“In the UK a so‐called internal market has been operating within the government‐run National Health Service since 1991.” Analysing the ethical tensions to which this gives rise is Tom Sorell, Editor of this FOCUS, author with John Hendry of Business Ethics , Professor of Philosophy at the University of Essex and Fellow in the Ethics and the Professions Program at Harvard for 1996/97.

“In the UK a so‐called internal market has been operating within the government‐run National Health Service since 1991.” Analysing the ethical tensions to which this gives rise is Tom Sorell, Editor of this FOCUS, author with John Hendry of Business Ethics, Professor of Philosophy at the University of Essex and Fellow in the Ethics and the Professions Program at Harvard for 1996/97.

Traditionally, medical professionals have taken a paternalistic stance towards their patients and have relied on a traditional approach to medical ethics. In recent years, in Britain, however, a new ‘managerialism’ has developed in the National Health Service (the NHS). This stresses consumerism and greater patient choice and is changing the relationship between doctors and patients. This paper draws out the implications for patients. It describes the ethical characteristics of the two conflicting approaches and argues the need to stress again the (...) view of the patient as an individual person. (shrink)

This article examines recent developments in the regulation of the medical profession in England, with particular reference to doctors working in the National Health Service (NHS). It is argued that the Health Act 1999 and associated government policies are bringing about a shift from a «light touch», self-regulatory paradigm to a government-driven, interventionist approach. It is suggested that the reason for the change is not simply a governmental concern with the quality and nature of care provided by doctors, but more (...) significantly, a concern with the cost of that care. The article offers a critique of the new regime, drawing on the socio-legal literature on regulation. Some aspects of the reforms ignore the need to persuade doctors to comply, and may therefore result in cheating or «creative compliance»; other aspects of the reforms provide doctors with opportunities to «neutralize» their impact. It concludes with an examination of the wider significance of the change in regulatory paradigm, and of the agenda for future research in this field. (shrink)

This paper uses the recent history of marketization and privatization in the UK National Health Service as a case study through which to explore the relationship between health-care organization and health-care goods. Phases and processes of marketization are briefly reviewed in order to show that, although the scope of both marketization and privatization reforms have, until recently, been very heavily circumscribed (and can only be understood in the context of the rise of managerialism), they have nonetheless had a major (...) impact on the “value field” of UK health services. The second half of the paper draws upon the concerns of the critics of market-style reforms to set out and explore the ways in which organizational reform and the shifts in institutional norms consequent upon it construct health-care goods and argues that the investigation of this organization-goods axis ought to have a central place in health-care ethics. (shrink)

Significant changes are proposed for the research ethics system governing the review of the conduct of medical research in the UK. This paper examines these changes and whether they will meet the aimed-for goal of improving the efficiency of the research ethics system. The author concludes that, unfortunately, they will not and thus should be rejected.

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further ‘market-style’ reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in (...) the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. (shrink)

The recently published Report of theAHAG on the Operation of NHS Research Ethics Committees advocates major reforms of the NHS research ethics committees system. The main implications of the proposed changes and their probable effects on the major stakeholders are described.The Ad Hoc Advisory Group on the operation of NHS research ethics committees, set up in November 2004 by Lord Warner on behalf of the Department of Health, submitted its report in June 2005.1 The report advocates major reforms (...) of the research ethics committee system. The primary aim of the report is to streamline the processes around the approval of research projects and to pursue conformity of governance across Europe. Implicit in the report is the contention that failure to achieve this objective would be harmful to everyone with vested interests in improving health and social care. Moreover, it is stated that the reforms will enhance the mechanisms that protect the interests of all parties concerned.1Being mindful of two published critiques of the Warner Report, we suggest that its alleged benefits should not be taken at face value.2,3 In fact, the reformed system will give rise to moral failings akin to those of the existing system, but will differ from the existing system in its effect on the stakeholders. Thus, whereas the outgoing system has given each stakeholder a unique mixture of benefit and harm, the incoming system offers benefit only to sponsors and researchers and nothing but detriment to participants in research and consumers of its products.In the light of this conclusion, we finally suggest that the Warner Report be construed not merely as an ill-considered document, but rather as an ideological reflection of a long-established hegemonic contract fine-tuning itself to contemporary global challenges.To avoid …. (shrink)

Researchers have frequently complained that the NHS ethical review system stifles good research. At last measures are being put in place to address this criticism, but will they undermine the protection of research participants? The Declaration of Helsinki recognizes that medicine will not progress without good quality research, but also demands that the well-being of research participants takes precedence over the interests of science and society. This article examines the implications of the ongoing reform of the NHS research ethics review (...) system for researchers, ethics committees and research participants. (shrink)

How could we better use public inquiries to stem the recurrence of healthcare failures? The question seems ever relevant, prompted this time by the inquiry into how former nurse Letby was able to murder newborns under National Health Service care. While criminality, like Letby’s, can be readily condemned, other factors like poor leadership and culture seem more often regretted than reformed. I would argue this is where inquiries struggle, in the space between ethics and law—with what is awful but lawful. (...) In response, we should learn from progress with informed consent. Inquiries and civil litigation have seen uninformed ‘consent’ shift from being undesirable to unlawful. If better leadership and culture were sole drivers here, we would likely be doing far better in many other areas of healthcare too. Instead, one could argue that progress on consent has been made by reducingepistemic injustice—by naming and addressingepistemicissues in ways that enhancesocial powerfor patients. If this is an ingredient that transforms clinician–patient working, might it also shift conduct within other key relationships, by showing up what else should become unlawful and why? Namingmedical paternalismmay have helped with consent reform, so I continue this approach, first naming two areas of epistemic injustice:management feudalismandlegal chokeholds. Remedies are then considered, including the democratisation of management and reforms to legal ethics, legislation and litigation. In brief, public inquiries may improve if they also target epistemic injustices that should become unlawful. Focus on informed consent and epistemic relationships has improved the medical profession. Likewise, it could help healthcare leaders shift from fiat towards consent, and their lawyers from a stifling professional secrecy towards the kind of candour a prudent public expects. (shrink)

It has been claimed that beneath the government rhetoric of patient choice, no real choice exists either in law or in National Health Service policy. Thus, choice is considered to be a fallacy in that patients are not able to demand specific treatment, but are only able to express preferences amongst the available options. This article argues that, rather than considering choice only in terms of patient autonomy or consumer rights, choice ought to be seen as serving other functions: Choice (...) serves as a mechanism of destabilisation, i.e., as a lever for change. This is apparent at the level of patient and doctor, and at the level of patient and health authority, but even more so, at the level of government. Patient choice, rather than benefiting the individual, can have effects on a wider scale. It encourages change and reform in healthcare practices and in the NHS institutions. (shrink)

The BMA’s recent discussion paper A rational way forward for the NHS in England, while wishing to free the English NHS from day-to-day politics, merely shifts the locus of the political conflict.In May this year, the British Medical Association published a discussion paper entitled “A rational way forward for the NHS in England”, outlining the association’s suggestions for reform of the English NHS.1The paper is worth reading for its insightful dissection and analysis of the current problems of the English NHS, (...) as well as for its interesting but not totally unexpected conflation of professional and clinical with medical in most of the report. Many of the recommendations are eminently sensible, but some of the suggestions for reconfiguration of the highest-level structures of the English NHS are problematic and unrealistic. What the BMA wants is to free the English NHS from the influence of day-to-day politics by the establishment of a constitution and an independent board of governors, while keeping it free at the point of delivery and paid by general taxation. This is expressed in the first five of the total of 24 recommendations that outline the BMA proposals …. (shrink)

Using the conceptual lenses offered by the ideational and cultural path taken in the health care arena, this article attempts to explain the trajectory of recent major health care reforms in Italy and the reasons for their failure, as well as providing some directions for successful intervention. A diachronic analysis of the relatively under-investigated phenomenon of health care reforms in Italy is carried out, drawing on a systematic review of the Italian and international literature combined with the research (...) work carried out by the Author. For all the three major health reforms examined, a significant gap between the authoritative policy choices taken and the overall implementation, in terms of process and system changes, can be observed, determining a growing distance between the theoretical efficiency and the practical effectiveness of the Italian National Health Service (NHS) as well as its detachment from the social system. The main obstacle to effective reform seems to be the cultural hegemony of the administrative-managerial and the biomedical paradigms, which, by reinforcing one another, yielded infertile ground for renewing in a post-modern sense the Italian NHS. The various Reforms have not been conceived to break such a positivistic monopoly in that they did not promote cultural or educational intervention. In this context, intervention that acts at a cultural level, such as reforming university education for physicians and managers or devising immigration policies to attract adequately acculturated people to the Italian NHS, seems to be the most promising. (shrink)

Zen Master Thích Nhá̂t Hạnh's commentary on Nāgārjuna's Treatise on the Middle Way, one of the most famous Buddhist texts in existence. Nāgārjuna is a giant in the Buddhist canon, thought to be the greatest Buddhist philosopher after the Buddha. He lived in southern India in the 2nd century CE. Cracking the Walnut contains the text of Nāgārjuna's Treatise on the Middle Way (Mulamadhyamakakarika), defending the essential premise that all things have the nature of emptiness, they have no self-nature, but (...) are in a constant process of change and interrelationship with one another. Weaving Nāgārjuna's text with commentary by Thích Nhá̂t Hạnh', taken from talks given at two 3-month-long retreats, helps us bring these teachings into our daily life. They are strong teachings, designed to break through all metaphysical speculation. To a greater or lesser extent, we all have notions and ideas about life. Sometimes our ideas can contribute to the advancement of humanity, but the problem comes when we are caught in our ideas and believe them to be the absolute truth. When people believe that something is the absolute truth, they may be ready to fight, kill, or die for it. This brings about polarization, deep division, and suffering in ourselves, our society, community, and family. This is not the way ahead for humanity. This book helps us let go of our ideas and go in the direction of understanding and compassion. (shrink)

Business ethics in the socialist-oriented market economy in Vietnam.

History of philosophical thought of Vietnam up to XX century.

From unlocking the connection to our inner self, forging deeper and more meaningful bonds with those around us to discovering a true sense of oneness with our natural world, this is the essential guide to help you master the art of connection." -- goodreads.com.

How to Eat is the second in a Parallax's series of how-to titles by Zen Master Thich Nhat Hanh that introduce beginners to and remind seasoned practitioners of the essentials of mindfulness practice. Pocket-sized, with bold black-and-white illustrations by Jason DeAntonis, How to Eat explains what it means to eat as a meditative practice and why eating mindfully is important. Specific instructions are followed by a collection of verses written for secular practitioners that help set a mindful intention for each (...) activity connected with preparing, serving, eating, and cleaning up after meals. The results of mindful eating are both global and personal. Eating a meal in mindfulness shows practitioners that the whole universe is supporting them. This awareness helps develop compassion and understanding, reminding practitioners that there are things they can do to help nourish people who are hungry and lonely. Encouraging moderation, mindful eating can lead to optimum health and body weight, while diminishing waste, and contributing to a more healthy society. Scientific studies indicate that meditation contributes tremendously to well-being, general health, and longevity. How to Eat is perfect for those who want a comprehensive yet simple guide to eating as a meditative practice. (shrink)

Reach true clarity and insight by looking deeply, minimizing misperceptions, and having the courage to see things as they really are. The seventh book in the bestselling Mindfulness Essentials series, a back-to-basics collection from world-renowned Zen Master Thich Nhat Hanh that introduces everyone to the essentials of mindfulness practice. Profound and always approachable, Thich Nhat Hanh teaches us the art of looking deeply—in to our knee-jerk assumptions and runaway thoughts—so we can recognize the true meaning and essence of our lives. (...) How to See teases apart the act of seeing-both inside and outside of ourselves, and points the way to developing true clarity. Written with his signature warmth, these pithy meditations are accompanied by playful sumi-ink drawings by California artist Jason DeAntonis. (shrink)

An introduction to mindful walking, which can be done anywhere, at any time—even on a commute to work or school. The fourth book in the bestselling Mindfulness Essentials series, a back-to-basics collection from world-renowned Zen Master Thich Nhat Hanh that introduces everyone to the essentials of mindfulness practice. Slow, concentrated walking while focusing on in- and out-breaths allows for a unique opportunity to be in the present. There is no need to arrive somewhere—each step is the arrival to concentration, joy, (...) insight, and the momentary enlightenment of aliveness. When your foot touches the Earth with awareness, you make yourself alive and the Earth real, and you forget for one minute the searching, rushing, and longing that rob our daily lives of awareness and cause us to "sleepwalk" through life. Thich Nhat Hanh shares amusing stories of the impact mindful walking has on both the walker and those who notice him, and shows how mindful walking can be a technique for diminishing depression, recapturing wonder, and expressing gratitude. Pocket-sized, with original two color illustrations by Jason DeAntonis, How to Walk is a unique gift for all ages, sharing a simple practice that can have a profound effect on practitioners. (shrink)

In Is Nothing Something? Zen Master Thich Nhat Hanh answers heartfelt, difficult, and funny questions from children of all ages. Illustrated with original full-color artwork by Jessica McClure, Is Nothing Something? will help adults plant the seeds of mindfulness in the young children in their lives. Beginning with the most basic questions, "What is important in life?" and "Why is my brother mean to me?" and progressing through issues that we all wrestle with, such as "How do I know if (...) I really love somebody?", "How long am I going to live?", and "What does God look like?", each page presents a question with a short answer from Thich Nhat Hanh, appropriate for beginning readers to work with on their own. The back of the book has the first complete children's biography of Thich Nhat Hanh, along with basic, kid-friendly instructions for mindful breathing and mindful walking. Both humorous and profound, Is Nothing Something? is the perfect resource for kids with questions, adults looking to answer them, and anyone with questions of their own. (shrink)

For the first time Thich Nhat Hanh shares his inspiration and experience of living in stillness and timelessness. Written to pull you into the moment as he sees it, Inside the Now offers teachings inspired by the spirit of poetry. More personal than the majority of his writing, Inside the Now shares the Zen Master's experience using poetry and meditation to endure and move beyond violence and oppression. Inspired by Being Time by Zen Master Dogen, Thich Nhat Hanh shares short (...) meditations along with revelations from his past to give the reader a sense of entering a space of timelessness. In these meditations, he reveals his own doubts and his own searching. (shrink)

The secret to happiness is to acknowledge and transform suffering, not to run away from it. In No Mud, No Lotus, Thich Nhat Hanh offers practices and inspiration for transforming suffering and finding true joy. Thich Nhat Hanh acknowledges that because suffering can feel so bad, we try to run away from it or cover it up by consuming. We find something to eat or turn on the television. But unless we're able to face our suffering, we can't be present (...) and available to life, and happiness will continue to elude us. Nhat Hanh shares how the practices of stopping, mindful breathing, and deep concentration can generate the energy of mindfulness within our daily lives. With that energy, we can embrace pain and calm it down, instantly bringing a measure of freedom and a clearer mind. No Mud, No Lotus introduces ways to be in touch with suffering without being overwhelmed by it. With his signature clarity and sense of joy, Thich Nhat Hanh helps us recognize the wonders inside us and around us that we tend to take for granted and teaches us the art of happiness. (shrink)

A new gift edition of the classic guide to meditation and mindfulness, featuring archival photography and beautiful calligraphy by Thich Nhat Hanh. Since its publication in 1975, The Miracle of Mindfulness has been cherished by generations of readers for its eloquent and useful introduction to the practice of meditation. Readers interested in an introduction to Buddhist thought, as well as those seeking to learn about mindfulness and stress reduction, continue to look to Thich Nhat Hanh's classic work for guidance and (...) inspiration. This new hardcover gift edition features elegant calligraphic illustrations by Thich Nhat Hanh, as well as a dozen photographs spanning his early days as a peace activist to his life in Plum Village, a spiritual community that he founded in France. Also included in this edition is a historical chronology of Thich Nhat Hanh's life and work, and a revised afterword by Jim Forest. (shrink)

This new translation of the Buddha's most important, most studied teaching offers a radical new interpretation. In September, 2014 Thich Nhat Hanh completed a profound and beautiful new English translation of the Prajñaparamita Heart Sutra, one of the most important and well-known sutras in Buddhism. The Heart Sutra is recited daily in Mahayana temples and practice centers throughout the world. This new translation came about because Thich Nhat Hanh believes that the patriarch who originally compiled the Heart Sutra was not (...) sufficiently skillful with his use of language to capture the intention of the Buddha's teachings--and has resulted in fundamental misunderstandings of the central tenets of Buddhism for almost 2,000 years. In The Other Shore: A New Translation of the Heart Sutra with Commentaries, Thich Nhat Hanh provides the new translation with commentaries based on his interpretation. Revealing the Buddha's original intention and insight makes clear what it means to transcend duality and pairs of opposites, such as birth and death, and to touch the ultimate reality and the wisdom of nondiscrimination. By helping to demystify the term "emptiness," the Heart Sutra is made more accessible and understandable. Prior to the publication of The Other Shore, Thich Nhat Hanh's translation and commentaries of the Heart Sutra, called The Heart of Understanding, sold more than 120,000 copies in various editions and is one of the most beloved commentaries of this critical teaching. This new book, The Other Shore, supersedes all prior translations. (shrink)

We all need to Chop Wood and Carry Water". In Thich Nhat Hanh's latest teachings on how to use applied Buddhism in daily life, he looks at how we deal with workplace scenarios, handle home and family responsibilities, and endure traffic jams and other challenges of modern life. By carefully examining our everyday choices he encourages us to become a lotus in a muddy world by building mindful communities, learning about compassionate living, and come to an understanding of our inert (...) "Buddha nature." Part-time Buddha aims at contributing to new models of leadership and doing business, but is also full of life-coaching advise and finding our true happiness. (shrink)

One of the key tenets of the Zen school of Mahayana Buddhism is that each of us is already a Buddha -- our enlightenment is inherent within us and the practice of mindfulness is the tool to bring this truth to our awareness. While it can bring much relief, this simple statement does not preclude the need for practice. We must strive to be aware of our Buddha nature rather than waiting until times of emotional upheaval when it is more (...) difficult to practice. Thich Nhat Hanh uses the teachings of ninth century Zen Master Linji, founder of the Rinzai school, to elaborate on this simple truth and to give readers tools that can help awaken them to their true inner nature. One of the unique aspects of Linji's teaching, is the need to "wake ourselves up," not only by means of listening to enlightened teachings, but also through unique techniques such as the shout, the stick, and the empty fist. The teachings of Master Linji bring readers back to reality and to simply being. Powerful, direct, and uncompromising, Thich Nhat Hanh's reflections on the teachings of Master Lin Chi are destined to join the ranks of classic Buddhist writings. (shrink)

It has recently been pointed out that the 1989 White PaperWorking for Patients, which provides the basis for the current reforms of the British National Health Service, has some common features with the 1944 White PaperA National Health Service, which was the unadopted model for the service produced by the Wartime Coalition Government. Moreover, it is likely that the Conservatives, if elected in the 1945 General Election, would have introduced a service based on a modified version of the 1944 (...) document. We can compare these two blueprints to shed some light on Conservative thinking on health care over a period of nearly 50 years. There are some similarities in terms of the notions of purchaser and provider, contracts and pluralism. However, there are striking contrasts, notably in their attitude towards planning versus competition and local democracy versus patronage. It is claimed that the profound differences outweigh the apparent similarities and consequently the two blueprints show the discontinuity rather than the continuity of Conservative thinking on health care. (shrink)

The United Kingdom's coalition government has just begun the most sweeping overhaul of the National Health Service since its inception.1 Under the reforms, 80 percent of the NHS budget will be handed over to about five hundred local consortia of primary care physicians, who will be empowered to make medical spending and allocation decisions for their patients. The 152 existing Primary Care Trusts (PCTs), which purchase hospital and community care for patients and oversee primary care physicians in their regions, (...) will close their doors, leaving local doctors with the power to decide which interventions are appropriate, and which too expensive.2 Hospitals and community service providers will have greater freedom .. (shrink)

Collaboration of tradition and modern from the East and Western on the humanity and cultural view in Vietnam.

In Good Citizens: Creating Enlightened Society, Thich Nhat Hanh lays out the foundation for an international solidarity movement based on a shared sense of compassion, mindful consumption, and right action. Following these principles, he believes, is the path to world peace. The book is based on our increased global interconnectedness and subsequent need for harmonious communication and a shared ethic to make our increasingly globalized world a more peaceful place. The book will be appreciated by people of all faiths and (...) cultural backgrounds. While based on the basic Buddhist teachings of the Four Noble Truths and the Eight-Fold Path, Thich Nhat Hanh boldly leaves Buddhist terms behind as he offers his contribution to the creation of a truly global and nondenominational blueprint to overcoming deep-seated divisions and a vision of a world in harmony and the preservation of the planet. Key topics include the true root causes of discrimination; the exploration of the various forms of violence; economic, social, and sexual violence. He encourages the reader to practice nonviolence in all daily interactions, elaborates on the practice of generosity, and teaches the art of deep listening and loving speech to help reach a compromise and reestablish communication after misunderstandings have escalated into conflicts. Good Citizens also contains a new wording of the Five Mindfulness Trainings (traditionally called "precepts") for lay practitioners, bringing them in line with modern-day needs and realities. In their new form they are concrete and practical guidelines of ethical conduct that can be accepted by all traditions. Good Citizens also includes the complete text of the UN Manifesto 2000, a declaration of transforming violence and creating a culture of peace for the benefit of the children of the world. It was drafted by numerous Peace Nobel Prize recipients and signed by over 100 million people worldwide. Coinciding with a US presidential election year, Good Citizens reaches across all political backgrounds and faith traditions. It shows that dualistic thinking--Republican/Democrat, Christian/Muslim--creates tension and a false sense of separateness. When we realize that we share a common ethic and moral code, we can create a community that can change the world. (shrink)

A collection of powerful and inspiring teachings in a convenient pocket-size book. These writings provide a wonderful overview of mindfulness in our daily lives, Buddhism and enlightenment, working with emotions and relationships, and transforming society.

365 days of practical, powerful teachings from the beloved Zen teacher Inspiring, joyful, and deeply insightful, this book offers daily contemplations and words of wisdom from one of today's most important spiritual teachers. Thich Nhat Hanh is, with His Holiness the Dalai Lama, the best-known Buddhist teacher in the world, and his teachings have touched millions. These powerful and transformative words of wisdom, drawn from the works of this best-selling and prolific author, touch all apsects of our lives, from the (...) personal to the global, and reflect the great themes of Thich Nhat Hanh's teachings: how the practice of mindfulness brings joy and insight into every moment of our lives; how to transcend fear and other negative emotions; how we can heal our inner wounds with gentleness and awareness; how to transform our relationships through love, presence, and deep listening; and how to practice peace for our world and caring for the earth. Through Thich Nhat Hanh's great brilliance, this book presents these profound themes in short teachings that are practical yet powerful, and will uplift and inspire your day. (shrink)