Healthcare services should be provided according to contemporary ethical norms that require patients’ active engagement in all the relevant processes. However, authoritarian attitudes and behaviors in healthcare, one of which is paternalism, put patients in a passive role. But, as Avedis Donabedian emphasizes, patients are co-producers of care, reformers of healthcare, informants, and definers and evaluators of quality. Overlooking these significant functions and merely focusing on physicians’ benevolence due to their medical knowledge and skills in the production of (...) healthcare services would leave the fate of patients in the hands of clinicians and impose physicians’ hegemony on patients and their choices. Nevertheless, the concept of co-production is a practical and effective mechanism to redefine the language used in healthcare by recognizing patients as co-producers and equal partners. The application of co-production in healthcare would improve the therapeutic relationship, decrease ethical violations, and promote the patient’s dignity. (shrink)

We have benefited from conversations with Archon Fung, Brian Jacob, Todd Pittinsky, Peter Schuck, Ani Satz, Andrew Williams, and students in a joint class on statistics and ethics at the John F. Kennedy School of Government in October 2002. We are also grateful to our audience at the conference “The Priority of Practice,” organized by Jonathan Wolff at University College London in September 2003, and to Arthur Applbaum, Miriam Avins, Frances Kamm, Simon Keller, Frederick Schauer, Alan Wertheimer, and the Editors (...) of Phi- losophy & Public Affairs for insightful comments. We have benefited from prepublication reading of Schauer’s work on profiling, Profiles, Probabilities, and Stereotypes (Cambridge, Mass: Harvard University Press, 2003). We thank Avedis Koutoujian for research assistance. (shrink)

Bioethics education has remarkably grown across the globe in the last few decades. The data of the UNESCO Global Ethics Observatory proves that bioethics education is a global phenomenon with various bioethics institutions, teaching programs, and academicians. However, this situation does not mean that bioethics education has reached a stable and flawless level. Especially, the effectiveness of bioethics programs or their quality assessment is a major area that should be analyzed through more academic works. For filling that gap, this article (...) aims to formulate a general framework to address the quality standards and indicators in bioethics education. The article adapts Donabedian’s three approaches—structure, process, and outcome— as three levels to measure quality in bioethics education. The proposed model considers the indicators the ultimate quantifiable points by creating a sequential classification as the three levels, main categories, standards, and indicators, which means that it applies an inductive approach following a path from the indicators to the standards, from the standards to the main categories, and from the main categories to the levels in order to reach a conclusion about the effectiveness of each level. (shrink)

In their recent work, Kok et al propose a theoretical framework for the evaluation of clinical ethical case interventions, in particular moral case deliberation (MCD).1 According to the authors, this framework provides ‘empirically accessible hypothesis that describe the relationship between MCD and care quality at the organisational level’.1 Evaluation of ethical interventions in healthcare is an important topic. As Donabedian has noted, evaluation can be understood as defining reasonable quality expectations and to check by means of empirical research whether (...) and to what extent these expectations have been met.2 If suitable for ethical interventions like MCDs, the carefully compiled framework by Kok et al would surely present a major step towards satisfying the requirements outlined by Donabedian. However, caution is in order whether this holds true. The authors start by observing that most of the recent research regarding the evaluation of MCD tends to follow a paradigm that can be outlined by two premises. First, focusing on quality is justified by the need to provide a rationale for an intervention’s consumption of resources.3 Second, this implies research that is usually centred around the quality …. (shrink)

Na doença falciforme, o genótipo HbSS da anemia falciforme, considerado a forma mais grave, prevalente no continente africano, tem alta morbidade e mortalidade. Objetivo: identificar se a estrutura instalada na atenção às pessoas com anemia falciforme e seus familiares, contribui para a redução da mortalidade precoce em Angola. Material e Método: pesquisa exploratória descritiva, realizada em Luanda-Angola, no período entre agosto e dezembro de 2022. Foram aplicados questionários estruturados para 20 pessoas com doença falciforme e 15 familiares, todos com mais (...) de 21 anos. A metodologia utilizada foi bola de neve. Para análise e discussão dos dados, foi utilizado o referencial teórico de Donabedian, com ênfase no eixo estrutura. Resultados: diagnóstico feito por sinais e sintomas, idade do diagnóstico entre 1 e 5 anos. A crise de dor predominou entre eventos agudos. Conclusão: inexistência de estrutura instalada de saúde em Luanda que garantam no serviço público gratuito o acesso à medicamentos, transfusão de sangue, vacinas especiais e exames complementares. A transferência de tecnologias sociais da organização de sociedade civil brasileira para a de Luanda mostra ser adequada. (shrink)