BackgroundIt has been well documented that patients can feel abused in health care and that many patients suffer from these experiences. Insight lacks into contributing factors behind such events. Silence surrounding the abuse has been suggested as a possible mechanism. The present study explores silence surrounding the abuse as a possible contributing factor. We have explored whether this silence is connected with the staff’s hierarchical position and with the staff’s own experiences as patients abused in (...) class='Hi'>health care.MethodsDuring January 2008, a paper questionnaire was sent to all staff members at a Swedish women’s clinic. The questionnaire included questions on sociodemography and profession and multiple questions about abuse in health care. After univariate testing, a binary logistic regression model including variables concerning profession and staff’s own experiences of abuse was built.ResultsOur data show that in contrast to midwives and gynaecologists, auxiliary nurses seldom report hearing about cases of abuse in health care. Staff who themselves experienced abuse in health care as patients, so-called wounded healers, were more likely to have heard about abuse in health care during the last 12 months.ConclusionsThis study suggests that a form of silence reigns over events of abuse in health care that is not randomly distributed over staff. Professional hierarchies and staff’s own experiences of abuse as patients could be considered in the design of interventions to break the silence surrounding patients’ experiences of abuse in health care. (shrink)

Efforts to counteract abuse in health care, defined as patient-experienced abuse, have mainly focused on interventions among caregivers. This study is the first to test an online intervention focusing on how patients can counteract such abuse. The intervention aimed at increasing patients’ intention and perceived ability to act in future situations where they risk experiencing abuse.

In earlier studies we have shown that abuse in health care (AHC) is commonly reported among both male and female patients. In this study, we present an evaluation of an intervention against AHC based on Forum Play. The evaluation was conducted by means of pre- and postintervention interviews with the staff at a woman's clinic. The interviews were analysed using the constant comparative method. The results of this postintervention study stand out in loud contrast to the results (...) of the preintervention studies. Staff had moved from a distant and fluctuating awareness of AHC to a standpoint characterized by both moral imagination and a sense of responsibility. (shrink)

ABSTRACT Defining a nonpaternalistic yet achievable form of trust in medicine in an era of simultaneous patient empowerment and institutional control has been and remains an important task of bioethics. The ‘crisis of trust’ in medicine has been viewed mainly as the problem of getting patients to trust their health care providers, especially physicians. However, since paradigmatic cases of trust are mutual, bioethicists must pay more attention to physician trust in patients. A physician’s view of the reasonableness of (...) trust in a particular patient is affected not just by his or her relationship with that patient, but also by what is going on institutionally, professionally, legally, and politically with regard to a given treatment or intervention. Since general moral principles are insufficient in determining the moral value and reasonableness of trust in particular instances, I discuss in detail the role of trust and distrust in the specific case of treating patients with medications implicated in drug abuse. I conclude that it is important to become aware, first, of the clinical significance of physician trust and distrust in patients, and second, of the many factors which inform both of these moral attitudes. These two claims together suggest that a central, but overlooked, virtue of medical practice is reflective, context‐responsive trust in patients. (shrink)

The argument for children's rights in health care has been long in the making. The success of this position is reflected in the 1995 American Academy of Pediatrics recommendations for the role of children in health care decisionmaking, which suggest that children be given greater voice as they mature. But there are good moral and practical reasons for exercising caution in these health care situations, especially when the child and parents disagree. Parents need the (...) moral and legal space within which to make decisions that will facilitate their child's long‐term autonomy, not only her present‐day autonomy. Moreover, third‐party intrusion, by physicians or the state, should be resisted unless negligent and abusive decisions are in the making. (shrink)

Hope is a central concept in nursing and other fields of health care. However, there is no consensus about the concept of hope. We argue that seeking consensus is futile given the multifaceted and multidimensional nature of the concept, but instead we encourage in‐depth studies of the assumptions behind talk about hope in specific contexts. Our approach to the ‘science of hope’ is inspired by philosophical pragmatism. We argue that hope is a concept that opens different rooms for (...) action in different contexts and that accordingly, all hope interventions are contextually sensitive. Careful attention to how the relative positions and power of nurses and patients influence what can be inferred from their different ways of talking about hope may make hopeful conversations more meaningful in health care relationships. (shrink)

El presente texto se inscribe dentro de la temática dirigida a la investigación sobre la violencia intrafamiliar. Tiene como objetivo sistematizar aspectos históricos y teóricos inherentes al estudio del maltrato infantil y sus consecuencias en el ámbito social y familiar para su detección y tratamiento en el nivel de atención primaria de los servicios de salud en Cuba. Mediante una revisión bibliográfica se logró concretar un análisis documental de materiales y textos en soporte digital e impreso que condujo a los (...) acercamientos teórico e histórico del fenómeno en el ámbito internacional y nacional, para su conceptualización, la determinación de su tipología y el establecimiento de sus consecuencias; elementos imprescindibles del saber profesional del futuro egresado de las ciencias médicas, en función de su desempeño en los diferentes niveles de atención de salud, en especial, la atención primaria. The text falls within the research on intrafamiliar violence subject matter. Its objective is to systematize historical and theoretical aspects inherent to the study of child abuse and its consequences within the social and domestic scopes for its detection and treatment in the Cuban primary health care services. By means of a bibliographic review, a documentary analysis of electronic and printed form materials and texts was summarized. It led to theoretical and historical approaches to the phenomenon within the national and international scopes for its conceptualization, the establishment of its typology and consequences. They are essential elements of the professional knowledge of future medical sciences graduates towards their performance in different health care levels, especially in primary health care. (shrink)

Few areas of health law practice present as many quandaries for the ethical health lawyer as health care fraud and abuse. The activities addressed by the anti-fraud laws – such as payment for referrals and submission of false claims – not only have a direct impact on the financial viability of the federal health care programs, but go to the heart of the ethical behaviors expected of those who transact business with the government. (...) The severe consequences of violating these proscriptions include significant monetary penalties, ineligibility to participate in the federal health care programs, and even imprisonment. It is no wonder, then, that compliance with the fraud and abuse laws is a key consideration in any health care venture. At the same time, ethical considerations make this area of health law particularly vexing for counsel, raising numerous challenges that include how to balance the strategic goals of current clients against the interests of future clients and whether to advise clients to self-report potential violations even when illegal intent may not easily be shown. (shrink)

Objectives: This study attempts to analyse the ethical dilemmas arising from the microallocation of scarce health care resources, in terms of deontology and utilitarianism.Methods: A group of 395 people were interviewed in the region of Diadema, greater San Paulo, Brazil, while visiting patients in the only state hospital in town. Each interviewee was given a list of eight simulated emergencies . In each of the eight cases the interviewee had to choose which of the two patients described, both (...) of whom suffered from exactly the same problem, should receive the only hospital bed currently available. The differences between the hypothetical patients were as follows: age, gender, family dependency, and lifestyle. Each interviewee was asked to justify one of their responses. These responses were then analysed.Results: The results pointed to the co-existence of deontological and utilitarian orientations among the people interviewed. A tendency to give priority to the destitute was revealed throughout the research, contradicting the idea that society, valuing only productive people, wishes only such people to receive the most resources, thus maximising the benefits to be gained from resources. The results showed that people’s disapproval of the alcoholic was stronger than that of the nicotine abuser. (shrink)

The complex regulatory framework governing the U.S. health care system can be an obstacle to programming that address health-related social needs. In particular, health care fraud and abuse law is a pernicious barrier as health care organizations may minimize or forego programming altogether out of real and perceived concern for compliance. And because health care organizations have varying resources to navigate and resolve compliance concerns, as well as different levels of (...) risk tolerance, fears related to the legal landscape may further entrench inequities in access to meaningful programs that improve health outcomes. This article uses food and nutrition programming as a case study to explore the complexities presented by this area of law and to highlight pathways forward. (shrink)

This paper discusses a number of critical ethical problems that arise in interactions between queer patients and health care professionals attending them. Using real-world examples, we discuss the very practical problems queer patients often face in the clinic. Health care professionals face conflicts in societies that criminalise same sex relationships. We also analyse the question of what ought to be done to confront health care professionals who propagate falsehoods about homosexuality in the public domain. (...) These health care professionals are more often than not motivated by strong religious convictions that conflict with mainstream medical opinion on homosexuality. We argue that they ought to be held accountable for their conduct by their professional statutory bodies, given that they abuse their professional standing to propagate sectarian views not representative of their profession. Lastly, we propose that medical schools have special responsibilities in training future health care professionals that will enable them to respond professionally to queer patients seeking health care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation (...) to its patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the... (shrink)

Background In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care. Method Ten health-care workers participating in (...) a Forum Play course took part in this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison. Results The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency. Conclusion The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation. (shrink)

This article examines the current use of Jesus language in a convenience sample of twenty-five mission statements from Roman Catholic hospitals and health care systems in the United States. Only twelve statements specifically use the words “Jesus” or “Christ” in their mission statements. The author advocates the use of explicit Jesus language and modeling. While the witness of Jesus in the Gospel healing narratives is not the only corrective to current abuses in the health care delivery (...) system, it is foundational to the integrity of Roman Catholic health care identity and mission. An analysis of Gospel healing narratives is used to illustrate the prophetic dimension of Jesus' wisdom, word, and witness. (shrink)

The last year, June 1992 through September 1993, has seen a great deal of ferment with respect to access to and financing of health care in the United States. The elections of 1992 portend dramatic changes in the American health care system, and vigorous debate regarding both expansion of access to health care and transformation of the health care financing system is taking place at the federal and the state levels. In fact, (...) however, the time period covered here produced remarkably few changes in the law, particularly at the federal level. The one piece of Medicare and Medicaid legislation passed by Congress in the fall of 1992, H.R. 11, was vetoed by President Bush immediately after the election. The Omnibus Budget Reconciliation Act of 1993 contained a host of minor adjustments to the Medicare and the Medicaid programs, but only the Medicaid asset transfer provisions and extensions to the self-referral provisions of the fraud and abuse laws, discussed below, are of import to us. (shrink)

The impact of domestic violence and abuse is far reaching not least in terms of both the immediate and longer term physical and mental wellbeing of those who have experienced abuse. DVA also exerts a considerable detrimental impact on the wider family including children. While professional perspectives of working with DVA survivors is increasingly well documented, there remains a paucity of accounts of encounters with healthcare services and/or healthcare professionals from survivors of DVA themselves. A central aim of (...) this study was the exploration of women’s experiences of healthcare encounters told purely as personal narrative rather than framed in more traditional research terms. The focus of this paper therefore is unedited personal stories of encounters with healthcare professionals. The position of narrative as research method and the presentation of narratives in this particular instance are also considered. (shrink)

Studies on health care practices, financing, and organization increasingly rely on Medicare and other expanded data sets. These studies are of critical importance for public policy and for the development of strategies to contain escalating health care costs, but they often use data that have been corrupted by fraud and abuse. Mistaken conclusions, as to the effectiveness of policy and procedures, are likely being reached in studies that have used corrupted data. Researchers need to consider (...) the suspect nature of results obtained from the corrupted data, and determine methods for making the data more valid. (shrink)

The last year, June 1992 through September 1993, has seen a great deal of ferment with respect to access to and financing of health care in the United States. The elections of 1992 portend dramatic changes in the American health care system, and vigorous debate regarding both expansion of access to health care and transformation of the health care financing system is taking place at the federal and the state levels. In fact, (...) however, the time period covered here produced remarkably few changes in the law, particularly at the federal level. The one piece of Medicare and Medicaid legislation passed by Congress in the fall of 1992, H.R. 11, was vetoed by President Bush immediately after the election. The Omnibus Budget Reconciliation Act of 1993 contained a host of minor adjustments to the Medicare and the Medicaid programs, but only the Medicaid asset transfer provisions and extensions to the self-referral provisions of the fraud and abuse laws, discussed below, are of import to us. (shrink)

This paper discusses how to apply a collective decision model of the principle of voluntary informed consent in African communitarian culture, in a culturally sensitive way, in order to protect research candidates from potential exploitations and abuses. Dismissing cultural and ethical skepticism surrounding the global application of the principle of voluntary informed consent, the paper ultimately concludes that international collaboration on diagnostic and therapeutic medical research in Africa, especially HIV vaccine trials, is a moral imperative.

Menzel and Light have argued that the conservative principle of self-sufficiency gives good reasons to strive for universal health coverage. This paper gives further reasons for connecting universal health care with self-sufficiency and continues Menzel’s and Light’s project in four more ways. First, a more extended analysis of a conservative conception of government shows how a general opposition to welfare programs is consistent with guaranteeing universal basic health care. Second, common fears about the abuse (...) of health care when universal access is guaranteed are unfounded. Third, worldwide experience shows that the most effective way to bring high quality health care to a population is through a government mandate, not the free market. Fourth, while socioeconomic status is an important determinant of health independent of the accessibility of health care itself, this does not undermine the case for universal health care based on a minimal, conservative conception of equality of opportunity. (shrink)

This article aims to foreground alcohol abuse by cancer patients and explore how alcohol abuse functions as a biographic master motive and at the same time is a shadow side in the oncological field and research. The research is based on a single case study which draws on empirical material from interviews, field notes and staff policy, with analysis using Bourdieu’s concepts of trajectory of life and habitus. The findings show that the cancer patient’s alcohol abuse is (...) an important part of the trajectory of his private life and spare time. In social life with family and friends alcohol is given and normal and acts as a socialisator. Alcohol abuse provides both stability and instability in the cancer patient’s life. When cancer results in work breaks and retirement, and spare time often is used as drinking time, then all daily life becomes drinking time for the cancer patient. Alcohol is often a hidden abuse at the working place and in the oncological field. In meetings with healthcare professionals, the patient chooses not to speak about his alcohol abuse to avoid further medicalisation. The challenge for the healthcare professionals is to see and accept alcohol abusers with cancer and their social lives without always trying to change their ‘unhealthy’ lifestyles. (shrink)

In an earlier edition of CambridgeQuarterly, in the section (CQ Vol 9, No 4), Larry Gottlieb sought advice on ethics committee assembly and policy implementation for a community mental health center. One concern mentioned is that staff members frequently encounter ethical issuesregarding the care of clients whose decisionmaking abilities are impaired by chronic mental illness and/or substance abuse. My response offers a suggestion for policy development and implementation, which may be integrated into guiding staff members of community (...) mental health centers toward a model of care planning that is centered on clients' experiences of their treatments and on relationship-building among clients, community members, and mental health professionals. (shrink)

This study aimed to analyze experiences that consider ICTs in the management of learning in health and to identify some components that can facilitate a management mechanism to promote training and knowledge development for the care of drug use, abuse, and dependence from the perspective of evidence-based learning. To carry out this work, a community-based research methodology has been used, through an educational project with drug learning communities with 200 people from countries in the Americas such as (...) Colombia, Mexico, Panama, Chile, and Paraguay. (shrink)

In the past several years, the Office of Inspector General, the branch of the Department of Health and Human Services that combats fraud and abuse, has begun enforcing a little-used provision that allows the government to exclude owners and managers of sanctioned entities based on their position in the company. The OIG's exclusion authority under 42 USC § 1320a-7 is not unique in applying strict liability to individual executives as a tool to halt corporate misconduct, but it represents (...) a startling change for health care executives who could now face exclusion for their company's misdeeds. While the OIG has expanded its use of this statute, it has indicated some hesitancy in exercising the full scope of its statutory power.Pursuant to §1128 and §1156 of the Social Security Act, the OIG can exclude individuals and entities from participating in federal healthcare programs. The OIG has both mandatory and permissive exclusion power, based on the circumstances of the offense. (shrink)

There are now over 1.1 million people overseen by Immigration and Customs Enforcement (ICE), with about 33,000 detained in jails and federal detention centers around the country at any particular time. The average detention time is two months, but some are detained for much longer periods. Since its inception, one hundred and twenty one deaths and countless cases of medical neglect have occurred. Given its secrecy, and lack of accountability and oversight, it is not clear how many of these deaths (...) are the result of grossly inadequate medical care. ICE is a branch of a government agency in a democratic country, thus the citizens on whose behalf it allegedly operates have an obligation to ensure that it operates in conformity with the fundamental principles of justice on which this nation was founded. ICE is a young and rapidly growing bureaucracy with little oversight. It operates using a mix of federal, state, local and private centers, many of which are penal institutions. It has a history of serious abuse, and even when it operates in conformity with its penal standards, it inflicts additional harm onto vulnerable people, especially asylum seekers and parents of minor children. It thus requires our constant vigilance and concern. Our immigration policies and detention practices are deeply troubling, but until we elect to reform them, we have a special obligation to the vulnerable populations that we house in ICE detention. (shrink)

This essay summarizes key insights across the essays in the Hastings Center Report's special report “Time to Rebuild: Essays on Trust in Health Care and Science.” These insights concern trust and trustworthiness as distinct concepts, competence as a necessary but not sufficient input to trust, trust as a reciprocal good, trust as an interpersonal as well as structural phenomena, the ethical impermissibility of seeking to win trust without being trustworthy, building and borrowing trust as distinct strategies, and challenges (...) to trustworthiness posed by the contingent nature of science. Together, these insights stand to advance an area of research that we believe has been historically stymied by conceptual confusion and a long‐standing insistence on treating trust as a purely instrumental good. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of (...) class='Hi'>health care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

This paper critically engages ethical issues in the allocation of novel, and potentially costly, health care resources to patients with disorders of consciousness. First, we review potential benefits of novel health care resources for patients and their families and outline preliminary considerations to address concerns about cost. We then address two problems regarding the allocation of health care resources to patients with disorders of consciousness: (1) the problem of uncertain moral status; and (2) the (...) problem of accurately measuring the welfare burdens these resources would relieve. We conclude by suggesting that opportunity-based frameworks might complement standard approaches for justifying resources allocation to patients with disorders of consciousness. (shrink)

Australia's policy of mandatory indefinite detention of those seeking asylum and arriving without valid documents has led to terrible human rights abuses and cumulative deterioration in health for those incarcerated. We argue that there is an imperative to research and document the plight of those who have suffered at the hands of the Australian government and its agents. However, the normal tools available to those engaged in health research may further erode the rights and well being of this (...) population, requiring a rethink of existing research ethics paradigms to approaches that foster advocacy research and drawing on the voices of those directly affected, including those bestowed with duty of care for this population. (shrink)

Is health care “special”? That is, do we have moral reason to treat health care differently from how we treat other sorts of social goods? Intuitively, perhaps, we might think the proper response is “yes.” However, to date, philosophers have often struggled to justify this idea—known as the “specialness thesis about health care” or STHC. In this article, I offer a new justification of STHC, one I take to be immune from objections that have (...) undercut other defenses. Notably, unlike previous utility- and opportunity-based theories, I argue that we can find normative justification for STHC in what I term our special duty to assist those unable to help themselves. It is this duty, I argue, that ultimately gives us reason to treat health care differently from other sorts of goods and to distribute it independently of individuals’ ability to pay. (shrink)

This article aims to present the problem of the impact of artificial intelligence on respect for human dignity in the sphere of care for people who, for various reasons, are described as particularly vulnerable, especially seniors and people with various disabilities. In recent years, various initiatives and works have been undertaken on the European scene to define the directions in which the development and use of artificial intelligence should go. According to the human-centric approach, artificial intelligence should be developed, (...) used and monitored with people in mind, their needs and rights. It is artificial intelligence that should adapt to the rules set by people, not the other way around. The source of all human rights and freedoms is respect for human dignity. This is evidenced by numerous European, international, national regulations and documents. Respecting this value is also one of the works on the AI development. One of the areas of our life into which AI enters more and more boldly and which in the near future, due to demographic reasons and aging population, may be almost dominated by modern technologies, is the medical and care system. The usefulness of industrial co-robots made us think about the possibility of using similar devices in the non-industrial sphere, including in the sphere of care, nursing and therapy. Actually, despite the impressive development of technology and AI, intelligent robots/devices used for care, nursing or therapy (so-called care/nursing or therapy robots) perform rather simple activities. They provide information, navigate, bring something and give it (e.g. medicines, food), help to get up. They are an important support for medical staff in this respect. Performing tasks that are more complex in terms of technology and movement, such as feeding, washing, intimate hygiene, dressing or undressing, is still beyond the reach of the currently used robots. The question we must ask ourselves is whether, in the future, care robots will be able to perform such tasks, and should they do so? Will this lead to the replacement of human medical personnel in the performance of the above-mentioned activities with such robots. Would anyone want to be "looked after" by a soulless machine? Should potential wards/patients, in other words all of us in fact, have the right to object to being taken into the care of an intelligent robot? There is no doubt that intelligent robots have great potential, especially when it comes to ensuring or maintaining the independence or mobility of people with various health limitations. However, we must not forget about the risks and dangers they may generate. Even a simple robot generates serious legal and ethical problems. Who should be liable for damage caused in connection with improper care performed with the participation of a robot? Robots based on AI systems are able to collect a significant amount of sensitive data, for example through the face and speech recognition function. There is considerable scope for abuse in this area, not only in terms of personal data protection but also in terms of informational self-determination, privacy and dignity. Bearing in mind the above risks, the creation of a new right to object to being looked after by a robot should be considered. (shrink)

Lifestyle diseases constitute an increasing proportion of health problems and this trend is likely to continue. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge. Holding individuals accountable for their choices in the context of health care is, however, controversial. There are powerful arguments both for and against such policies. In this article the main arguments for and the traditional arguments against the use of individual responsibility as (...) a criterion for the distribution of scarce health resources will be briefly outlined. It is argued that one of the most prominent contemporary normative traditions, liberal egalitarianism, presents a way of holding individuals accountable for their choices that avoids most of the problems pointed out by the critics. The aim of the article is to propose a plausible interpretation of liberal egalitarianism with respect to responsibility and health care and assess it against reasonable counter-arguments. (shrink)

This paper discusses the key role medical regulators have in setting standards for doctors who use artificial intelligence (AI) in patient care. Given their mandate to protect public health and safety, it is incumbent on regulators to guide the profession on emerging and vexed areas of practice such as AI. However, formulating effective and robust guidance in a novel field is challenging particularly as regulators are navigating unfamiliar territory. As such, regulators themselves will need to understand what AI (...) is and to grapple with its ethical and practical challenges when doctors use AI in their care of patients. This paper will also argue that effective regulation of AI extends beyond devising guidance for the profession. It includes keeping abreast of developments in AI-based technology and considering the implications for regulation and the practice of medicine. On that note, medical regulators should encourage the profession to evaluate how AI may exacerbate existing issues in medicine and create unintended consequences so that doctors (and patients) are realistic about AI’s potential and pitfalls when it is used in health care delivery. (shrink)

Equity in health and health care is animportant issue. It has been proposed that thepursuit of equity in health care is beinghampered by the dominance of individualism inhealth care practices. This paper explores theway in which communitarian ideals and practicesmight lend themselves to the pursuit of equity.Communitarians acknowledge, respect and fosterthe bonds that unite and identify communities.The paper argues that, to achieve equity inhealth care, these bonds need to be recognisedand harnessed rather than (...) ignored. The notionof individual autonomy in the context of thecommunity is examined. Alternative concepts ofautonomy – social autonomy and communityautonomy – are seen to be more respectful andnurturing of both the individual and thecommunity. Moreover, these concepts appeardesirable for the pursuit of health care equitygoals. The paper concludes with some thoughtsabout how equity in Australia's health caresystem can reasonably progress within acommunitarian vision. Disadvantaged communitiesare discussed throughout, in particular,Australian Aboriginal communities. (shrink)

The problem of providing mandated medical care has become commonplace as correctional systems in the United States struggle to manage unprecedented increases in its aging prison population. This study explores older incarcerated women’s perceptions of prison health care policies and their day-to-day survival experiences. Aggregate data obtained from a sample of 327 older women residing in prison facilities in five Southern states were used to identify a baseline of health conditions and needs for this vulnerable group. (...) With an average of 4.2 chronic health conditions, frequently histories of victimization, and high rates of mental health issues, the women’s experiences of negotiating health care was particularly challenging. By incorporating the voices of older women, we expose the contradictions, dilemmas, and obstacles they experience in their attempts to obtain health care. It is clear from the personal accounts shared that, despite court mandates, penal harm practices such as delaying or denying medical treatment as well as occasional staff indifferences are common in women’s prisons. With older women having the greatest need for health care, an age- and gender-sensitive approach is recommended. (shrink)

To better understand the available publications addressing ethical issues in rural health care we sought to identify the ethics literature that specifically focuses on rural America. We wanted to determine the extent to which the rural ethics literature was distributed between general commentaries, descriptive summaries of research, and original research publications. We identified 55 publications that specifically and substantively addressed rural health care ethics, published between 1966 and 2004. Only 7 (13%) of these publications were original (...) research articles while (12) 22% were descriptive summaries of research and 36 (65%) were general commentaries. The majority of publications examined (55%) were clinically focused while 27% addressed organizational ethics and 18% addressed ethical ramifications of rural health care policy at a national or community level. Our findings indicate that there are a limited number of publications focusing on rural health care ethics, suggesting a need for scholars and researchers to more rigorously address rural ethics issues. (shrink)

A just social arrangement must guarantee a right to health care for all. This right should be understood as a positive right to basic human functional capabilities. The present article aims to delineate the right to health care as part of an account of distributive justice in health care in terms of the sufficiency of basic human functional capabilities. According to the proposed account, every individual currently living beneath the sufficiency threshold or in jeopardy (...) of falling beneath the threshold has a legitimate claim to justice. People's entitlements to health care should not be determined on the basis of brute luck and their efforts to maintain healthy lifestyles. The prioritization of competing claim-rights of individuals is guided by two allocation principles: number and benefit-size weighted sufficiency (among people beneath the threshold) and need-weighted utilitarianism (among people above the threshold). (shrink)

The Trump Administration's recent attempts to repeal the Affordable Care Act have reignited long‐running debates surrounding the nature of justice in health care provision, the extent of our obligations to others, and the most effective ways of funding and delivering quality health care. In this article, I respond to arguments that individualist systems of health care provision deliver higher‐quality health care and promote liberty more effectively than the cooperative, solidaristic approaches that (...) characterize health care provision in most wealthy countries apart from the United States. I argue that these claims are mistaken and suggest one way of rejecting the implied criticisms of solidaristic practices in health care provision they represent. This defence of solidarity is phrased in terms of the advantages solidaristic approaches to health care provision have over individualist alternatives in promoting certain important personal liberties, and delivering high‐quality, affordable health care. (shrink)

Background: Hospitalized children have the right to “partake in practices related to their treatment and care.” Midwives and nurses have important roles and responsibilities regarding the protection and enforcement of these rights, such as providing information and advocating for children. Objectives: This study aims to determine the attitudes of midwives and nurses toward their roles and responsibilities in the implementation of child rights in healthcare services and the factors affecting their attitudes. Methods: This descriptive cross-sectional study included 122 midwives (...) and nurses in total. The data were collected through a questionnaire. Ethical considerations: Written permission was obtained from an ethics committee in the center of the city where the research was conducted. Results: The mean age of the participants was 36.70 ± 8.03 years; 58.9% of midwives and nurses stated that they understood the child’s consent about the treatment by looking at the child’s facial expression; 36% of midwives and nurses stated that children could not participate in decisions regarding their own health. It was observed that obtaining the child’s consent in matters related to treatment does not make any difference between midwives and nurses. The rate of the midwives stating that they would report suspicious violence-neglect and abuse was found to be higher. Conclusion: The variables of the unit of employment, the state of having children, choosing the profession and practicing in it willingly, and getting training on children’s rights make a difference in terms of children’s rights in healthcare services. Midwives and nurses should be reminded of child rights in healthcare services through regular in-service training programs. (shrink)

Background Moral courage means courage to act according to individual’s own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. Objective To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. Research design Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale©, (...) a video vignette of the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. Participants and research context Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses’ Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. Ethical considerations Good scientific inquiry guidelines were followed. Permission to use the Nurses’ Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses’ Association. Findings The mean value of potential whistle-blowers’ moral courage on a Visual Analogue Scale (0–10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers’ moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. Discussion and conclusion In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing. (shrink)

The practice of health-care professional involvement in capital punishment has come under scrutiny since the implementation of lethal injection as a method of execution, raising questions of the goals of medicine and the ethics of medicalized procedures. The American Medical Association and other professional associations have issued statements prohibiting physician involvement in capital punishment because medicine is dedicated to preserving life. I address the three primary arguments against health-care professionals being involved in lethal injection and argue (...) that they are not strong enough to prohibit physician involvement in the lethal injection process. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support (...) excellence in maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

Trust is taken to be one of the foundational values in the doctor-patient relationship, facilitating access to the benefits of health care and providing a guarantee against possible harms. Despite this foundational role, some doctors betray the trust of their patients. Trusting involves granting discretionary powers and makes the truster vulnerable to the trustee. Patients trust medical practitioners to act with goodwill and to act competently. Some patients carry pre-existing vulnerabilities, for reasons such as gender, poverty, age, ethnicity, (...) or disability, and these vulnerabilities can be exacerbated when such patients extend their trust to a doctor. Gender stereotypes reduce women's ability to challenge and thereby assess their doctor's competency. In addition, women are more likely to be distrusted by their doctors and have their experiences of medical symptoms discounted. In this paper, we analyze two extreme examples of breaches of medical trust that exploited the vulnerability of women in the health care system: the "unfortunate experiment" at the National Women's Hospital in New Zealand and the Harold Shipman murders of elderly patients in the United Kingdom, examining the potential role of gender in the outcomes with regard to trust. Major breaches of medical trust such as these typically lead to government inquiries, revisions of ethical guidelines, and substantive policy change in an effort to re-establish public and patient trust. We argue that the medical profession has an ethical obligation to put mechanisms in place to protect vulnerable patients from abuses of trust, to monitor colleagues' competence, and to be prepared to blow the whistle to protect patients who are not in a position to recognize misplaced trust. Such mechanisms will act disprosportionately to reduce harm to women as patients. (shrink)

Artificial intelligence holds great promise for improved health‐care outcomes. But it also poses substantial new hazards, including algorithmic discrimination. For example, an algorithm used to identify candidates for beneficial “high risk care management” programs routinely failed to select racial minorities. Furthermore, some algorithms deliberately adjust for race in ways that divert resources away from minority patients. To illustrate, algorithms have underestimated African Americans’ risks of kidney stones and death from heart failure. Algorithmic discrimination can violate Title VI (...) of the Civil Rights Act and Section 1557 of the Affordable Care Act when it unjustifiably disadvantages underserved populations. This article urges that both legal and technical tools be deployed to promote AI fairness. Plaintiffs should be able to assert disparate impact claims in health‐care litigation, and Congress should enact an Algorithmic Accountability Act. In addition, fairness should be a key element in designing, implementing, validating, and employing AI. (shrink)

Institutional review boards distinguish health care quality improvement and health care quality improvement research based primarily on the rigor of the methods used and the purported generalizability of the knowledge gained. Neither of these criteria holds up upon scrutiny. Rather, this apparently false dichotomy may foster under-protection of participants in QI projects and over-protection of participants within QIR.

The article provides answers to comments in this journal on my recent book, Setting Health-Care Priorities. What Ethical Theories Tell Us. Did I address all of the relevant theories? Yes, I did. Was my argument underdeveloped in any respects? Yes, at least in one as I should perhaps have discussed contractual ethical thinking more carefully. I do so in this response. Moreover, the critical comments raised have helped me to clarify my argument in many ways, for which I (...) thank my critics. (shrink)