This article looks at some of the moral implications of the radical reforms in the United Kingdom since the Griffiths Report was first published in 1988. It is suggested that, among others, two outcomes are particularly problematic. These are firstly, findings that care managers (the preferred name in the UK for social workers dealing mainly with adults and older people who require social care support in the community) no longer spend much time with clients, and secondly, suggestions that (...) many aspects of care management practice promote forms of inequality, especially amongst already disadvantaged groups. The article also considers recent studies regarding the opinions of social work practitioners, and it is concluded that ultimately the care management hegemony is difficult to defend from an ethical perspective. (shrink)

The purpose of this prospective study was to develop a grounded theory explaining the process that family decision makers use to make care decisions with or for a family member with advanced cancer. Adult surrogate decision makers were recruited for multiple interviews over the patient’s care trajectory: 40 surrogates provided 80 semi-structured interviews. Analysis of these narratives revealed a process of responsive care management that is inclusive of, but not limited to, decision-making roles. Monitoring, buffering, and (...) taking over comprise the three phases of the process. Decision making was embedded within the family member’s broader relational and care responsibilities. (shrink)

The aim of this article is to reveal how care workers in the home-help services handle the process when older people’s relocation to a residential home is under consideration. Since the care workers are engaged daily in defining care receivers’ needs and yet have no formal influence on care decisions in Sweden, the focus is on how they solve this dilemma. In this inductive study, the theoretical framework is based on occupational alliances, relationship-based practice, and discretion. (...) Thirty-three care workers in home-help services are included in open semi-structured interviews. Prominent features in the findings are that the care workers take their stand at the borderland of care management, when they know or try to find out what is right. The conclusions drawn are that care workers find ways to informally influence the decision-making process, quite contrary to the idea of approaches referred to as purchaser/provider models. The implications for social work policy and practice are that a distinction between assessment and intervention may not benefit the field of eldercare and should therefore be regarded as an area in need of thorough reconsideration. (shrink)

The care of patients should be professional, human and humane. This is an ethical issue. The words human (inhimillinen) and humane (ihmisläheinen) have different meanings in the Finnish language. At Kuopio University Hospital (1200 beds), in Finland, it was decided to provide patients with professional and humane caring. Ethical values differ for different groups of people. Therefore humane caring was assessed by questioning both hospital patients (n = 160) and staff (n = 196). The data were subjected to content (...) analysis. The result was that the values obtained for both patients and staff were similar. Five descriptive categories of humane caring emerged. To discover what kind of caring was provided for patients, the categories were operationalized into 66 criteria and a questionnaire was drawn up on the basis of these criteria. The data for evaluation of the quality of caring were collected from patients (n = 1708). The data were analysed using cross-tabulations and the chi-squared test; sum variables were calculated for the five standards. The results suggest that special attention should be paid to vulnerable patient groups (e.g. the elderly and the young). One means of ethical management is to support our staff to care more humanely by discussing with them the results of this study, setting standards and criteria for humane caring and what this means in practice. It is hoped our caring will therefore be more humane. (shrink)

The author considers the issue of what it is for a health care institution to be intentionally Christian. He begins with a review of Catholic social teaching, and considers how this perspective is shaping Catholic thought and action regarding health care management and public policy reform. He then proposes some standards for intentionally Christian institutions.

Mary Ann Meeker’s article admirably reminds readers that family members are involved in—or “responsively manage”—the care of relatives with severe illness in ways that run considerably beyond the stereotypes at play in many bioethical discussions of advance directives. Her observations thus make thinking about the role of families in healthcare provision more adequate to the facts, and this is an important contribution. There’s reason to be worried, however, that one explicit aim of the article—to ease the standing anxieties that (...) many clinicians and ethicists have about the reliability of family members as proxy decision makers—will be frustrated by its very success. Those already inclined to suspicion may tend to think that the more intricate and pervasive the ways in which families influence the healthcare decision making of their sick, the more chances they have for altering the connection between patients’ interests and the actions of professional providers.To determine whether and when such alterations are something to be concerned about, we’ll need to supplement a better grasp of the pertinent facts with a deeper sense of how human agency works and why we value it. We may also need some reminders about the defensibility of diverse moral understandings. Although both professionals and family members may profess an ethic that sets patients’ interests above those of non-patients—as Meeker’s own results suggest—any strict allegiance to such a framework may be more notional than normative—as her findings also hint. The actual working norms (among professionals, as well as within families) will likely be more complex, but not necessarily any the less defensible for that. (shrink)

Healthcare management is a burning issue at the moment and this timely and topical book explores the ethical issues that arise in the context of healthcare management. Among the topics discussed are healthcare rationing, including an exposition and defence of the Qaly criterion of healthcare rationing and an examination of the contribution that ethical theory can make to the rationing debate, an analysis of how managers can be preoccupied with the goals of management and the values of (...) doctors simultaneously, an outline of potential guidelines towards formulating a cohesion of healthcare management and ethical management and a reassessment of the role of healthcare professionals. Ethics and Values in Healthcare Management provides a valuable and much needed analysis of the ethical problems associated with healthcare management and offers some solutions towards ameliorationg healthcare organisations. (shrink)

Background:Nurse managers are expected to continuously ensure that ethical standards are met and to support healthcare workers’ ethical competence. Several studies have concluded that nurses across various healthcare settings lack the support needed to provide safe, compassionate and competent ethical care.Objective:The aim of this study was to explore and understand how nurse managers perceive their role in supporting their staff in conducting ethically sound care in nursing homes and home nursing care.Design and participants:Qualitative individual interviews were performed (...) with 10 nurse managers with human resources responsibilities for healthcare workers in four nursing home wards and six home nursing care districts. Content analysis was used to analyse the data.Ethical considerations:The Norwegian Centre for Research Data granted permission for this study.Findings:The analysis resulted in seven subcategories that were grouped into three main categories: managers’ perception of the importance of the role, managers’ experiences of exercising the role and managers’ opportunities to fulfil the role. Challenges with conceptualizing ethics were highlighted, as well as lack of applicable tools or time and varying motivation among employees.Discussion:The leaders tended to perceive ethics as a ‘personal matter’ and that the need for and benefit of ethical support (e.g., ethics reflection) depended on individuals’ vulnerability, attitudes, commitment and previous experiences. The managers did not seem to distinguish between their own responsibility to support ethical competence and the responsibility of the individual employee to provide ethical care.Conclusions:Our findings suggest that nurse managers need support themselves, both to understand and to carry out their responsibilities to foster their staffs’ ethical conduct. Supporting staff in conducting ethically sound care requires more than organizing meeting places for ethical reflection; it also requires greater awareness and understanding of what ethical leadership means. (shrink)

In view of the ethical crises that have proliferated over the last decade, scholars have reflected critically on the ideal of management as a value-neutral, objective science. The alternative conceptualization of management as a craft has been introduced but not yet sufficiently elaborated. In particular, although authors such as Mintzberg and MacIntyre suggest craft as an appropriate alternative to science, neither of them systematically describes what “craft” is, and thus how it could inform an ethical managerial orientation. In (...) this paper, we draw from the literature to elaborate three caring orientations associated with craft practices: caring for materials, caring for process, and caring for end-users. We suggest that conceptualizing management as a craft in these terms offers an approach to business ethics that goes beyond the “ethics of compliance” and toward a more embodied and embedded form of ethical enactment within organizations. (shrink)

To achieve its goals of managing andrestricting access to psychiatric care, managedcare organizations rely on an instrument, theoutpatient treatment report, that carriessignificant implications about how they viewpsychiatric patients and psychiatric care. Inaddition to involving ethical transgressionssuch as violation of patient confidentiality,denial of access to care, spurious use ofconcepts like quality of care, and harassmentof practitioners, the managed care approachalso depends on an overly technical,instrumental interpretation of human beings andpsychiatric treatment. It is this grounding ofmanaged (...) class='Hi'>care in technical reason that I willexplore in this study. I begin with a reviewof a typical outpatient treatment report andshow how, with its dependence on the DSM-IV,on behavioral symptoms and patient`functioning'', on the biomedical model ofpsychiatric illness, and on gross quantitativemeasures, the report results in a crude,skeletonized view of the human being as acongeries of behavioral symptoms and functions. I then develop the managed care construal ofhuman existence further by showing itsgrounding in technical reason, exploring thelatter in its modern embodiment and deriving itand its opposite, practical reason, fromAristotle''s distinction between technical andpractical reason, techne and phronesis. Inthis analysis of the role of technical reasonin managed care, I point out that managed caredid not have to develop its rationale de novobut could rather lift its arguments, e.g. thebiomedical model, from contemporary psychiatryand simply apply them in a restrictive manner. Finally, I conclude this study by arguing forpsychiatry''s status as a discipline ofpractical knowledge. (shrink)

Background Middle managers play a key role in promoting a caring culture in nursing homes. However, there is limited knowledge about middle managers’ inner motives and their experiences of their responsibility in developing a caring culture. Research aim The aim of the study is to get a deeper understanding of middle managers’ motives and their experiences of their responsibility to develop a caring culture in nursing homes. Research design A qualitative design with a hermeneutic approach inspired by Gadamer was chosen (...) which guided the interpretation of data. Qualitative semi-structured interviews were conducted. Participants and research context Data were collected from thirteen middle managers in nursing homes, in six municipalities in northern Norway in September and October 2021. Ethical considerations The study was approved by the Norwegian Centre for Research Data. Oral and written informed consent was obtained from participants. Findings The findings show that the middle managers had non- egoistic motives to promote a caring culture as expressed in their attitudes and actions. They felt responsible to promote a caring culture where both patients and staff experienced care and were respected and recognized as unique individuals. Middle managers as good role models are responsible for being present and raising awareness of the importance of care in the nursing home culture by systematically reflecting on care values. However, a strong focus on the financial and administrative demands limits the middle managers’ possibilities to promote a caring culture and prevented them from always acting as they wanted to act, which often causes moral distress. Conclusion Being in contact with inner motives, enables the leader to promote a homelike and caring culture where both patients and staff feels respected and recognized as unique individuals. This study highlights the importance of systematic reflection on caring values in nursing homes which leads to value awareness among all actors. (shrink)

The problem of inadequate pain management for both terminally ill patients and patients with chronic pain has recently been documented by a number of authors and studies. A 1997 report by the Institute of Medicine, for example, states that “a significant proportion of dying patients and patients with advanced disease experience serious pain, despite the availability of effective pharmacological and other options for relieving most pain.” There are particularly impressive data that pain associated with cancer is not adequately treated.The (...) problem has been attributed to inadequate education of physicians on approaches to pain management and an often misguided belief that prolonged therapy with certain pain medication will lead to addiction; legal obstacles, such as physicians’ fear of criminal prosecution and other disciplinary actions by state licensing boards for overprescribing narcotics; and inadequate insurance coverage as a result of narrow eligibility criteria for hospice care for Medicare beneficiaries, and inadequate reimbursement more generally for pain management and palliative care. (shrink)

This article reviews the relationship between managed care and public health. Managed care, with its seemingly infinite structural and organizational variation, dominates the modern American health-care system for the non-elderly U.S. population. Through its emphasis on standarhzed practice norms and performance measurement, coupled with industrial purchasing techniques, prepayment, risk downstreaming, and incentives-based compensation, managed care has the potential to exert considerable influence over the manner in which the health-care system is organized and functions. Given the (...) degree to which the attainment of the basic public health goal of protecting the public against population health threats for which there are known and effective medical interventions depends on the successful interaction between public health policy and the medical care system, the importance of a viable working relationship between public health and managed care is difficult to overstate.The potential for conflict between public health and medical care is nothing new; indeed, delineating the boundaries of public health to shape and influence medical practice has occupied the energies of policymakers and the medical industry for well over a century. (shrink)

It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s/surrogate’s timely access to information, counseling, and referral. (...) (2) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on colleagues, supervisors, department heads, other administrators, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. Formal review may not be required in all cases, but when it is appropriate, several recommendations are offered about standards and the review process. A key recommendation is that when reviewing an objector’s reasons, contrary to what some have proposed, it is not appropriate to adopt an adversarial approach modelled on military review boards’ assessments of requests for conscientious objector status. According to the approach recommended, the primary function of reviews of objectors’ reasons is to engage them in a process of reflecting on the nature and depth of their objections, with the objective of facilitating moral clarity on the part of objectors rather than enabling department heads, supervisors, or ethics committees to determine whether conscientious objections are sufficiently genuine. (shrink)

The dramatic appearance of managed care organizations (MCOs) on the U.S. health scene has generated tremendous anxiety among health care providers and patients. These fears are based on the belief that managed care techniques pose greater risks of under treatment than do fee-for-service modes of payment. In addition, many physicians and patients resent the limits placed on clinical autonomy by the MCO model and the stresses that it places on the traditional physician-patient relationship. These misgivings have been (...) exacerbated by the mostly negative response to MCOs in the media and academia. Legislatures have responded to these claims and public fears with a wave of regulatory initiatives. Some of these regulations are attempts to protect patients. Others, however, are motivated primarily by antipathy toward the concept of managed care itself. This essay is an attempt to develop a social ethic of regulation and argues that the sole reason that private enterprise may be justifiably limited is when it presents a risk of harm to others or society. While some regulation and proposed regulation of MCOs meet this standard, much legislation represents an unjustified attempt to limit or handicap otherwise legal behavior merely because a segment of the population and medical profession find it aesthetically unpleasing and oppose its approach to the delivery of health services. (shrink)

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see (...) more patients per unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so. (shrink)

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see (...) more patients per unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so. (shrink)

In the past four decades, obstetric and neonatal care practices have changed dramatically throughout the western world. As a result, humans now confront unprecedented situations for which they have no biological preparation or cultural experience. In these special issues, an integrated view of the evolving practices of birthing and infant care are discussed from a variety of perspectives. Contributors attempt to show how understanding of the biomedical and psychosocial issues can be informed by cross-cultural and cross-species evidence concerning (...) birth management, neonatal care, and early development. The individual contributions are summarized in this introductory article. (shrink)

This paper addresses how interactions between UK palliative care nursing staff and the bodies of the deceased they care for function as a mechanism to help them make sense of death in line with their work as carers. Through an analysis of postmortem care rituals, I will argue that nurses play an integral role in the ‘making of the dead’, and look at how this functions in relation to their role as carers of bodies in line with (...) associated states of personal wellbeing. Further to this, there is an argument to be made for the recognition of the nurse’s place in biomedical models as managers of the transient body; as the constructors of the well, sick, living and dead body. (shrink)

Care has increasingly been promoted as an element of successful management practice. However, an ethic of care is a normative theory that was initially developed in reference to intimate relationships, and it is unclear if it is an appropriate normative standard in business. The purpose of this review is to bridge the social scientific study of care with philosophical understandings of care and to provide a theoretical justification for care as a managerial value. We (...) review the three different forms of care advanced by the ethics literature: caring relations, organizational care, and care as a virtue. We compare these forms of care to the management litertature. In doing so, we integrate what has previously been a scattered, yet growing, body of research on care. Our review of the literature reveals that care has increasingly been studied in management in relation to an ethic of care. Yet, many of the properties of care have also played a role in other established research domains (e.g., leadership). We discuss and critique the management and ethics literatures on care, paying attention to areas of agreement or disagreeement between the two. We go on to provide a normative justification of care as a value in business. Finally, we close by suggesting directions for future research. (shrink)

Despite the importance of ethics in corporate crisis management, they have received limited attention in the academic literature. This article contributes to the evolving conversation on ethics in crisis management by elucidating the ethics of "justice" and "care" and distinguishing between them. Examples of the two approaches are offered through consideration of cases in corporate crisis management, including the alleged glass contamination case faced by Gerber Products Company, and, the shooting tragedy at San Ysidro faced by (...) McDonald''s Corporation. It is argued that both an ethic of justice and an ethic of care can be appropriate approaches in corporate crisis management. Areas for future research are discussed. (shrink)

Cancer care has transitioned from clinical-based to home-based care to support longterm care in a more familiar and comfortable environment. This care transition has put family caregivers (FCGs) in a strategic position as care providers. Cancer care at home involves psychological and emotional treatment at some point, making FCGs deal with the stress of cancer patients frequently. Due to their limited care competencies, they need supportive care from healthcare professionals in cancer stress (...) management. This study aims to examine how types of demanded healthcare information affect the FCG’s role in reducing the stress of female cancer patients. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were 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 healthcare information, FCGs with higher demand for cancer-specific information were more likely to need support in reducing the stress of female cancer patients. Meanwhile, FCGs with a higher demand for information about support services were less likely to need support to reduce cancer patients’ stress. Other types of healthcare information have ambiguous effects on the need for support in reducing cancer-induced stress. This study reveals that the demanded cancer-specific information, e.g., cancer prognosis or likely outcome, must be prioritized to assist FCG’s role in managing cancer stress. (shrink)

The problem of inadequate pain management for both terminally ill patients and patients with chronic pain has recently been documented by a number of authors and studies. A 1997 report by the Institute of Medicine, for example, states that “a significant proportion of dying patients and patients with advanced disease experience serious pain, despite the availability of effective pharmacological and other options for relieving most pain.” There are particularly impressive data that pain associated with cancer is not adequately treated.The (...) problem has been attributed to inadequate education of physicians on approaches to pain management and an often misguided belief that prolonged therapy with certain pain medication will lead to addiction; legal obstacles, such as physicians’ fear of criminal prosecution and other disciplinary actions by state licensing boards for overprescribing narcotics; and inadequate insurance coverage as a result of narrow eligibility criteria for hospice care for Medicare beneficiaries, and inadequate reimbursement more generally for pain management and palliative care. (shrink)

This article reviews the relationship between managed care and public health. Managed care, with its seemingly infinite structural and organizational variation, dominates the modern American health-care system for the non-elderly U.S. population. Through its emphasis on standarhzed practice norms and performance measurement, coupled with industrial purchasing techniques, prepayment, risk downstreaming, and incentives-based compensation, managed care has the potential to exert considerable influence over the manner in which the health-care system is organized and functions. Given the (...) degree to which the attainment of the basic public health goal of protecting the public against population health threats for which there are known and effective medical interventions depends on the successful interaction between public health policy and the medical care system, the importance of a viable working relationship between public health and managed care is difficult to overstate.The potential for conflict between public health and medical care is nothing new; indeed, delineating the boundaries of public health to shape and influence medical practice has occupied the energies of policymakers and the medical industry for well over a century. (shrink)

For-profit managed care organizations face decisions about cost sharing that can involve a tradeoff between the interests of investors and the interests of patients. No successful business can ignore the interests of its investors, but moral philosophy points to ethical reasons for managed care organizations to make patients’ health, rather than investors’ profit, their primary goal. One reason is the ethical obligation of all businesses to avoid wrongful exploitation of vulnerable customers. An insurance company’s cost-sharing policy can exploit (...) customers either by collecting an unfairly large amount of money from them or by unfairly deterring them from making claims for resources they medically need. Another reason stems from the fact that managed care organizations’ profits derive in part from the existence of artificial barriers to access to medicine, notably including patents. Putting a fence around a water well in the desert is legitimate only if doing so facilitates a financial arrangement that maximizes people’s access to water they need. Likewise, patents and other artificial barriers to access to medically necessary drugs are legitimate only if they are used to help finance access to medical resources people need. For these reasons, managed care organizations should make cost-sharing decisions that maximize the sustainable availability of effective drugs to patients who need them. (shrink)

This study describes the ways in which professionals in two contexts of health care: general practice and homeopathic consultations, respond to patients' affective expressions of a trouble or a problem. The focus is on the turns of professionals that display understanding, compassion or agreement with the patient's account. Different types of affiliative turns are described and their consequences for the following interaction are scrutinized in relation to the institutional task of solving the patients' health-related problems. It is shown that (...) in both contexts, affiliation is oriented to as working towards closing the sequence of troubles-telling and serves to shift back to problem-solving activity, whilst in homeopathy, it may also serve as a means to problem-solving and thus help to complete the institutional task at hand. Some implications of these observations for professional—client interaction will be described. To conclude, the role of emotion in institutional interaction will also be discussed. (shrink)

Throughout the post-World War II decades, the United States has wrestled in its own unique style with a problem that is shared by all modern societies: how to achieve a reasonably equitable distribution of health care, without losing control of total spending on health care, and without suffocating the delivery system with controls and regulations that inhibit technical progress.Because an equitable distribution of health care inevitably requires at least some government regulation, and because government regulations tend to (...) impose rigidity on any system, it is widely believed in the United States that a trade-off actually exists between fairness in the distribution of care and the health system’s ability to innovate. This troublesome trade-off bedevils American policy makers to this day. (shrink)

The ‘managed care’ idea: implications for health service systems in Australia The growth of corporatism in health‐care in the US, and the consequences arising from US models of health‐care delivery systems provide an enormously valuable point of comparison with health systems of other developed economies, such as Australia. If lessons are to be learnt from the US, then an analysis of the structure and performance of the US health‐care system provides important background for understanding and assessing (...) contemporary policy changes to administrative and organizational designs and techniques for patient care in Australia. (shrink)