In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the (...) new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician’s opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician’s advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient’s confidence in physician referral and advice. (shrink)

Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an (...) appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation’s policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes. (shrink)

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses (...) hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while (...) internationally studies highlight instances of covert rationing/missed care/care left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

We show that a given data ow language l has the property that for any program P and any demand for outputs D (which can be satis ed) there exists a least partial computation of P which satis es D, i all the operators of l are stable. This minimal computation is the demand-driven evaluation of P. We also argue that in order to actually implement this mode of evaluation, the operators of l should be further restricted (...) to be e ectively sequential ones. (shrink)

This article analyzes the contribution Christian ethics might be able to make to the ethical debate on policy and caregiving in health and social care in the United Kingdom. The article deals particularly with the concepts of solidarity and subsidiarity which are essential in Christian social ethics and health care ethics, and which may be relevant for the ethical debate on health and social caregiving in the United Kingdom. An important argument in the article is that utilitarian and (...) market-driven policies in the National Health Service (NHS) and the social care system have marginalized the position of the elderly and have seriously impoverished the quality of care for the elderly. The neglect of the elderly and other vulnerable groups is also the result of widespread consumerist attitudes among patients and of libertarian models of noninterference which are affirmed by a public ethos of self-sufficiency and counter-dependency. Those who need care dare not make their need known to others and ask for help, while simultaneously those who could help are so intimidated by the public affirmation of privacy and negative rights that they do not dare to offer help except if this is explicitly demanded. This distant and standoffish attitude is in an important way responsible for the fact that the voice of those in need is altogether lost to the public forum. Christian ethics puts much emphasis on responsibility and solidarity with the needy other but is not able to have much impact on the delivery of care in a secularized society and health care system like the NHS. Nonetheless, Christianity still has a powerful and respected voice, by speaking up for those who cannot speak for themselves, such as the elderly and the handicapped. Christians can find allies in the ethics of care and other relational approaches in health care ethics in order to combat libertarianism, consumerism, and utilitarianism. (shrink)

Although many governments have privatized their agricultural extension services, there is widespread agreement that the public sector still needs to play a role in the “agricultural knowledge market” in order to prevent market failure and other undesirable phenomena. However, appropriate mechanisms for intervention in the agricultural knowledge market are still in their infancy. This article discusses the case of the Nutrient Management Support Service (NMSS), a government-funded support service in The Netherlands designed to optimize the fit between the demand (...) and supply of “agricultural knowledge products” that reduce nutrient emissions into the environment. The activities of the support service were four-fold: (1) distributing vouchers to farmers, (2) establishing mechanisms for quality control, (3) facilitating the articulation of end-users’ needs, and (4) improving market transparency. We analyze the extent to which the NMSS has succeeded in supporting a demand-driven knowledge market for nutrient management issues. We question some of the conceptual and practical assumptions underlying this style of intervention. In addition, we argue that the notion of demand requires considerable refinement before it can be useful for guiding state involvement in demand-driven extension. (shrink)

Although many governments have privatized their agricultural extension services, there is widespread agreement that the public sector still needs to play a role in the “agricultural knowledge market” in order to prevent market failure and other undesirable phenomena. However, appropriate mechanisms for intervention in the agricultural knowledge market are still in their infancy. This article discusses the case of the Nutrient Management Support Service (NMSS), a government-funded support service in The Netherlands designed to optimize the fit between the demand (...) and supply of “agricultural knowledge products” that reduce nutrient emissions into the environment. The activities of the support service were four-fold: (1) distributing vouchers to farmers, (2) establishing mechanisms for quality control, (3) facilitating the articulation of end-users’ needs, and (4) improving market transparency. We analyze the extent to which the NMSS has succeeded in supporting a demand-driven knowledge market for nutrient management issues. We question some of the conceptual and practical assumptions underlying this style of intervention. In addition, we argue that the notion of demand requires considerable refinement before it can be useful for guiding state involvement in demand-driven extension. (shrink)

In Justice, Care, and Value Thomas Randall advances the radical potential of care ethics as a distinct (and preferable) theory of distributive justice. Advancing the care ethical literature this book defends a vision of society that can best enable such relations to flourish. Specifically, Randall uses breakthrough arguments to propose a values-driven theory of care ethics that identifies good caring relations through classifying the values of care. He argues that such a theory gives us (...) unique and meaningful solutions to contemporary questions and encourages us to think about distributive justice across personal, political, global, and intergenerational domains. Through this the book makes significant strides to engage care ethics with the broader moral and political philosophy literature. Topical and interdisciplinary, Randall demonstrates that care ethics has the conceptual resources to ground distributive theories of socialism, territorial and natural resource rights, obligations to future generations, and historic redress. The book will be of great interest for academics, researchers, and students in feminist philosophy, but also in liberalism, global and intergenerational theories of justice, and political economy. (shrink)

Adaptation and stress are two main concepts useful for better understanding the phases of illness and health-related human behavior. The two faces of adaptation, adaptation as a process and adaptation as a product, have raised the question of how long the adaptation process will take in cancer trajectories. The care setting transition from clinical-based into home-based cancer care has stressed the role of family caregivers (FCG) in cancer management. This study examines how types of demanded healthcare information affect (...) the FCG’s role in catalyzing the adaptation of female cancer patients. The mindsponge theory was used in conceptual development and results interpretation. Bayesian Mindsponge Framework (BMF) analytics was used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of demanded healthcare information, FCGs with a higher tendency to demand cancer-specific information are more likely to need support in catalyzing the adaptation of female cancer patients. Meanwhile, FCGs with a higher demand for information on alternative therapies are less likely to need support in catalyzing cancer adaptation. Other types of healthcare information have ambiguous effects on the need for support in cancer adaptation assistance. This study reveals that the demanded cancer-specific information, e.g., cancer’s prognosis or likely outcome, must be prioritized to assist FCG’s role in catalyzing adaptation among female cancer patients. Cancer prognosis and outcomes reflect the future of cancer care results. (shrink)

The role of churches in primary health care delivery in Africa's poor contexts is widely acknowledged. Discussion of churches' work in health largely focuses on the spiritual side and tends to downplay the practical side. A clear challenge and gap in the role of churches in primary health delivery is the lack of clear models and approaches to determine the efficacy of the interventions. Hence, the role of churches as a player in the delivery of primary health care (...) needs examination. This paper examines the role of church-driven primary health care, using a practical case study of the health work of the Salvation Army in East Africa. It outlines the primary health services rendered by the Salvation Army and deduces five models that emerged from the work of the various implementing churches in delivering primary health care. The article proceeds from an analysis of the meaning of primary health care and how churches are historically and currently positioned to contribute to primary health care. The article demonstrates that, viewed from a primary health care delivery perspective, churches in Africa play a critical practical contribution further to a spiritual role. From a practical theology perspective, the paper provides insight into how churches could operate in communities within the interface of church and health spaces. However, the church's role and function is organic and differs in every community. (shrink)

When a reasonable agent deliberates about what to do, she entertains only a limited range of possible courses of action. A theory of practical reasoning must therefore include an account of deliberative attention: an account that both explains the patterns of deliberative attention that reasonable agents typically display and allows us to see why these patterns of deliberative attention are reasonable. I offer such an account, built around two, central claims. A reasonable agent who cares about some end is disposed (...) to exclude courses of action which she believes to be incompatible with that end from the range of possibilities that she will entertain as options in practical deliberation. As I shall put it, an agent’s cares establish deliberative boundaries for her practical thought. The stability of a deliberative boundary varies with the depth of the care that explains it. These two claims motivate the Boundary-Driven Model of the path that a reasonable agent’s deliberative attention will take in temporally extended deliberation. If we locate the model within a maximizing conception of practical rationality, then boundary-driven deliberation, of the sort that the model describes, can be understood and justified instrumentally, as a heuristic device. But if we suppose that there is no single index of value that successful practical choice maximizes, then boundary-driven deliberation is partly constitutive of reasonableness in practical thought. It allows an agent facing plural and incommensurable values to frame her deliberative problems narrowly enough that, in conjunction with deliberative devices which are not part of the model but which are compatible with it, she may be able to reach a non-arbitrary decision – and so give a determinate, verdictive sense to the phrase “the best course of action available to me” in cases in which a determinate meaning for this phrase would otherwise be lacking. (shrink)

Background: Nurses encounter complex ethical dilemmas in everyday nursing care. It is important for nurses to have moral courage to act in these situations which threaten patients’ safety or their good care. However, there is lack of research of moral courage. Purpose: This study describes nurses’ experiences of care situations demanding moral courage and their actions in these situations. Method: A qualitative descriptive research design was applied. The data were collected with an open-ended question in the questionnaire (...) used in validation of the Nurses’ Moral Courage Scale. The sample consisted of 286 nurses from four different clinical fields in a major university hospital in Finland, providing a total of 611 answers. Data were analyzed using inductive content analysis. Ethical considerations: The study followed the commonly recognized principles of good scientific practice. The use of data was authorized by the developer of the instrument, the data collector, and the participating hospital. Ethical approval was obtained from the university ethics committee. Findings: Nurses acted morally courageously in most situations but sometimes they failed to do so. Although situations demanding moral courage varied, they could be categorized into seven main domains relating to colleagues, physicians, patients, relatives, nurses themselves, managers, and organizations. Nurses acted in the situations in different ways. The main acts in solving the situations were verbal communication or immediate action, such as interrupting of action. Conclusion: Care situations demanding moral courage focus on good and safe patient care and the patient’s good is at the center of attention. The situations are mostly related to the activities of other healthcare professionals. Findings may be applied in developing ethical nursing care through basic and continuing nursing education. Research is needed on the moral courage of physicians and managers, as well as on patients’ and their relatives’ experiences of care situations demanding moral courage. (shrink)

All over Europe, the provision of healthcare services is widely considered a primary duty of the government. Universal access to medical care can be considered a basic ingredient of the so-called “European social model.” But if universal access to medical care is seldom questioned, European governments—faced with expanding costs caused by an increasing demand driven by an aging population and technology-driven improvements—are contemplating the possibility of “rationing”1 treatments, or the possibility of allowing a greater role (...) for private suppliers. If a “multi-tier” healthcare system has long been anathema to the European leadership, guaranteeing a uniform access to state-of-the-art care seems to be well beyond the means of states suffering from persisting debt crisis. Was the failure of state-controlled “adequate” healthcare totally unpredictable? Far-sighted criticisms had been offered by two eminent thinkers in the classical liberal tradition, Herbert Spencer and Friedrich A. von Hayek . Neither author is usually recognized as a forerunner of contemporary critics of the welfare state, and both investigated the issue of the state financing and providing health services well before or right after the establishment of national health services. With the benefit of hindsight, reading Spencer and Hayek helps us to understand how the crisis of state-supplied healthcare is not rooted in the mere progress of clinical technology, but is rather the logical consequence of the theoretical basis of the model itself. Whereas modern theorists of the welfare state tend to offer theories that are impervious to a critical appraisal of their unintended consequences—insofar as they are framed in a language of “rights”—both Hayek and Spencer understood that human systems are complex, and that unwanted effects of public policy should be taken into account. Although Spencer emphasized the moral hazards accruing from the paternalism involved in governmental provision of health services, Hayek explained how modern healthcare systems differ from real, private insurance designed to offer proper coverage against risks. These authors appreciated that the politicization of healthcare was bound to result in both standardization of care and disregard for the responsibility that comes with personal freedom. These two “diagnoses before the illness” can help us in defining the challenges and the potential solutions that healthcare systems face today. Understanding the fatal conceits inherent in the very architecture of national health services can be the first step toward healing our healthcare systems. (shrink)

Having a sense of dignity is one of the core emotions in human life. Is our dignity, and accordingly also our sense of dignity under threat in elderly care, especially in robotic care? How can robotic care support or challenge human dignity in elderly care? The answer will depend on whether it is robot-based, robot-assisted, or teleoperated care that is at stake. Further, the demands and realizations of human dignity have to be distinguished. The demands (...) to respect humans are based on human dignity and the inalienable high and equal moral standing that everyone has. For human moral agents, these demands take the form of negative and positive duties. For robots, they arguably take the form of corresponding ought-to-be norms. The realizations of dignity consist in variable responses to these demands, by oneself by others, and by society at large. This article examines how robot-based, robot-assisted, and teleoperated care can amount to realizations of dignity. The varieties of robotic care can, in different ways, be responsive to the demands of dignity and recognize humans as vulnerable beings with needs, as autonomous agents, and as rational subjects of experience, emotion, and thought. (shrink)

This article explores staff work patterns in an Australian residential aged care facility and the implications for high‐quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to explore (...) the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector. (shrink)

In order to care ethically nurses need to care holistically; holistic care includes religious/spiritual care. This research attempted to answer the question: Do nurses have the resources to offer religious care? This article discusses only one aspect - the provision of religious care within the Taiwanese health care system. It is assumed that, if hospitals do not provide enough religious services, nurses working in these hospitals cannot be fully ethical beings or cannot respect (...) patients’ religious needs. The relevant literature was reviewed, followed by a survey study on the provision of religious facilities and services. Aspects considered are: the religions influences in and on Taiwanese society; the religious needs of patients and their families; strategies that patients use to enable them to cope with their health care problems; professional motives for attuning to patients’ religious needs; and hospital provision for meeting the religious and spiritual needs of patients. A survey of nursing executives showed differences between religious service provision in hospitals with and without a hospice ward. The practical implications for hospital management and nursing practice are discussed. (shrink)

Ancillary care is care that research participants need that is not essential to make the research safe or scientifically valid and is not needed to remedy injuries that eventuate as a result of the research project itself. Ancillary care duties have recently been defended on the grounds of beneficence, entrustment, utility and consent. Justice has also been mentioned as a possible basis of ancillary care duties, but little attention has been paid to this approach. In this (...) paper, the author seeks to rectify this omission by arguing that ancillary care duties can be based on a principle of justice as rectification. (shrink)

Various kinds of consumer-driven reforms have been attempted over the last 20 years in an effort to rein in soaring costs of health care in the United States. Most are based on a theory of moral hazard, which holds that patients will over-utilize health care services unless they pay enough for them. Although this theory is a basic premise of conventional health insurance, it has been discredited by actual experience over the years. While ineffective in containing costs, (...) increased cost-sharing as a key element of consumer-driven health care leads to restricted access to care, underuse of necessary care, lower quality and worse outcomes of care. This paper summarizes the three major problems of U.S. health care urgently requiring reform and shows how cost-sharing fails to meet that goal. (shrink)

Effectiveness, efficiency and equity in health care are discussed in this article against the background of concerns that cost containment may lead to reductions in quality of care. It is suggested that effectiveness is best seen from the patient's point of view and that it relates to more than simply improved health status. Efficiency and equity are better viewed from a societal stance.The paper discusses the role of the medical profession in effectiveness, efficiency and equity and argues that (...) the role of medical doctors needs to be constrained. (shrink)

Background In the UK, the solidaristic character of the NHS makes it one of the most trusted public institutions. In recent years, the introduction of data-driven technologies in healthcare has opened up the space for collaborations with private digital companies seeking access to patient data. However, these collaborations appear to challenge the public’s trust in the. Main text In this paper we explore how the opening of the healthcare sector to private digital companies challenges the existing social contract and (...) the NHS’s solidaristic character, and impacts on public trust. We start by critically discussing different examples of partnerships between the NHS and private companies that collect and use data. We then analyse the relationship between trust and solidarity, and investigate how this relationship changes in the context of digital companies entering the healthcare system. Finally, we show ways for the NHS to maintain public trust by putting in place a solidarity grounded partnership model with companies seeking to access patient data. Such a model would need to serve collective interests through, for example, securing preferential access to goods and services, providing health benefits, and monitoring data access. Conclusion A solidarity grounded partnership model will help establish a social contract or licence that responds to the public’s expectations and to principles of a solidaristic healthcare system. (shrink)

Paid care services such as child care, elder care, teaching, and nursing are vulnerable to competitive pressures that often generate low-pay/low-quality outcomes. Both workers and consumers suffer as a result. This article develops an economic analysis of the “care sector” that emphasizes the potential to build political coalitions that could push for a high-pay/high-quality alternative.

This is a response to a review of my book Learning From My Daughter. I argue that what the reviewers object to in my ethics of care is based partially on a mistaken view of my understanding of care.

Large-scale data systems are increasingly envisioned as tools for justice, with big data analytics offering a key opportunity to advance health equity. Health systems face growing public pressure to collect data on patient “social factors,” and advocates and public officials seek to leverage such data sources as a means of system transformation. Despite the promise of this “data-driven” strategy, there is little empirical work that examines big data in action directly within the sites of care expected to transform. (...) In this article, I present a case study on one such initiative, focusing on a large public safety-net health system’s initiation of sexual orientation and gender identity data collection within the clinical setting. Drawing from ethnographic fieldwork and in-depth interviews with providers, staff, and administrators, I highlight three main challenges that elude big data’s grasp on inequality: provider and staff’s limited understanding of the social significance of data collection; patient perception of the cultural insensitivity of data items; and clinic need to balance data requests with competing priorities within a constrained time window. These issues reflect structural challenges within safety-net care that big data alone are unable to address in advancing social justice. I discuss these findings by considering the present data-driven strategy alongside two complementary courses of action: diversifying the health professions workforce and clinical education reform. To truly advance justice, we need more than “just data”: we need to confront the fundamental conditions of social inequality. (shrink)

Recent medical and bioethics literature shows a growing concern for practitioners’ emotional experience and the ethical environment in the workplace. Moral distress, in particular, is often said to result from the difficult decisions made and the troubling situations regularly encountered in health care contexts. It has been identified as a leading cause of professional dissatisfaction and burnout, which, in turn, contribute to inadequate attention and increased pain for patients. Given the natural desire to avoid these negative effects, it seems (...) to most authors that systematic efforts should be made to drastically reduce moral distress, if not altogether eliminate it from the lives of vulnerable practitioners. Such efforts, however, may be problematic, as moral distress is not adequately understood, nor is there agreement among the leading accounts regarding how to conceptualize the experience. With this article I make clear what a robust account of moral distress should be able to explain and how the most common notions in the existing literature leave significant explanatory gaps. I present several cases of interest and, with careful reflection upon their distinguishing features, I establish important desiderata for an explanatorily satisfying account. With these fundamental demands left unsatisfied by the leading accounts, we see the persisting need for a conception of moral distress that can capture and delimit the range of cases of interest. (shrink)

Henry Shue’s model of basic rights and their correlative duties provides an excellent framework for analysing the requirements of global distributive justice, and for theorising about the minimum acceptable standards of human entitlement and wellbeing. Shue bases his model on the claim that certain ‘basic’ rights are of universal instrumental value, and are necessary for the enjoyment of any other rights, and of any ‘decent life’. Shue’s model provides a comprehensive argument about the importance of certain fundamental goods for all (...) human lives, though he does not consider health or health care in any significant detail. Adopting Shue’s model, I argue that access to health care is of sufficient importance to the enjoyment of any other rights that it qualifies as what Shue describes as a ‘basic’ right. I also argue that the basic right to health care is compatible with the basic rights model, and is required by it in order to for it to achieve its goal of enabling right holders to enjoy any decent life. In making this claim I also explore the requirements of the basic right to health care in terms of Shue’s triumvirate of duties and with reference to several key examples. (shrink)

This essay examines the management of ventilatory failure in disaster settings where clinical needs overwhelm available resources. An ethically defensible approach in such settings will adopt a “sufficiency of care” perspective that is: (1) adaptive, (2) resource-driven, and (3) responsive to the values of populations being served. Detailed, generic, antecedently written guidelines for “ventilator triage” or other management issues typically are of limited value, and may even impede ethical disaster response if they result in rescuers’ clumsily interpreting events (...) through the lens of the guideline, rather than customizing tactics to the actual context. Especially concerning is the tendency of some expert planners to mistakenly assume that medical treatment of respiratory failure: (1) always requires full-feature mechanical ventilators, (2) will always occur in hospitals, and (3) can be planned in advance without sophisticated public consultation about likely ethical dilemmas. (shrink)

By comparing alternative evolutionary models, the International Sexuality Description Project marks the transition of evolutionary psychology to the next level of scientific maturation. The lack of final conclusions might partly be a result of the composition of the Sociosexual Orientation Inventory and the sampled populations. Our own data suggest that correcting for both gives further support to the strategic pluralism model.

African communities face various challenges that require different sectors’ interventions to be effectively addressed. Churches as key community structures in Africa along with people experience these life challenges. The situation prompts churches to continually re-examine their role in communities to develop relevant responses that are deeply rooted in Christian approaches and heritage. Pastoral care as a community frontline ministry is expected to intervene practically to address people’s holistic needs. However, the questions that emerge are the following: how can pastoral (...) care practically be performed in a manner that it performs a public community caring role? How can public pastoral care be practically implemented? What models can be employed in providing public pastoral care? This article considers how pastoral care can be practically performed at the intersection of public theology and community development. Pastoral care performed at this intersection is termed public pastoral care. The article discusses and notes the ‘murky’ terrain and ‘apparent confusion’ on the notion of public pastoral care. Furthermore, it employs a church and community mobilisation process case study to progress beyond theoretical discussion to examine how public pastoral care can be operationalised in real-life situations. In doing so, it discerns the possibilities and challenges of positioning pastoral care to address public issues. (shrink)

Legal frameworks are in place to protect those who lack the capacity to consent to research, such as the Mental Capacity Act in the UK. Assent is sought instead from a proxy, usually a relative. However, the same legislation may, perversely, affect the welfare of those who lack capacity and of others by hindering the process of recruitment into otherwise potentially beneficial research. In addition, the onus of responsibility is moved from those who know most about the study (ie, the (...) scientific community) to those who know less (the proxies). In this paper, we describe the characteristics of a sample at different stages of the recruitment process of an influenza vaccine-based randomised control trial in elderly care home residents (the FEVER study). 62% (602/968) of potential subjects lacked capacity but only 29% (80/277) of those actually randomised. Older age, being female and living in an Elderly Mentally Ill care home were the only variables associated with lacking capacity. Considering this was a study based in a care home setting where the prevalence of dementia approximates 80%, the trial, like many others, was thus significantly biased. We believe that difficulties seeking proxy assent contributed significantly to this problem. Further thought should be given to how assent to enter research for those who lack capacity should be provided, and we suggest avenues for further discussion such as independent risk/benefit expert panels. (shrink)

This paper argues for the necessity of universal health care (as well as universal free education) using a different argument than most that have been made heretofore. It is not meant to conflict with but to strengthen the arguments previously made by others. Using the second paragraph of the Declaration of Independence and the Preamble to the Constitution we argue that universal health care in this day and age has become a necessary condition if the ideals of life, (...) liberty and the pursuit of happiness are to be more than an empty promise and if the discussion of “promoting of general welfare” in the preamble is to have any meaning. (shrink)

This study examined the patterns and characteristics of non-parental child care arrangements for Chinese very young children before they enter preschool and the extent to which families’ utilization of non-parental child care influenced parenting stress. A total of 3,842 Chinese parents of infants and toddlers were selected from 10 provinces to participate in this study. The results indicated that Chinese families relied heavily on grandparents to care for their children; a set of family demographics predicted the utilization (...) of non-parental child care arrangements, including parents’ educational level, household income, labor force participation, and maternal age; there existed a clear parental preference for publicly funded, affordable, and high-quality child care services; and families’ use of non-parental child care was generally not linked to parenting stress. These findings shed light on the development of the infant-toddler non-parental child care system in the Chinese sociocultural context. (shrink)

This article gives a practice-based and theoretical overview of the transformation from a traditional hierarchical organization in the care and cure sector towards a so-called Community-driven organization providing human happiness to 6000 elderly people. The actual case study is intertwined with conceptual information for better understanding of the innovative transition which took place at Humanitas. The case description includes its initial situation, its new core values, mission and objectives and shows the sequence of emerging policies and interventions that (...) resulted in a stakeholder oriented business model for the care sector. The selected concepts are Graves' Emerging Cyclical Level of Existence Theory (or Spiral Dynamics), Ken Wilber's Four Quadrant Model, Roberts Simons' Four Levers of Control and various elements from the European Corporate Sustainability Framework sponsored by the European Commission. The conclusion marks the match between theory and practice in transforming Humanitas Rotterdam into providing cure, care, housing and well-being to elderly people. (shrink)

The Covid-19 pandemic broke on a world whose grip on epistemic trust was already in disarray. The first months of the pandemic saw many governments publicly performing reliance on epidemiological and modelling expertise in order to signal that data would be the basis for justifying whatever population-level measures of control were judged necessary. But comprehensive data has not become available, and instead scientists, policymakers and the public find themselves in a situation where policy inputs determine the data available and vice (...) versa. This essay asks how we can live with what Amoore has termed ‘post-Cartesian doubt’ in situations of existential risk, and what kind of approach to science and data can answer the moral and human demands of a situation such as the Covid-19 pandemic. I suggest that science and policy could be able to control the pandemic better by addressing the sources of uncertainty and missing data not as gaps in the information landscape, but as individuals who are likely to be members of less-visible and less powerful groups including low-wage workers, the elderly, migrants, prisoners and others. This would shift both data use and policy toward an ethics of care, an embodied approach which asks what people need and how they behave in relation to each other, rather than how to manage population-level behaviour. This approach, I argue, is more appropriate for pandemic response than a utilitarian calculation of how many people each country should expect to lose as a result of the disease. (shrink)

The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists. Originally, these labels were invoked by volunteer research efforts propelled by amateurs outside of traditional research institutions and aimed at appealing to those looking for more “democratic,” “patient-centric,” or “lay” alternatives to the professional science establishment. As mainstream translational biomedical research requires increasingly larger participant pools, however, corporate, academic and governmental research (...) programs are embracing this populist rhetoric to encourage wider public participation. We examine the ethical and social implications of this recruitment strategy. We begin by surveying examples of “citizen science” outside of biomedicine, as paradigmatic of the aspirations this democratizing rhetoric was originally meant to embody. Next, we discuss the ways these aspirations become articulated in the biomedical context, with a view to drawing out the multiple and potentially conflicting meanings of “public engagement” when citizens are also the subjects of the science. We then illustrate two uses of public engagement rhetoric to gain public support for national biomedical research efforts: its post-hoc use in the “care.data” project of the National Health Service in England, and its proactive uses in the “Precision Medicine Initiative” of the United States White House. These examples will serve as the basis for a normative analysis, discussing the potential ethical and social ramifications of this rhetoric. We pay particular attention to the implications of government strategies that cultivate the idea that members of the public have a civic duty to participate in government-sponsored research initiatives. We argue that such initiatives should draw from policy frameworks that support normative analysis of the role of citizenry. And, we conclude it is imperative to make visible and clear the full spectrum of meanings of “citizen science,” the contexts in which it is used, and its demands with respect to participation, engagement, and governance. (shrink)

Patient data is used to drive an ecosystem of advanced digital tools in health care, like predictive models or artificial intelligence‐based decision support. Patients themselves, however, receive little information about these technologies or how they affect their care. This raises important questions about patient trust and continued engagement in a health care system that extracts their data but does not treat them as key stakeholders. This essay explores these tensions and provides steps forward for health systems as (...) they design advanced health information‐technology (IT) policies and practices. It centers patients, their concerns, and the ways they perceive trustworthiness to reframe advanced health IT in service of patient interests. (shrink)

This article gives a practice-based and theoretical overview of the transformation from a traditional hierarchical organization in the care and cure sector towards a so-called Community-driven organization providing human happiness to 6000 elderly people. The actual case study is intertwined with conceptual information for better understanding of the innovative transition which took place at Humanitas. The case description includes its initial situation, its new core values, mission and objectives and shows the sequence of emerging policies and interventions that (...) resulted in a stakeholder oriented business model for the care sector. The selected concepts are Graves'' Emerging Cyclical Level of Existence Theory (or Spiral Dynamics), Ken Wilber''s Four Quadrant Model, Roberts Simons'' Four Levers of Control and various elements from the European Corporate Sustainability Framework sponsored by the European Commission. The conclusion marks the match between theory and practice in transforming Humanitas Rotterdam into providing cure, care, housing and well-being to elderly people. (shrink)

Artificial intelligence, as a nonhuman entity, is increasingly used to inform, direct, or supplant nursing care and clinical decision‐making. The boundaries between human‐ and nonhuman‐driven nursing care are blurred with the advent of sensors, wearables, camera devices, and humanoid robots at such an accelerated pace that the critical evaluation of its influence on patient safety has not been fully assessed. Since the pivotal release of To Err is Human, patient safety is being challenged by the dynamic healthcare (...) environment like never before, with nursing at a critical juncture to steer the course of artificial intelligence integration in clinical decision‐making. This paper presents an overview of artificial intelligence and its application in healthcare and highlights the implications which affect nursing as a profession, including perspectives on nursing education and training recommendations. The legal and policy challenges which emerge when artificial intelligence influences the risk of clinical errors and safety issues are discussed. (shrink)

Abstract In light of the complexity of unfolding disasters, the diversity of rapidly evolving events, the enormous amount of generated information, and the huge pool of casualties, emergency responders (ERs) may be overwhelmed and in consequence poor decisions may be made. In fact, the possibility of transporting the wounded victims to one of several hospitals and the dynamic changes in healthcare resource availability make the decision process more complex. To tackle this problem, we propose a multicriteria decision support service, based (...) on the Analytic Hierarchy Process (AHP) method, that aims to avoid overcrowding and outpacing the capacity of a hospital to effectively provide the best care to victims by finding out the most appropriate hospital that meets the victims’ needs. The proposed approach searches for the most appropriate healthcare institution that can effectively deal with the victims’ needs by considering the availability of the needed resources in the hospital, the victim’s wait time to receive the healthcare, and the transfer time that represents the hospital proximity to the disaster site. The evaluation and validation results showed that the assignment of hospitals was done successfully considering the needs of each victim and without overwhelming any single hospital. (shrink)