethics 2016. [DOI: 10.1093/phe/phw042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The commentary brings up two topics. The first concerns whether and how a patient’s socioeconomic status (SES) should count in clinical care. We provide a brief summary of Puschel and colleagues’ view and discuss it in relation to other accounts. We share their conclusion; considering SES in clinical care can be justified from a fairness perspective. Yet, we question the claim that this is a new perspective, and argue that the reason for the claim of novelty is an insufficient use of references. This leads to the second topic, which is a discussion of citation practices in philosophical/ethics papers. We describe common deviations from academic standards, and suggest how unfortunate practices can be reduced.
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Phase-dependent justification: the role of personal responsibility in fair healthcare. JOURNAL OF MEDICAL ETHICS 2015; 41:836-40. [PMID: 26269464 DOI: 10.1136/medethics-2014-102645] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 07/22/2015] [Indexed: 05/24/2023]
Abstract
The main aim of this paper is to examine the fairness of different ways of holding people responsible for healthcare-related choices. Our focus is on conceptualisations of responsibility that involve blame and sanctions, and our analytical approach is to provide a systematic discussion based on interrelated and successive health-related, lifestyle choices of an individual. We assess the already established risk-sharing, backward-looking and forward-looking views on responsibility according to a variety of standard objections. In conclusion, all of the proposed views on holding people responsible for their lifestyle choices are subjected to reasonable critiques, although the risk-sharing view fare considerably better than the others overall considered. With our analytical approach, we are able to identify how basic conditions for responsibility ascription alter along a time axis. Repeated relapses with respect to healthcare associated with persistent, unhealthy lifestyle choices, call for distinct attention. In such situations, contextualised reasoning and transparent policy-making, rather than opaque clinical judgements, are required as steps towards fair allocation of healthcare resources.
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Providing free heroin to addicts participating in research - ethical concerns and the question of voluntariness. BJPsych Bull 2015; 39:28-31. [PMID: 26191421 PMCID: PMC4495824 DOI: 10.1192/pb.bp.113.046565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/31/2014] [Accepted: 04/08/2014] [Indexed: 11/23/2022] Open
Abstract
Providing heroin to people with heroin addiction taking part in medical trials assessing the effectiveness of the drug as a treatment alternative breaches ethical research standards, some ethicists maintain. Heroin addicts, they say, are unable to consent voluntarily to taking part in these trials. Other ethicists disagree. In our view, both sides of the debate have an inadequate understanding of 'voluntariness'. In this article we therefore offer a fuller definition of the concept, one which allows for a more flexible, case-to-case approach in which some heroin addicts are considered capable of consenting voluntarily, others not. An advantage of this approach, it is argued, is that it provides a safety net to minimise the risk of inflicting harm on trial participants.
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Translational ethics: an analytical framework of translational movements between theory and practice and a sketch of a comprehensive approach. BMC Med Ethics 2014; 15:71. [PMID: 25267434 PMCID: PMC4254389 DOI: 10.1186/1472-6939-15-71] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 09/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. Discussion The analytic distinctions needed to base an ethics aiming to translate between theory and practice are identified as ‘movements of translation’. I explore briefly what would constitute success and limitations to these intended translational movements by addressing the challenges of the epistemological gap between philosophical and practical ethics. The categories of translational movements I suggest can serve as a starting point for a systematic, collective self-inspection and discussion of the merits and limitations of the various academic and practical activities that bioethicists are engaged in. I further propose that translational ethics could be considered as a new discipline of ethical work constructively structured around compositions of translational movements. Summary Breaking the idea of translational ethics into distinct translational movements provide us with a nuanced set of conditions to explore and discuss the justification and limitations of various efforts carried out in the field of bioethics. In this sense, the proposed framework could be a useful vehicle for augmented collective, self-reflexivity among both philosophers and practitioners who are ‘doing bioethics’. Also, carefully designed, overall approaches combining justified, self-reflexive philosophical and practical efforts according to the suggested distinctions could be expected to realise – or at least improve a facilitation of – translation of ethics across the theory-practice gap.
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Balancing efficiency, equity and feasibility of HIV treatment in South Africa - development of programmatic guidance. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2013; 11:26. [PMID: 24107435 PMCID: PMC3851565 DOI: 10.1186/1478-7547-11-26] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/20/2013] [Indexed: 12/31/2022] Open
Abstract
South Africa, the country with the largest HIV epidemic worldwide, has been scaling up treatment since 2003 and is rapidly expanding its eligibility criteria. The HIV treatment programme has achieved significant results, and had 1.8 million people on treatment per 2011. Despite these achievements, it is now facing major concerns regarding (i) efficiency: alternative treatment policies may save more lives for the same budget; (ii) equity: there are large inequalities in who receives treatment; (iii) feasibility: still only 52% of the eligible population receives treatment.Hence, decisions on the design of the present HIV treatment programme in South Africa can be considered suboptimal. We argue there are two fundamental reasons to this. First, while there is a rapidly growing evidence-base to guide priority setting decisions on HIV treatment, its included studies typically consider only one criterion at a time and thus fail to capture the broad range of values that stakeholders have. Second, priority setting on HIV treatment is a highly political process but it seems no adequate participatory processes are in place to incorporate stakeholders' views and evidences of all sorts.We propose an alternative approach that provides a better evidence base and outlines a fair policy process to improve priority setting in HIV treatment. The approach integrates two increasingly important frameworks on health care priority setting: accountability for reasonableness (A4R) to foster procedural fairness, and multi-criteria decision analysis (MCDA) to construct an evidence-base on the feasibility, efficiency, and equity of programme options including trade-offs. The approach provides programmatic guidance on the choice of treatment strategies at various decisions levels based on a sound conceptual framework, and holds large potential to improve HIV priority setting in South Africa.
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Just health: On the conditions for acceptable and unacceptable priority settings with respect to patients' socioeconomic status. JOURNAL OF MEDICAL ETHICS 2011; 37:526-529. [PMID: 21478418 DOI: 10.1136/jme.2010.042085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
It is well documented that the higher the socioeconomic status (SES) of patients, the better their health and life expectancy. SES also influences the use of health services-the higher the patients' SES, the more time and specialised health services provided. This leads to the following question: should clinicians give priority to individual patients with low SES in order to enhance health equity? Some argue that equity is best preserved by physicians who remain loyal to 'ordinary medical fairness' in non-ideal circumstances when health disparities persist; ie, doctors should allocate care according to needs only and treat everyone with equal regard by being neutral with respect to patients' SES. This paper furthers a discussion of this view by questioning how equitable needs relate to SES. To clarify, it distinguishes between four versions of 'healthcare need' and approaches an acceptable conceptualisation of the notion supported by Norman Daniels' theory on health equity. It concludes that doctors should remain neutral to patients' SES in cases in which several patients require the same health care. However, equitable health care requires considerations of the impact of socioeconomic factors (SEF) on patients' capacity to benefit from the care. Remaining neutral towards patients' SES in this respect does not promote equal regard. It follows that priority setting on the basis of SEF is required in fair clinical distribution of care, eg, through allocating more time to patients with low SES. In order to advance equity accurately, the concept of ordinary medical fairness should be amplified according to this clarification.
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Prioritering i global helse. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:1667-9. [DOI: 10.4045/tidsskr.11.0743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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