Background Speaking up to safeguard patients is a crucial ethical and moral obligation for nurses, but it is also a difficult and potentially dangerous component of nursing work. Health advocacy is gaining impetus in the medical literature, despite being hampered by barriers resulting in many nurses in Ghana remaining mute when faced with advocacy-required situations. We explored situations that thwart nurses from performing their health advocacy role. Research question What would cause nurses to take no (...) action when they witness situations that require them to act as health advocates for their clients or communities? Research Design An inductive, descriptive qualitative design was used to collect and analyse data on barriers that prevent nurses from practising their health advocacy role in Ghana. Individual one-on-one in-depth interviews were conducted using a semi-structured interview guide. The data were analysed using qualitative content analysis. Participants and research context Twenty-four professional nurses and midwives registered with the Nursing and Midwifery Council were recruited from three regional hospitals in Ghana. These public hospitals were chosen from the upper, middle and coastal regions. Ethical considerations The UKZN Ethics Review Committee in South Africa and the GHS Ethics Review Committee in Ghana both gave their approval for this study. Findings Intrapersonal barriers, interpersonal barriers, and structural barriers emerged as major obstacles that nurses experience when performing their health advocacy role. Conclusions Barriers to health advocacy have undermined nurses' ability to function as health advocates and are preventing them from utilising their health advocacy position in nursing practise. Giving nursing students positive role models in the classroom and in the clinic can help them become more effective health advocates. (shrink)

This study examines the effectiveness of the inoculation strategy in countering vaccine-related misinformation among Hong Kong college students. A three-phase between-subject experiment was conducted to compare the persuasive effects of inoculation messages, supportive messages, and no message control. The results show that inoculation messages were superior to supportive messages at generating resistance to misinformation, as evidenced by more positive vaccine attitudes and stronger vaccine intention. Notably, while we expected the inoculation condition would produce more resistance than the control condition, there (...) was little evidence in favor of this prediction. Attitudinal threat and counterarguing moderated the experimental effects; issue involvement and political trust were found to directly predict vaccine attitudes and intention. The findings suggest that future interventions focus on developing preventive mechanisms to counter misinformation and spreading inoculation over the issue is an effective strategy to generate resistance to misinformation. Interventions should be cautious about using health advocacy initiated by governments among populations with low political trust. (shrink)

In Ecological Thinking, Lorraine Code argues that advocacy “often makes knowledge possible” and without it “certain kinds of knowing are impossible.” By acknowledging the value of subjectivity and testimony in knowledge creation, I argue that ecological thinking serves as an appropriate framework for engagement with individuals who are living with mental illnesses. Contrasted with the dominant Anglo-American epistemologies that involve excessive degrees of mastery and control (with the tendency to silence the voices of Others), I argue that ecological thinking (...) facilitates healthy advocacy practices precisely because of its inclusivity and receptivity towards different perspectives in knowledge creation. (shrink)

Public Health Science and practice expanded during the course of the 20th century. Initially focused on controlling infectious disease through basic public health programs regulating water, sanitation and food, by 1988 the Institute of Medicine broadly declared that “public health is what we, as a society, do collectively to. assure the conditions for people to be healthy.” Commensurate with this definition, public health practitioners and policymakers today work on ;in enormous range of issues. The 2002 policy (...) agenda of the American Public Health Association reflects positions on genomics’ role in public health; national health and safety standards for child care programs; sodium in Americans’ diets; the health and safety of emergency rescue workers; and war in Central Asia and the Persian Gulf. (shrink)

Public Health Science and practice expanded during the course of the 20th century. Initially focused on controlling infectious disease through basic public health programs regulating water, sanitation and food, by 1988 the Institute of Medicine broadly declared that “public health is what we, as a society, do collectively to. assure the conditions for people to be healthy.” Commensurate with this definition, public health practitioners and policymakers today work on ;in enormous range of issues. The 2002 policy (...) agenda of the American Public Health Association reflects positions on genomics’ role in public health; national health and safety standards for child care programs; sodium in Americans’ diets; the health and safety of emergency rescue workers; and war in Central Asia and the Persian Gulf. (shrink)

Background The practice of health advocacy in nursing has been defined as a process aimed at promoting the independence and autonomy of users of health services, in addition to providing information on healthcare decision-making and offering support for decisions taken. Ethical considerations Ethics approval was not required to conduct this review. Aim This integrative review aims to synthesize evidence in the literature on health advocacy in professional nursing practice. Methods An integrative review methodology guided by (...) Whittemore and Knalf was used. Studies were identified by conducting searches on PubMed, Scopus, Web of Science, CINAHL, and LILACS databases. Of 2179 records, 34 studies matched the inclusion criteria. Results The main aspects involved in the practice of health advocacy by professional nurses are related to the ethical principles of the nursing profession, such as protecting patients seeking autonomy and care. Furthermore, the practice of health advocacy by nurses requires an empathetic attitude, responsibility, and assertive communication. Conclusion The diverse possibilities for the practice of advocacy synthesized in this study allow nurses to approach and become familiarized with the topic, being able to acquire and complement knowledge that will reflect on their professional practice in different work environments such as the educational field, in hospital practice, or basic health care. (shrink)

Religion constitutes an important element in every society as regards coping with the demands as well as vicissitudes of life. Mental health issues are becoming a recurrent decimal in societies overwhelmed by stress and other social factors. This paper examines how the presence of religious beliefs affects how some Christians respond to cases that have to do mental health. At the same time, it surveys how a near absence of religious attitude, that is, clinical medicine approach to mental (...) health issues betters the state of those suffering from these psychopathologies. This work sees participatory partnership approach as an effective means of correcting unhealthy biases that prevent a better understanding of mental health care. Sociological theory of structural functionalism will be used in assessing how religion can reinvent itself in areas that are associated with mental health. Ethnographic methodology through quantitative analysis of administered questionnaire is used as a research tool for this research. Three persons were also interviewed. The research findings show that religion is a crucial agent of socialization that can change how religious beliefs impact on mental health and there is need for medical professionals to collaborate with pastoral agents. (shrink)

Protecting the public's health has always been an inherently political endeavor. The field of public health, however, is conspicuously and persistently absent from sustained, sophisticated engagement in political processes, particularly elections, that determine policy outcomes. This results, in large part, from widespread misunderstanding of rules governing how, and how much, public advocates working in tax-exempt organizations can participate in public policy development.This article briefly summarizes the rules governing public policy engagement by exempt organizations. It then describes different types (...) of exempt organizations, and how they can work together to expand engagement. Next, it identifies several key mechanisms of policy development that public health advocates could influence. Finally, it suggests some methods of applying the tax rules to increase participation in these arenas. (shrink)

In “The Bioethics of Environmental Injustice,” Ray and Cooper (2024) lay out compelling arguments to increase attention to environmental health within bioethics. Advocacy is crucial, they argue, co...

Working at the bedside and within communities as patient advocates, nurses frequently intervene to advance individuals’ health and well-being. However, the International Council of Nurses’ Code of Ethics asserts that nurses should expand beyond the individual model and also promote a rights-enabling environment where respect for human dignity is paramount. This article applies the results of an ethnographic human rights study with displaced populations in Rwanda to argue for a rights-based social advocacy role for nurses. Human rights (...) class='Hi'>advocacy strategies include sensitization, participation, protection, good governance, and accountability. By adopting a rights-based approach to advocacy, nurses contribute to health agendas that include more just social relationships, equitable access to opportunities, and health-positive living situations for all persons. (shrink)

State health departments are at the core of the United States public health infrastructure. Surveillance to monitor trends in disease and injury; the development, coordination, and delivery of services; and public education are some of the core functions health department employees oversee every day. As such, agencies and their employees are well positioned to inform policy decisions that affect the public’s health. However, little is known about the role of health department staff — a sizeable (...) proportion of the public health workforce — as advocates for public health policies, independent of their agency roles. Anecdotally, some health department employees with whom we have spoken expressed reluctance to engage in policy advocacy for fear of violating little known or understood agency or state rules. (shrink)

The goal of this project was to expand an existing public health law curriculum to incorporate lessons on population health outcomes research, extra-legal advocacy, and the population health perspective. The project also created opportunities for students not only to read about and discuss concepts, but also to employ the lessons more practically through exercises and by writing white papers on public health law reform topics relevant to population health in Missouri. To do this, the (...) project expanded an existing didactic course and created a new credit-bearing, experiential “Lab.”. (shrink)

This article discusses how advocacy can be taught to both law and public health students, as well as the role that public health law faculty can play in advocating for public health. Despite the central role that advocacy plans in translating public health research into law, policy advocacy skills are rarely explicitly taught in either law schools or schools of public health, leaving those engaged in public health practice unclear about whether (...) and how to advocate for effective policies. The article explains how courses in public health law and health justice provide ideal opportunities to teach advocacy skills, and it discusses the work of the George Consortium, which seeks to engage public health law faculty in advocacy efforts. (shrink)

In recent years, the rights of patients have assumed a more pivotal role in international discussion. Stricter laws on the protection of patients place greater priority on the perspective and the status of patients. The purpose of this study is to emphasize ethical aspects in communication, the role of patient advocates as contacts for the concerns and suggestions of patients, and how many problems of ethics disappear when communication is highlighted. We reviewed 680 documented cases of consultation in a 10-year (...) period of patient advocates’ activity at a big German university hospital with 1,300 beds. On the basis of this extensive material, the article will focus on the intersection of the advocate’s work with the problems of patients in hospitals. Deficits in the level of communication between health care professionals and patients were frequently uncovered. Patients primarily complain about the lack of dialogue and empathy. Middle-aged patients consulted the patients’ advocate disproportionately more often. Measured against this baseline, the group of 65 and older complained less frequently. Besides complaints the advocate was asked in more than one-third of all cases for information about medical matters, hospital regulations or administrative problems. Patients obviously see the advocate as a well-connected and ideally unbiased contact person for uncertainties concerning their malady or a potential stay in hospital. Those seeking help often set hope in the information given by the voluntary patient representative. It should be highly recommended for every German hospital to establish the position of a patient advocate. Furthermore, patients can profit from regular exchange between the advocate and the Ethics Committee, also, to help ensure that their rights are taken into account and implemented in an ethically desirable context. (shrink)

Background:The concept of patient advocacy is still poorly understood and not clearly conceptualized. Therefore, there is a gap between the ideal of patient advocacy and the reality of practice. In order to increase nursing actions as a patient advocate, a comprehensive and clear definition of this concept is necessary.Research objective:This study aimed to offer a comprehensive and clear definition of patient advocacy.Research design:A total of 46 articles and 2 books published between 1850 and 2016 and related to (...) the concept of patient advocacy were selected from six databases and considered for concept analysis based on Rodgers’ evolutionary approach.Ethical considerations:This study was approved by the Research Ethics Committee of Tarbiat Modares University.Findings:The attributes of patient advocacy are safeguarding (track medical errors, and protecting patients from incompetency or misconduct of co-workers and other members of healthcare team), apprising (providing information about the patient’s diagnosis, treatment, and prognosis, suggesting alternatives of healthcare, and providing information about discharge program), valuing (maintaining self-control, enabling patients to make decisions freely, maintaining individualization and humanity, maintaining patient privacy, and acting in the patients’ values, culture, beliefs, and preferences), mediating (liaison between patients, families, and healthcare professionals, being patients’ voice, and communicate patient preferences and cultural values to members of the healthcare team), and championing social justice in the provision of healthcare (confronting inappropriate policies or rules in the healthcare system, identifying and correcting inequalities in delivery of health services, and facilitating access to community health services and health resources).Discussion and conclusion:The analysis of this concept can help to develop educational or managerial theories, design instruments for evaluating the performance of nurses in patient advocacy, develop strategies for enhancing patient advocacy, and improve the safety and quality of nursing care in the community and healthcare system. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 19-20, August 2012.

In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs,1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process.2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV as well (...) as criminalisation, stigma and lack of access to needed healthcare, prevention and social services. We take this opportunity to respond to the excellent points raised by the commentators. All of the commentaries support our emphasis on robust community engagement with PWID and other stakeholders in designing and conducting HIV prevention research, but urge us to go farther. Wolfe highlights the difficulty of even engaging with community members in oppressive settings, where authorities severely restrict civil liberties of PWID so that even discussing issues related to drug use and enforcement may place individuals at risk. To overcome such limitations, he appropriately suggests interviewing confidentially those who have previously been detained in closed settings as part of the community engagement process. Similarly, Wolfe observes that critical issues can be overlooked with a narrow focus on study procedures if contextual factors before, during or after a study are ignored. For example, he cites the risk of overdose for study participants who have been abstinent during a study and subsequently resume injecting when the study concludes. These kinds of risks may not be obvious …. (shrink)

In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs, 1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process. 2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV (...) as well as criminalisation, stigma and lack of access to needed healthcare, prevention and social services. We take this opportunity to respond to the excellent points raised by the commentators. All of the commentaries support our emphasis on robust community engagement with PWID and other stakeholders in designing and conducting HIV prevention research, but urge us to go farther. Wolfe highlights the... (shrink)

I argue that, contrary to what Tom Regan suggests, his rights view implies that subsistence hunting is wrong, that is, killing animals for food is wrong even when they are the only available food source, since doing so violates animal rights. We can see that subsistence hunting is wrong on the rights view by seeing why animal experimentation, specifically xenotransplanation, is wrong on the rights view: if it’s wrong to kill an animal to take organs to save a human life, (...) it’s wrong to kill an animal to eat that animal to save a human life or improve human health. I discuss these arguments’ implications for animal rights-based vegan advocacy, insofar as some people claim that they don’t feel their best on vegan diets and so their eating meat is morally justified. I argue that such an attempt to justify consuming animal products fails on Regan’s rights view, but discuss some attempts to morally excuse such violations of animals’ rights. These attempts are inspired by Regan’s attempts at potentially excusing animal rights advocates’ using medications developed using animals. (shrink)

It remains unclear what patient advocacy actually entails and what values it ought to embody. It will be useful to ascertain whether advocacy means supporting any decision the patient makes, or if the advocate can claim to represent the patient by asserting well-intentioned paternalistic claims on the patient's behalf. This is especially significant because the position of advocate brings with it certain privileges on the basis of of presumed insight into patient-perceived interests, namely, entitlement to take part in (...) clinical decision making and increased professional standing. Three issues related to patient advocacy will be explored: are patient advocates necessary; what does advocacy entail, and who ought to represent patients in this way—arguments for and against prospective candidates will also be covered. The paper considers whether advocates are necessary since not only can they be dangerously paternalistic, but the salutary values advocacy embodies are already part of good professional health care. (shrink)

Background:The decision whether to initiate cardiopulmonary resuscitation may sometimes be ethically complex. While studies have addressed some of these issues, along with the role of nurses in cardiopulmonary resuscitation, most have not considered the importance of nurses acting as advocates for their patients with respect to cardiopulmonary resuscitation.Research objective:To explore what the nurse’s advocacy role is in cardiopulmonary resuscitation from the perspective of patients, relatives, and health professionals in the Basque Country (Spain).Research design:An exploratory critical qualitative study was (...) conducted from October 2015 to March 2016. Thematic analysis was used to analyse the data.Participants:Four discussion groups were held: one with patients and relatives (n = 8), two with nurses (n = 7 and n = 6, respectively), and one with physicians (n = 5).Ethical considerations:Approval was obtained from the Basque Country Clinical Research Ethics Committee.Findings:Three significant themes were identified: (a) accompanying patients during end of life in a context of medical dominance, (b) maintaining the pact of silence, and (c) yielding to legal uncertainty and concerns.Discussion:The values and beliefs of the actors involved, as well as pre-established social and institutional rules reduced nurses’ advocacy to that of intermediaries between the physician and the family within the hospital environment. On the contrary, in primary health care, nurses participated more actively within the interdisciplinary team.Conclusion:This study provides key information for the improvement and empowerment for ethical nursing practice in a cardiac arrest, and provides the perspective of patients and relatives, nurses and physicians. (shrink)

Rare genetic diseases collectively impact millions of individuals in the United States. These patients and their families share many challenges including delayed diagnosis, lack of knowledgeable providers, and limited economic incentives to develop new therapies for small patient groups. As such, rare disease patients and families often must rely on advocacy, including both self-advocacy to access clinical care and public advocacy to advance research. However, these demands raise serious concerns for equity, as both care and research for (...) a given disease can depend on the education, financial resources, and social capital available to the patients in a given community. In this article, we utilize three case examples to illustrate ethical challenges at the intersection of rare diseases, advocacy and justice, including how reliance on advocacy in rare disease may drive unintended consequences for equity. We conclude with a discussion of opportunities for diverse stakeholders to begin to address these challenges. (shrink)

Parents and guardians in child protection systems are in unequal power relationships with child protection practitioners. This relationship is experienced as exclusionary or even oppressive by many parents and guardians. For families and communities in the child protection system who experience intersectional discrimination and disadvantage, such as people with intellectual disabilities and First Nations people, this unequal relationship and subsequent potential exclusion and oppression can be even more profound. A growing body of literature indicates that advocacy can assist in (...) addressing unequal relationships in other contexts, such as involuntary mental health. This paper explores the role of representational advocacy in supporting parents in child protection settings through a case study of an advocacy service in Victoria, Australia. Using a human rights framework to guide the analysis, the paper highlights how advocacy can help support rights, but that broader structural change will be required to consistently uphold the rights of parents. (shrink)

Nursing professionals are in key positions to support end-of-life decisions and to advocate for patients and families across all health care settings. Advocacy has been identified as the common thread of quality end-of-life nursing care. The purpose of this comparative descriptive study was to reveal acute care nurses' perceptions of advocacy behaviors in end-of-life nursing practice. The 317 participating nurses reported frequent contact with dying patients despite modest exposure to end-of-life education. This study did not confirm an (...) overall difference in advocacy behaviors among novice, experienced and expert nurses; however, it offered insight into the supports and barriers nurses at different skill levels experienced in their practice of advocacy. (shrink)

The paper discusses the use of term ‘advocacy science’ which is communication of science which goes beyond simple reporting of scientific findings, using the case study of biotechnology. It argues that advocacy science should be used to distinguish the engagement of modern civil society organizations to interpret scientific knowledge for their lobbying. It illustrates how this new communicative process has changed political discourse in science and general perception of the role of science in contemporary society.

Caring for the competent, fragile, elderly patient at the end of life is becoming increasingly challenging. This case explores several ethical areas of concern that arise when caring for patients who have written durable powers of attorney for health care decisions and face life or death choices. Areas covered are informed consent with the elderly patient, the family's right to be involved in decision-making, futility of treatment, and the nurse's role as patient advocate during times of difficult decision-making. Recommendations (...) for increased nursing intervention during these times are incorporated. Les soins des personnes âgés, fragiles mais toujours compétentes et dont la vie touche à sa fin, posent des problèmes de plus en plus urgents. Cet article discute de plusieurs aspets qui se manifestent dans les soins des malades ayant écrit des mandats concernants leurs soins et qui doivent maintenant prendre des décisions graves concernant la vie ou la mort. Les aspets dont il s'agit dans cet article sont: le consentement informé des personnes âgés: le droit de la famille de participer à la décision; les traitements inutiles; et le rôle des infirmiers/ères pour plaider leur cause pendant des moments difficles de prises de décisions. Des recommendations pour de plus importantes interventions infirmières sont comprises. Die Pflege der geistig kompetenten aber hinfälligen Personen im hohen Alter stellt immer grössere Anforderungen. Dieser Artikel untersucht verschiedene ethische Aspekte, die bei der Pflege von Patienten, die eine schriftliche Vollmacht über medizinische Behandlung ausgestellt haben für ihre Pflege und jetzt Entscheidungen über Leben oder Tod treffen müssen. Der Artikel umfasst folgende Bereiche: informierten Zustimmung des Patienten, das Mitbestimmungsrecht der Familie, Zwecklosigkeit der Behandlung, und die Rolle des Pflegepersonals als Fürsprecher der Patienten bei schwierigen Entscheidungen. Empfehlungen für eine grössere Beteiligung oder Mitbestimmung des Pflegepersonals in diesen Fällen sind eingeschlossen. (shrink)

Doctors are increasingly enjoined by their professional organisations to involve themselves in supraclinical advocacy, which embraces activities focused on changing practice and the system in order to address the social determinants of health. The moral basis for doctors’ decisions on whether or not to do so has been the subject of little empirical research. This opportunistic qualitative study of the values of medical graduates associated with the Sydney Medical School explores the processes that contribute to doctors’ decisions about (...) taking up the advocate role. Our findings show that personal ideals were more important than professional commitments in shaping doctors’ decisions on engagement in advocacy. Experiences in early life and during training, including exposure to power and powerlessness, significantly influenced their role choices. Doctors included supraclinical advocacy in their mature practices if it satisfied their desire to achieve excellence. These findings suggest that common approaches to promoting and facilitating advocacy as an individual professional obligation are not fully congruent with the experiences and values of doctors that are significant in creating the advocate. It would seem important to understand better the moral commitments inherent in advocacy to inform future developments in codes of medical ethics and medical education programs. (shrink)

The systemic difficulties of health care in the USA have brought to light another issue in nurse—patient advocacy — those who require care yet have inadequate or non-existent access. Patient advocacy has focused on individual nurses who in turn advocate for individual patients, yet, while supporting individual patients is a worthy goal of patient advocacy, systemic problems cannot be adequately addressed in this way. The difficulties nurses face when advocating for patients is well documented in the (...) nursing literature and I argue that, through collective advocacy, professional nursing associations ought to extend the reach of individual nurses in order to address systemic problems in health care institutions and bureaucracies. (shrink)

Bioethicists in healthcare institutions have the skills and insights and can and must facilitate and promote measures that address deeply ingrained structural issues that exacerbate health inequity...

Medical and non-medical experts increasingly argue that individuals, whether they are diagnosed with a specific chronic disease or condition or not (and whether they are judged at minimal risk of these consequences or not), have an obligation to make ‘healthy’ food choices. We argue that this obligation is neither scientifically nor ethically justified at the level of the individual. Our intent in the article is not simply to argue against moralization of the value of prudential uses of food for nutritional (...) health, but to situate nutritional advocacy in the context of Western liberal democracy that values free choice. We have two objectives: (i) to untangle and examine the substance of discourses on ‘healthy’ food choice that simplify nutrition science and place a moral obligation on individuals and (ii) to establish a more comprehensive view of the relationship among food, ethics and health. Although critical of certain features of the liberal political and moral tradition, we argue that John Stuart Mill’s notion of experiments in living provides fertile ground for an improved ethical understanding of individual obligation and of the interconnections among food, health and well-being. (shrink)

The anti-psychiatry movement of the 20th century has notably denounced the role of values and social norms in the shaping of psychiatric categories. Recent activist movements also recognize that psychiatry is value-laden, however, they do not fight for a value-free psychiatry. On the contrary, some activist movements of the 21st century advocate for self-advocacy in sciences of mental health in order to reach a more accurate understanding of psychiatric categories/mental distress. By aiming at such epistemic gain, they depart (...) from the anti-psychiatry movement. Through the analysis of the epistemic and political influence of two of these movements – Neurodiversity and the Mad Studies, we show how this new activism has taken a scientific turn compatible with current philosophical scientific frameworks, while still developing a critical approach on psychiatry. (shrink)

Halley et al. (2023) highlight important equity challenges emerging out of existing health policy’s reliance on self- and family advocacy. As advocacy capacity varies dramatically across groups, pu...

This essay examines the fundamental role of veterinarians in companion animal practice by developing the idea of veterinarians as strong advocates for their nonhuman animal patients. While the practitioner-patient relationship has been explored extensively in medical ethics, the relation between practitioner and animal patient has received relatively less attention in the expanding but still young field of veterinary ethics. Over recent decades, social and professional ethical perspectives on human-animal relationships have undergone major change. Today, the essential role of veterinarians is (...) not entirely clear. Furthermore, veterinarians routinely face pressure, often insidious, to refrain from pursuing their patients’ vital interests. In exploring the concept of strong patient advocacy, this essay investigates the increasingly common suggestion that veterinarians have ‘primary obligation’ and ‘first allegiance’ to their animal patients rather than to other parties, such as their clients or employers. The related concept of a fiduciary duty, which is sometimes encountered in medical ethics, is similarly explored as it applies to companion animal practice. The resultant idea of a strong patient advocate places companion animal veterinarians conceptually and ethically close to human health professionals, not least pediatricians. (shrink)

Background:Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care.Objectives:The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and (...) die at home?, and identify gaps in the knowledge.Method:Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings.Results:34 international studies revealed themes of ‘the nursing relationship’, ‘environment’, ‘communication’, ‘support’ and ‘the holistic client centred district nursing role.Discussion:Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas.Conclusion:It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered. (shrink)

The United Kingdom Central Council for Nursing, Midwifery and Health Visitors (UKCC) document, Exercising Accountability, states that the role of patient's advocate is an essential aspect of good professional nursing practice (1). The author examines the case for and against the nurse being the best person to act as advocate, and critically evaluates the criteria of advocacy. The problematic moral issues arising are discussed, and a case made for negotiation between the members of the multidisciplinary team and the (...) patient/client (or a significant person to the patient) in order to promote the well-being of the patient and to minimise suffering. She concludes that the health care professional's (including the nurse's) role is to help people to assert control over the factors which affect their lives, that is empowerment, rather than advocacy. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:Women and Health Research:A Report from the Institute of MedicineAnna C. Mastroianni (bio), Ruth Faden (bio), and Daniel Federman (bio)In recent years, claims have been made by segments of the research community and by women's health advocacy groups that clinical research practices and policies have not benefitted women's health to the same extent as men's health. Central to these claims has been an assertion (...) that women have been inadequately represented as subjects of clinical studies and that as a result neither health conditions unique to women—e.g., menopause—nor women's manifestations of health problems affecting both sexes—e.g., heart disease—have been investigated sufficiently.The scientific community, including federal agencies that sponsor and regulate clinical studies, is increasingly responsive to these claims and is taking steps to raise the level of women's participation in clinical studies. Controversy and concern have surrounded these actions, however. Two of the claims that have been made are: (1) that women are more difficult to study than men because of their cyclical hormonal changes; and (2) that conducting gender-specific subgroup analyses would increase the size of study populations, raise the cost of studies, and thereby reduce the number of studies that could be performed with the limited resources available. In addition, controversy over the inclusion of women of childbearing potential and pregnant women has been particularly salient. Concerns have been expressed about avoiding potential harm to existing or potential fetuses and about the possible legal and financial ramifications of such harm. A further concern involves the perceived difficulties in enrolling women in studies and retaining them for the duration of the studies.Against this backdrop, the Office of Research on Women's Health at the National Institutes of Health (NIH) asked the Institute of Medicine (IOM) in October 1992 to establish the Committee on the Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies. The Committee's charge was to: (1) consider the ethical and legal implications of including women, particularly pregnant women and women of childbearing potential, in clinical studies; (2) examine known instances of litigation regarding injuries to research subjects [End Page 55] and describe existing legal liabilities and protections; and (3) provide practical advice on these issues for consideration by NIH, institutional review boards (IRBs), and clinical investigators.The 16 Committee members came from diverse backgrounds: bioethics, law, epidemiology and biostatistics, public health policy, obstetrics and gynecology, clinical research, pharmaceutical development, social and behavioral sciences, and clinical evaluative sciences.1 Chaired by two of the authors of this article, Ruth Faden and Daniel Federman, and coordinated by the third, IOM Study Director Anna Mastroianni, the Committee met five times over a fourteen-month period, convened a one-and-one-half day invitational workshop, and commissioned several background papers. The Committee's deliberations were complicated by the announcement of new federal policies late in its term. Specifically, the Food and Drug Administration (FDA) issued guidelines (FDA 1993) to replace its 1977 guidelines, which prohibited the inclusion of women of childbearing potential in early phases of most clinical drug trials. In addition, Congress passed the NIH Revitalization Act of 1993 (P.L. 103-43), which contains provisions mandating the inclusion of women and racial and ethnic minorities in NIH-sponsored clinical research. In February 1994, the IOM Committee publicly issued its final report and recommendations, Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, publishing the workshop presentations and commissioned papers in a separate volume.Deliberations of the CommitteeA number of issues arose at the outset as the Committee considered its charge. A few members initially believed that verification of the underrepresentation of women relative to men in clinical studies as a whole was a prerequisite to providing policy recommendations. Others believed that such an examination would be an important contribution to the knowledge base, but that it was not necessary for addressing the Committee's charge. As summarized in the Committee's report, the Committee's research indicated that firm conclusions about the relative underrepresentation of women could not be drawn from the available data because of the lack of systematic information... (shrink)

Client-provider relationships have significant effects on how individuals comprehend their life situation during chronic disease and illness. Yet, little is known about how frontline health care providers (HCPs) influence client’s identity formation through meaning-making with clients such as HIV-positive women living in poverty. This requires ethical consideration of the meanings made between clients and providers about client’s health and well-being, both individually and in the larger society. Health care providers (N = 15) and married women living with (...) HIV (N = 33) in north-central India engaged in separate intensive interviews providing narrative data which were analysed using a conceptual framework crossing Lipsky’s street-level bureaucracy theory (Lipsky 2010) with meaning-making processes. HCPs and women construct meanings of women’s role as caregivers that impact women’s sense of identity, health, and well-being. Findings indicate that despite being well-intentioned, HCPs inadvertently reinforce rigid gender norms and convey that women’s worth is tied to their familial caregiving role. HCPs’ discretionary advocacy may also reinforce societal images of women as incapable and needy, thereby harming them more generally. Attention to the gender-sensitive training of HIV health care providers may assure that discretion is ethically interrogated to promote gender equity and enhance women’s access to social welfare services. (shrink)

Drawing on insights from scholarship on contentious action frames, this article examines the framing of demands for social justice for migrant farmworkers in Spain, Italy and Canada during the COVID-19 pandemic. We focus particularly on how activists in each country aligned their action frames with prevalent public discourses on the essential contribution migrants make to agricultural production, the need to guarantee “health for all,” and “increased vulnerability” of migrants’ lives during the global health crisis. Using these diagnostic frames, (...) activists in the three countries called for secure legal status for all migrants. Drawing on the literature on contentious action frames, we then analyze if action frames advanced by activists during the COVID-19 pandemic “resonated” with the understanding of these issues by policymakers. We challenge an approach to understanding resonance in binary terms as either present or absent. Instead, we introduce the notion of “ambivalent resonance” to draw attention to the fact that some frames are accepted only partially or only by some policymakers but not the others, as was the case in the three countries under study. We then situate this ambivalent resonance in the context of immigration priorities and recent trends in immigration policy development in these three countries and suggest that activists can build on ambivalences to advance migrant rights to status. (shrink)

Approximately 11.2 million undocumented immigrants have settled in the United States. Providing health care to these residents is an everyday concern for the clinicians and health care organizations who serve them. Uncertain how to proceed in the face of severe financial constraints, clinicians may improvise remedies–a strategy that allows our society to avoid confronting the clinical and organizational implications of public policy gaps. There is no simple solution‐no quick fix‐that will work across organizations (in particular, hospitals with emergency (...) departments) in states with different concentrations of undocumented immigrants, varying public and private resources for safety‐net health care, and differing approaches to law and policy concerning the rights of immigrants. However, every hospital can help its clinicians by addressing access to health care for undocumented immigrants as an ethical issue. We offer some recommendations for doing this in a structured, fair, and transparent way. We also describe the problems that may result when clinicians are forced to grapple with this issue on their own. (shrink)

Events in 2020 have sparked a reimagination of how both individuals and institutions should consider race, power, health, and marginalization in society. In a response to these developments, we exa...

Mothers serve as an important layer of the health-care system, with special responsi-bilities to care for the health of families and nations. In our social discourse, we tend to treat maternal “choices” as though they were morally and causally Self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers’ caretaking practices and responsibilities, as they are situated within cultural meanings and (...) institutional pressures. I give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets. (shrink)

BackgroundInternational codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance (...) and cogency of an ethical code in occupational health for an African context through an iterative consultative process.DiscussionFirstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace.SummaryA stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region. (shrink)