Background Studying global health problems requires international multidisciplinary teams. Such multidisciplinarity and multiculturalism create challenges in adhering to a set of ethical principles across different country contexts. Our group on health system responses to violence against women (VAW) included two universities in a European high-income country (HIC) and four universities in low-and middle-income countries (LMICs). This study aimed to investigate professional and policy perspectives on the types, causes of, and solutions to ethical challenges specific to the ethics approval stage (...) of the global research projects on health system responses to VAW. Methods We used the Network of Ethical Relationships model, framework method, and READ approach to analyse qualitative semi-structured interviews (n = 18) and policy documents (n = 27). In March-July 2021, we recruited a purposive sample of researchers and members of Research Ethics Committees (RECs) from the five partner countries. Interviewees signposted policies and guidelines on research ethics, including VAW. Results We developed three themes with eight subthemes summarising ethical challenges across three contextual factors. The global nature of the group contributed towards power and resource imbalance between HIC and LMICs and differing RECs’ rules. Location of the primary studies within health services highlighted differing rules between university RECs and health authorities. There were diverse conceptualisations of VAW and vulnerability of research participants between countries and limited methodological and topic expertise in some LMIC RECs. These factors threatened the timely delivery of studies and had a negative impact on researchers and their relationships with RECs and HIC funders. Most researchers felt frustrated and demotivated by the bureaucratised, uncoordinated, and lengthy approval process. Participants suggested redistributing power and resources between HICs and LMICs, involving LMIC representatives in developing funding agendas, better coordination between RECs and health authorities and capacity strengthening on ethics in VAW research. Conclusions The process of ethics approval for global research on health system responses to VAW should be more coordinated across partners, with equal power distribution between HICs and LMICs, researchers and RECs. While some of these objectives can be achieved through education for RECs and researchers, the power imbalance and differing rules should be addressed at the institutional, national, and international levels. Three of the authors were also research participants, which had potential to introduce bias into the findings. However, rigorous reflexivity practices mitigated against this. This insider perspective was also a strength, as it allowed us to access and contribute to more nuanced understandings to enhance the credibility of the findings. It also helped to mitigate against unequal power dynamics. (shrink)

Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents, healthcare professionals and policy decision makers in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and (...) information attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities ; parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs. (shrink)

Rather than providing a list of "how-tos" and "must dos," this volume is premised on the understanding that by learning more about the current conditions under which teachers and other educators work and learn, it is possible to understand, ...

A subcategory of medical tourism, reproductive tourism has been the subject of much public and policy debate in recent years. Specific concerns include: the exploitation of individuals and communities, access to needed health care services, fair allocation of limited resources, and the quality and safety of services provided by private clinics. To date, the focus of attention has been on the thriving medical and reproductive tourism sectors in Asia and Eastern Europe; there has been much less consideration given to (...) more recent ‘players’ in Latin America, notably fertility clinics in Chile, Brazil, Mexico and Argentina. In this paper, we examine the context-specific ethical and policy implications of private Argentinean fertility clinics that market reproductive services via the internet. Whether or not one agrees that reproductive services should be made available as consumer goods, the fact is that they are provided as such by private clinics around the world. We argue that basic national regulatory mechanisms are required in countries such as Argentina that are marketing fertility services to local and international publics. Specifically, regular oversight of all fertility clinics is essential to ensure that consumer information is accurate and that marketed services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices. (shrink)

Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in‐depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing professionalization. The (...) use of a welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country‐level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill‐level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings. (shrink)

Background: Nurses, social workers, and medical residents are ethically mandated to engage in policy advocacy to promote the health and well-being of patients and increase access to care. Yet, no instrument exists to measure their level of engagement in policy advocacy. Research objective: To describe the development and validation of the Policy Advocacy Engagement Scale, designed to measure frontline healthcare professionals’ engagement in policy advocacy with respect to a broad range of issues, including patients’ ethical rights, (...) quality of care, culturally competent care, preventive care, affordability/accessibility of care, mental healthcare, and community-based care. Research design: Cross-sectional data were gathered to estimate the content and construct validity, internal consistency, and test–retest reliability of the Policy Advocacy Engagement Scale. Participants and context: In all, 97 nurses, 94 social workers, and 104 medical residents were recruited from eight acute-care hospitals in Los Angeles County. Ethical considerations: Informed consent was obtained via Qualtrics and covered purposes, risks and benefits; voluntary participation; confidentiality; and compensation. Institutional Review Board approval was obtained from the University of Southern California and all hospitals. Findings: Results supported the validity of the concept and the instrument. In confirmatory factor analysis, seven items loaded onto one component with indices indicating adequate model fit. A Pearson correlation coefficient of.36 supported the scale’s test–retest stability. Cronbach’s α of.93 indicated strong internal consistency. Discussion: The Policy Advocacy Engagement Scale demonstrated satisfactory psychometric properties in this initial test. Findings should be considered within the context of the study’s limitations, which include a low response rate and limited geographic scope. Conclusion: The Policy Advocacy Engagement Scale appears to be the first validated scale to measure frontline healthcare professionals’ engagement in policy advocacy. With it, researchers can analyze variations in professionals’ levels of policy advocacy engagement, understand what factors are associated with it, and remedy barriers that might exist to their provision of it. (shrink)

This study investigated (1) whether potential future purchasing agents were predisposed to accept gratuities or whether the practice of gratuity acceptance is a manifestation of the job itself, (2) whether the existence of a code of ethics forbidding gratuity acceptance curtails the occurrence, and (3) whether disparities in ethics policies between the sales and purchasing functions affect gratuity acceptance. Hypotheses based upon the concepts of organizational concern and institutionalized ethics are developed and empirically tested. Results suggest that future purchasing agents (...) are predisposed to accept gratuities and that formal written ethics policies decrease the acceptance of gratuities. Disparities in ethics policies between the sales and purchasing functions concerning gratuities failed to affect gratuity acceptance significantly. (shrink)

Science-policy interactions can both facilitate and hamper professional normative judgement, i.e. a value judgement about the desirability of a certain situation. Anthropogenic land subsidence, contributing to relative sea-level rise in the economically important Western peatland areas in the Netherlands is a case in point. The implementation of mitigation, adaptation and compensation measures is lagging, partly due to science-policy interaction problems potentially leading to conflicts between stakeholders, including agrarians, climate scientists and inhabitants. We find that professional normative judgement is (...) enhanced when researchers and societal stakeholders reflect more critically on their role and engage in more inclusive science-policy interactions. (shrink)

As the medical profession becomes more and more of a commercial enterprise, commentators are subjecting conflicts of interest in medicine to increasing scrutiny. However, one critical area of conflict has largely escaped discussion—the conflicts of interest raised by the advertising policies of medical journals. Moreover, when these conflicts are discussed, they are examined almost exclusively in terms of the concerns that they pose for journal editors. Yet, there is a second critical concern with journal advertising policies. The policies also create (...) serious conflicts of interest for the professional societies that own medical journals.In this article, we will discuss the conflicts of interest that are raised for journal editors and professional societies by journal advertising policies, and we will conclude that the policies are exactly backward. Currently, medical journals rely on advertisements from pharmaceutical companies and other health-related businesses and avoid—indeed exclude—advertisements from consumer-oriented companies, like producers of automobiles, golf equipment, or jewelry. We submit that the medical journals, the medical profession, and the public would be better served if consumeroriented advertisement were preferred over health-related advertising. (shrink)

As the medical profession becomes more and more of a commercial enterprise, commentators are subjecting conflicts of interest in medicine to increasing scrutiny. However, one critical area of conflict has largely escaped discussion—the conflicts of interest raised by the advertising policies of medical journals. Moreover, when these conflicts are discussed, they are examined almost exclusively in terms of the concerns that they pose for journal editors. Yet, there is a second critical concern with journal advertising policies. The policies also create (...) serious conflicts of interest for the professional societies that own medical journals.In this article, we will discuss the conflicts of interest that are raised for journal editors and professional societies by journal advertising policies, and we will conclude that the policies are exactly backward. Currently, medical journals rely on advertisements from pharmaceutical companies and other health-related businesses and avoid—indeed exclude—advertisements from consumer-oriented companies, like producers of automobiles, golf equipment, or jewelry. We submit that the medical journals, the medical profession, and the public would be better served if consumeroriented advertisement were preferred over health-related advertising. (shrink)

As the medical profession becomes more and more of a commercial enterprise, commentators are subjecting conflicts of interest in medicine to increasing scrutiny. However, one critical area of conflict has largely escaped discussion—the conflicts of interest raised by the advertising policies of medical journals. Moreover, when these conflicts are discussed, they are examined almost exclusively in terms of the concerns that they pose for journal editors. Yet, there is a second critical concern with journal advertising policies. The policies also create (...) serious conflicts of interest for the professional societies that own medical journals.In this article, we will discuss the conflicts of interest that are raised for journal editors and professional societies by journal advertising policies, and we will conclude that the policies are exactly backward. Currently, medical journals rely on advertisements from pharmaceutical companies and other health-related businesses and avoid—indeed exclude—advertisements from consumer-oriented companies, like producers of automobiles, golf equipment, or jewelry. We submit that the medical journals, the medical profession, and the public would be better served if consumeroriented advertisement were preferred over health-related advertising. (shrink)

The article focuses on the methodological specifics of qualitative sociological studies commissioned by public administration authorities (“the client”) which aim to provide solutions to specific problems defined by the client. In conducting this kind of study, the researcher is expected not only to describe and understand the existing state of affairs but also to provide a set of recommendations for amending it. The research terrain is not defined by the sociologist herself but basically by the client. This situation reveals a (...) series of methodological and epistemological issues. The article discusses some of them and proposes that the research strategy of heuristic investigation may be an answer to the associated dilemmas. The author argues that the correct use of reflexive methodology can help the researcher to overcome the limits imposed on the research by the client’s presence and even make the apparent disadvantages work for her. (shrink)

Given that, globally, health professionals' involvement in crises—especially complex crises where human action plays a contributing role—has risen to new proportions, emergency preparedness is an increasingly integral capacity of health systems. As the United States has come to see itself as vulnerable to violence, its leaders have begun to reorganize the country's health system around protection from terrorism and other health emergencies, upholding this as an essential element or “indispensable pillar” in their strategy for securing the homeland. Biodefense and emergency (...) preparedness have thus come to capture the energies and expertise of nearly all health professionals and, increasingly, to define the specific ends that organize their work. a. (shrink)

Given that, globally, health professionals' involvement in crises—especially complex crises where human action plays a contributing role—has risen to new proportions, emergency preparedness is an increasingly integral capacity of health systems. As the United States has come to see itself as vulnerable to violence, its leaders have begun to reorganize the country's health system around protection from terrorism and other health emergencies, upholding this as an essential element or “indispensable pillar” in their strategy for securing the homeland. Biodefense and emergency (...) preparedness have thus come to capture the energies and expertise of nearly all health professionals and, increasingly, to define the specific ends that organize their work. a. (shrink)

During the 1920s and 1930s geneticist L. C. Dunn of Columbia University cautioned Americans against endorsing eugenic policies and called attention to eugenicists' less than rigorous practices. Then, from the mid-1940s to early 1950s he attacked scientific racism and Nazi Rassenhygiene by co-authoring Heredity, Race and Society with Theodosius Dobzhansky and collaborating with members of UNESCO on their international campaign against racism. Even though shaking the foundations of scientific discrimination was Dunn's primary concern during the interwar and post-World War II (...) years, his campaigns had ancillary consequences for the discipline. He contributed to the professionalization of genetics during the 1920s and 1930s and sought respectability for human genetics in the 1940s and 1950s. My article aims to elucidate the activist scientist's role in undermining scientific discrimination by exploring aspects of Dunn's scientific work and political activism from the 1920s to 1950s. Definitions are provided for scientific discrimination and activist scientist. (shrink)

Professional Responsibility: New Horizons of Praxis addresses the manifold and complex challenges inherent in professional responsibility. Since the beginning of the 20th Century, professions have been accorded a conjoined mandate - political and moral responsibility - to serve the interests of individual's and society. The quality of professional work, how professionals understand and live out their responsibilities in practice, is a matter of pervasive concern since increasingly they have such a prominent presence in most people's lives. Until the late 1960's, (...) professionals' roles and responsibilities were rarely questioned, but such trust has since given way to collective scepticism concerning their commitment and willingness to live up to their moral and societal obligations. Abuse of power and privilege by some professionals has contributed to decline in trust by publics, the concept of 'good work' is increasingly challenged, and politicians and policy-makers have sought to regulate and hold professions to account. It is timely, therefore, to investigate critically conflicting discourses and practices on what counts as professional responsibility, to question how professionals understand and are prepared for a life of professional responsibility, and what acting with integrity and authority looks like in practice. One of the distinctive features of this book is the combination of normative and empirical dimensions that are used to dissect this question. The authors indicate from a diversity of disciplinary perspectives how professional responsibility includes particular thoughts and warranted actions yet remains multifaceted and inarticulate"-- Provided by publisher. (shrink)

Knowledge of pedagogy and social studies content influences a teacher's decision making and helps teachers conduct sound instructional practices despite the influence of high-stakes testing policies. Using national data from the Survey of the Status of Social Studies (S4), this study examined the associations of teachers’ professional characteristics, school environmental factors, and state testing policy on self-reported levels of authority that secondary level social studies teachers (grades 6–12) hold over key classroom tasks. Through hierarchical multiple regression analysis, key findings (...) from this study indicated that greater minority enrollments are associated with lower levels of instructional authority. Teachers who worked in states where a state-mandated social studies test was administered reported less freedom to choose what to teach and how to teach than those in non-testing states. Also, this study showed that in-field status, the type of licensure, and years of teaching experience are important factors in exercising social studies teachers’ instructional authority (e.g., their ability to balance effectively the demands of state-mandated reforms with teaching for meaningful student learning). This study recommends that schools with high minority enrollments, especially if these districts exist in a high stakes testing environment, should invest in teachers with high-quality social studies preparation. (shrink)

Historical continuities and constraints in the professionalization of nursingThe support of medicine and the state may be crucial to nursing's current professional aspirations for legitimation and implementation of nursing reforms and for new roles for nurses in health care. As such, medicine and the state are in the invidious position of influencing nursing's occupational future. This situation is not new. An historical analysis of the establishment of nursing at Prince Alfred Hospital, Sydney, Australia, at the end of the nineteenth (...) century reveals that the State Government of NSW and the medical profession supported nursing's occupational development, yet set the framework within which this could occur. For instance, the state provided patronage to nursing through recommendations of the 1873 Royal Commission and because it financially backed Prince Alfred Hospital, while the medical profession defined nursing knowledge and practice through its control of the nursing curriculum. Membership of the hospital board provided both medicine and the state with powerful positions over hospital policies that affected nursing. While nursing became established as a distinct occupation for women with the aid of State and medical support, its subordinate position in health care was, and continues to be, constrained by these traditional supporters. This relationship between nursing, medicine and the state has implications for nursing's current professionalization strategies and aspirations. (shrink)

(2013). Standards for Academic and Professional Instruction in Foundations of Education, Educational Studies, and Educational Policy Studies Third Edition, 2012, Draft Presented to the Educational Community by the American Educational Studies Association's Committee on Academic Standards and Accreditation. Educational Studies: Vol. 49, Critical, Interpretive, and Normative Perspectives of Educational Foundations: Contributions for the 21st Century, pp. 107-118.

This paper provides an evaluation of the spinoff of a for-profit company from the American Institute of Certified Public Accountants (AICPA), a nonprofit professional association. The evaluation is based on a review of the literature on public policy issues surrounding organizational conversions from nonprofit to for-profit legal status. Many criticisms of this for-profit spinoff were voiced by professional leaders and accounting regulators, and we demonstrate that these criticisms are grounded in widely recognized policy principles relating to nonprofit conversions. (...) The public policy issues raised by this study have implications for the governance of professional associations in all disciplines. (shrink)

The ethics of the Flexibility In duty hour Requirements for Surgical Trainees trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of (...) the relevant ethical issues. The 2012 Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials provides researchers and research ethics committees with specific guidance for the ethical design and conduct of CRTs. Second, we aim to demonstrate how the Ottawa Statement provides much-needed clarity to the ethical issues in the FIRST trial, including: research participant identification; consent requirements; gatekeeper roles; benefit-harm analysis and identification of vulnerable participants. We nonetheless also find that the FIRST trial raises ethical issues not adequately addressed by the Ottawa Statement. Hence, third and finally, we raise important questions requiring further ethical analysis and guidance, including: Does clinical equipoise apply to policy interventions with little or no evidence-base? Do healthcare providers have an obligation to participate in research? Does the power-differential in certain healthcare settings render healthcare providers vulnerable to duress and coercion to participant in research? If so, what safeguards might be implemented to protect providers, while allowing important research to proceed? (shrink)

The starting point for this paper is the ongoing debate about the relation between research and policy in education. Recent developments in England and Scotland are reviewed in the context of political and academic arguments about the nature and function of research activity. The defensiveness of the research community in the face of professional and political attacks is examined critically. A case study of the Higher Still programme is used to illustrate the complexity of the relationships between evidence, ideology, (...) values and professional practice. It is argued that the research community needs to become more politically sophisticated and to advance a clearer vision of its social function in advanced democratic societies if its potential contribution to educational development is to be realised. The dangers of a retreat to a narrow empirical role are highlighted. (shrink)

Discharging a homeless patient from hospital raises ethical issues which are compounded when the patient is from outside the United Kingdom. This article begins with an extended case study of a 30-year-old homeless man from Lithuania describing his complex medical and social needs. It is best practice for all homeless patients to have their housing needs planned for prior to discharge, but this is made more difficult by the United Kingdom’s ‘hostile environment’ policy which creates a subclass of homeless (...) people who are not eligible for support. This means healthcare professionals discharge patients back to homelessness, even when this is likely to adversely affect their health and dignity both directly and indirectly through impairing access to care for chronic conditions. Policies in health and social care which compel professionals to treat some patients with second-class care undermine the ethics of healthcare professions. (shrink)

Over the past twenty years there has been a shift in medical law and practise to increasingly distrust the judgement of health professionals. An increasing number of codes of conduct, disciplinary bodies, ethics committees and bureaucratic policies now prescribe how health professional and health researchers should act and relate to their patients. The result of this, Mark Henaghan argues, has been to undermine trust and professional judgement in health professionals, while simultaneously failing to trust the patient to make decisions about (...) their care. This book will look at the issue of health professionals and trust comparatively in a number of countries including the USA, Canada, Australia, New Zealand and the UK. The book will show by historical analysis of legislation, case law, disciplinary proceedings reports, articles in medical and law journals and protocols produced by management teams in hospitals, how the shift from trust to lack of trust has happened. Drawing comparisons between situations where trust is respected such as in emergency situations, and where it is not for example routine decisions such as obtaining consent for an anaesthetic procedure, the book shows how this erosion of trust has the potential to dehumanise the special nature of the relationship between healthcare professionals and patients. The effect of this is that the practice of health care is turned into a mechanistic enterprise controlled by "management processes" rather than governed by trust and individual care and judgement. This book will be an invaluable resource for students and scholars of medical law and medical sociology, public policy-makers and a range of associated professionals, from health service managers to medical science and clinical researchers. (shrink)

University and school preparation of new teachers should include work on the ethical and policy quandries of professional work. As it is, teacher education institutions too rarely tackle questions of protocol, ethics, policy, principles, and procedures. Professors may discuss matters of protocol, especially ethical conflicts arising from school and university practices and routines. But they rarely give in-depth treatment to ethics and policy in the teaching life. Moreover, treatment of these matters is often sparse in ethical theory (...) or in reasoned analyses of protocol and policies. This leaves the new teacher without initiation into centrally important elements of teaching. The appropriate treatment of protocol, ethical, and policy matters in education programs warrants a separate course of instruction. Here, students would be encouraged to improve their ethical reasoning and to learn ethical theory. They would learn various ways to assess protocol and policy problems likely to arise in classrooms and schools. Minimally, teacher education professors should draw attention to important protocol, ethical, and policy aspects of course content and do so in vigorous, educationally sound ways. In this article, I show how my treatment of protocol, ethics, and policies would apply more widely in general postsecondary education. (shrink)

Although the International Committee of Medical Journal Editors has published clear guidance on the authorship of scientific papers, short-term contract research workers, who perform much of the research that is reported in the biomedical literature, are often at a disadvantage in terms of recognition, reward and career progression. This article identifies several professional, ethical and operational issues associated with the assignment of authorship, describes how a university department of primary care set about identifying and responding to the concerns of its (...) contract research staff on authorship and describes a set of guidelines that were produced to deal with the ethical and professional issues raised. These guidelines include directions on how authorship should be negotiated and allocated and how short-term researchers can begin to develop as authors. They also deal with the structures required to support an equitable system, which deals with the needs of short-term researchers in ways that are realistic in the increasingly competitive world of research funding and publication, and may offer a model for more formal guidelines that could form part of institutional research policy. (shrink)

Seven COVID-19 vaccines are now being distributed and administered around the world (figure correct at the time of submission), with more on the horizon. It is widely accepted that healthcare workers should have high priority. However, questions have been raised about what we ought to do if members of priority groups refuse vaccination. Using the case of influenza vaccination as a comparison, we know that coercive approaches to vaccination uptake effectively increase vaccination rates among healthcare workers and reduce patient morbidity (...) if properly implemented. Using the principle of least restrictive alternative, we have developed an intervention ladder for COVID-19 vaccination policies among healthcare workers. We argue that healthcare workers refusing vaccination without a medical reason should be temporarily redeployed and, if their refusal persists after the redeployment period, eventually suspended, in order to reduce the risk to their colleagues and patients. This ‘conditional’ policy is a compromise between entirely voluntary or entirely mandatory policies for healthcare workers, and is consistent with healthcare workers’ established professional, legal and ethical obligations to their patients and to society at large. (shrink)

One of the most unpredictable things the pandemic brought to our societies was the closure of hospitals and other health services to visitors. Preventing the spread of infection was the main reason for these decisions in the early days of the pandemic when there was no clarity about the means of transmission and the origin of the virus. However, in view of the persistence of the restrictions to date and the numerous negative consequences they have had on the professional and (...) personal quality of life of doctors, nurses, patients and carers, the aim of this article is to analyse in depth the reasons why these decisions have been and, above all, are still being applied, also considering the hypothesis that the choices made so far in the training of health professionals should be questioned. The persistence of restrictions, the constant reduction of human and economic resources in the face of an increase in the demand for care have exacerbated the distance between health professionals and users, to the point of escalating into actual acts of violence and aggression. According to the Critical Pedagogy approach, educators can play a central role in activating formative and collaborative strategies, such as maieutic groups, to rebuild an alliance between those who today find themselves on opposite sides: health professionals on the one hand, and patients and families on the other. (shrink)