Including more than 50'000 documents - as well as 500 doctoral theses - the Globethics.net Health Ethics collection is a unique online resource covering topics related to health ethics such as pharmaceuticals, health economics, health politics, access to medical care, environmental issues and bioethics.

Recent Submissions

  • Exploring the formation of digital therapeutics

    Malone, Ruth E; Martin, Margaret Leeves (eScholarship, University of California, 2020-01-01)
    Purpose: This critical ethnographic study explores regulatory, social, and commercial spheres of behavioral health innovation in the United States through the lens of a burgeoning employment sector: digital therapeutics. By examining ways that digital therapeutics are being defined and operationalized in connection with shifting policies to evaluate digital health, this study draws on collected data to examine evolving conceptions of evidence, access, and public benefit happening in the name of health innovation. Background: Pursuant to the 2016 passage of the 21st Century Cures Act, The U.S. Food and Drug Administration is actively revamping its evaluation frameworks for digital health products. Policies to appropriately regulate software as a medical device (SaMD) are in development to review whole company characteristics rather than individual product efficacy, address the iterative nature of software product development cycles, and empower commercial actors to provide their own effectiveness analytics for post-market assessment purposes. Methods: A qualitative approach was used drawing on multiple data sources for this project. These sources included: collected documents (n=25), in-depth individual interviews with stakeholders working on or with knowledge of digital therapeutic products across professional areas including engineering, clinical science, regulatory science, executive leadership, academia, and financial services (n=41), and ethnographic observations (n=75 hours) taking place at two digital therapeutic conferences, technology sector worksites, interview locations, and an FDA workshop. Data were transcribed, thematically coded, and analyzed using a qualitative software program, Dedoose. Results: Digital therapeutics are being defined and operationalized in connection with the digitization of behavioral health. This shift entails a connected commercialization of behavioral science interventions. In an environment where standards to guide product development are unclear, regulatory expertise is heightened as an asset for which companies compete. The FDA’s evolving regulatory schema advantages commercial actors with more resources, which may impact the types of organizations from which innovative and FDA approved digital health products originate. Digital therapeutics advance conceptions of health that center the optimization of individual selfhood through processes that seek to “purify” interventions. These “purified” interventions, often digitized therapeutic encounters, eliminate interference and variation by human actors in the name of improving biomedical intervention standards. Commercial promises to increase digital access to care ignore varying ways that access is invoked through product creation, including the possibility that digital therapeutics may hinder in-person access to therapeutic relationships and contribute to stratifying occupational dynamics with implications for health equity.Conclusion: This study highlights ways that scientific evidence is being reshaped in the commercialization of behavioral health, in addition to the co-production of digitization and commercialization as stratifying processes. Findings shed light on the need to assess evidence production within emergent health technology production more closely. Ethical guidelines to define and center equity should be incorporated into digital health implementation strategies and are of considerable importance to the domains of regulatory and translational science.
  • Healthcare professionals' ethical competence : A scoping review

    University of Helsinki, HUSLAB; Koskenvuori, Janika; Stolt, Minna; Suhonen, Riitta; Leino-Kilpi, Helena (2019-01)
    Aim The aim of this study was to examine the extent and nature of the available research literature on healthcare professionals' ethical competence and to summarize the research findings in this field. Design Methods A scoping review guided by Arksey and O'Malleys methodological framework was conducted. Six databases including Pubmed/Medline, CINAHL, Web of Science Core Collection, PsycInfo, Philosophers' Index, and Scopus were searched systematically. Of 1,476 nonduplicate citations, 17 matched the inclusion criteria. Results Findings revealed that healthcare professionals' ethical competence is a limited but topical research area. The focus areas of the studies were conceptualization, measuring, and realization of the ethical competence. The studies provided varying definitions and constructions for ethical competence and a few instruments to measure ethical competence were identified. Research in this area seems to be in a transition phase from theorization to empirical measurement. Methodologically, the research was rather heterogeneous and mainly focused on nurses.
  • Severity as a priority setting criterion: Setting a challenging research agenda

    Barra, Mathias; Broqvist, Mari; Gustavsson, Erik; Henriksson, Martin; Juth, Niklas; Sandman, Lars; Solberg, Carl Tollef (Springer, 2020-06-17)
    Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda.
  • Application of the APA ethics code for psychologists working in integrated care settings: Potential conflicts and resolutions

    Chenneville, Tiffany; Gabbidon, Kemesha (Digital USFSP, 2020-01-01)
    Increasingly, there is evidence of the potential benefits of an integrated care model. In fact, the American Psychological Association (APA) supports the role of psychologists in integrated healthcare given the positive outcomes for patients in primary care settings such as increased access to mental health services, reduced mental illness stigma, and improved health associated with recognizing the impact of psychosocial factors on physical wellbeing. Less attention has been paid, however, to ethical dilemmas that may arise for psychologists working in integrated healthcare. This paper explores considerations for resolving potential ethical conflicts that may arise for psychologists working in integrated care settings.
  • Insegurança, ética e comunicação em saúde pública

    Luis David Castiel
    São descritos e abordados analiticamente como uma questão pertinente ao âmbito da saúde pública, aspectos da insegurança que atingem as sociedades contemporâneas. São apresentados tópicos que abordam a relação entre profissionais de saúde e instâncias de informação e comunicação pública de conteúdos ligados a riscos à saúde, com exemplos provenientes de questões vinculadas à biotecnologia. Analisa-se a necessidade de desenvolvimento de uma ética global voltada para problemas de saúde pública que envolve desigualdades sociais e vulnerabilidade de parcelas expressivas das populações em escala mundial.
  • Drowning our sorrows: clinical and ethical considerations of termination in alcohol-affected pregnancy

    Roger Martin; George Bruxner; Gary Ng; Catherine Brewster; Alka Kothari (BMC, 2020-06-01)
  • Webinar: Palliative Care and COVID-19: Implications for Clinical Practice, Part Three

    Adeboye, Olumuyiwa; Hibner, Nate; Sullivan, MC; VandeKieft, Gregg (Providence St. Joseph Health Digital Commons, 2020-04-16)
    The Catholic Health Association and the Supportive Care Coalition co-hosted this one hour webinar for palliative care teams being impacted by COVID-19. This is a continuation of our presentations on March 26th and April 2nd and discusses the ongoing challenges being faced by palliative care teams during the COVID pandemic.
  • Cuidados paliativos na prática médica: contexto bioético

    José Humberto Belmino Chaves; Vera Lúcia Gama de Mendonça; Leo Pessini; Guilhermina Rego; Rui Nunes
    JUSTIFICATIVA E OBJETIVOS: O estudo trata de pesquisa teórica, com levantamento bibliográfico e documental do tema, frente ao contexto histórico e a situação atual das questões relacionadas aos cuidados paliativos na prática médica. Objetivando avaliar a evolução do pensamento da sociedade em geral e da sociedade médica a respeito dos cuidados paliativos e procurando fundamentação consistente para a construção de argumentos capazes de satisfazer padrões atuais da bioética. CONTEÚDO: Apresenta-se introdução ao tema geral, seguida de análise da literatura, ressaltando aspectos introdutórios, histórico, evolução e definições sobre cuidados paliativos e a ortotanásia, fazendo acompanhamento ético e bioético, seguida de discussão sobre os princípios bioéticos aplicados ao tema. CONCLUSÃO: A ideologia dos cuidados paliativos é atender a pessoa, na fase final da vida, na sua globalidade de ser, promovendo o bem estar global e a dignidade do paciente crônico e terminal e sua possibilidade de não ser expropriado do momento final de sua vida, mas de viver a própria morte.
  • Scoring system to triage patients for spine surgery in the setting of limited resources: Application to the COVID-19 pandemic and beyond.

    Sciubba, Daniel M; Ehresman, Jeff; Pennington, Zach; Lubelski, Daniel; Feghali, James; Bydon, Ali; Chou, Dean; Elder, Benjamin D; Elsamadicy, Aladine A; Goodwin, C Rory (eScholarship, University of California, 2020-05-29)
    BACKGROUND:As of May 04, 2020, the COVID-19 pandemic has affected over 3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems the world over leading to the cancellation of elective surgical cases and discussions regarding healthcare resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak, and may recur with future pandemics, creating a need for a means of triaging emergent and elective spine surgery patients. METHODS:Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling. RESULTS:The devised scoring system included 8 independent components: neurological status, underlying spine stability, presentation of a high-risk post-operative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely-available web-based calculator (https://jhuspine3.shinyapps.io/SpineUrgencyCalculator/). CONCLUSION:Here we present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, while not all-encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.
  • Ethical Framework for Nutrition Support Resource Allocation During Shortages: Lessons From COVID-19.

    Barrocas, Albert; Schwartz, Denise Baird; Hasse, Jeanette M; Seres, David S; Mueller, Charles M (Providence St. Joseph Health Digital Commons, 2020-06-03)
    The coronavirus disease (COVID-19) pandemic has impacted all aspects of our population. The "Troubling Trichotomy" of what can be done technologically, what should be done ethically, and what must be done legally is a reality during these unusual circumstances. Recent ethical considerations regarding allocation of scarce resources, such as mechanical ventilators, have been proposed. These can apply to other disciplines such as nutrition support, although decisions regarding nutrition support have a diminished potential for devastating outcomes. The principal values and goals leading to an ethical framework for a uniform, fair, and objective approach are reviewed in this article, with a focus on nutrition support. Some historical aspects of shortages in nutrition supplies and products during normal circumstances, as well as others during national crises, are outlined. The development and implementation of protocols using a scoring system seems best addressed by multidisciplinary ethics and triage committees with synergistic but disparate functions. Triage committees should alleviate the burdens of unilateral decisions by the healthcare team caring for patients. The treating team should make every attempt to have patients and the public at large update or execute/develop advance directives. Legal considerations, as the third component of the Troubling Trichotomy, are of some concern when rationing care. The likelihood that criminal or civil charges could be brought against individual healthcare professionals or institutions can be minimized, if fair protocols are uniformly applied and deliberations well documented.
  • Eliminating Clinician Fears to Prescribing Pre-Exposure Prophylaxis for Human Immunodeficiency Virus

    Bishop, Andrea M (Digital Showcase @ University of Lynchburg, 2020-06-26)
    HIV is considered an epidemic, however, the rates of transmission of infection could be substantially reduced with a drug called Truvada®, a combination antiviral of Tenofovir Disoproxil Fumarate and Emtricitabine. By the CDC’s estimation regarding sexual and drug use behaviors among the U.S. population, 1.2 million individuals are eligible for Pre-Exposure Prophylaxis (PrEP), yet only about 80,000 individuals have been prescribed PrEP since the Food and Drug Administrations approved its use in 2012. To date, PrEP initiation and adoption has not been sufficient to have a large effect on HIV incidence. Further, research has shown that only a fraction of U.S. health care providers report having ever prescribed PrEP. The benefits of educating providers regarding the utilization of PrEP and encouraging them to incorporate the treatment into the care of their patients amounts to potentially reducing an epidemic, increasing the quality of life and saving lives
  • Special Issue "Health Care Law and the Rights of Individuals with Disabilities"

    Pendo,, Elizabeth, Guest Editor (Scholarship Commons, 2017-01-01)
    People with disabilities are vulnerable. They carry high risk for poor health and health outcomes. As a group, they experience social disadvantages such as poverty, underemployment and unemployment, isolation, and discrimination at a higher rate than the general population. They also face multiple barriers to quality health care and report poorer health status than people without disabilities. This Special Issue will explore the key health disparities and barriers to health care experienced by people with disabilities, and explore the legal, ethical, and social issues they raise. It will investigate the legal requirements of the Americans with Disabilities and other antidiscrimination laws as they apply to health and health care, the implications of health care reform efforts affecting people with disabilities, and other uses of law and policy to promote health determinants, such as access to education and work opportunities, a life in a community, and full participation in society for people with disabilities.
  • Towards including end-users in the design of prosthetic hands: ethical analysis of a survey of Australians with upper-limb differenced

    Walker, MJ; Goddard, E; Stephens-Fripp, B; Alici, G (Opragen Publications, 2020)
    Advances in prosthetic design should benefit people with limb difference. But empirical evidence demonstrates a lack of uptake of prosthetics among those with limb difference, including of advanced designs. Non-use is often framed as a problem of prosthetic design or a users response to prosthetics. Few studies investigate user experience and preferences, and those that do tend to address satisfaction or dissatisfaction with functional aspects of particular designs. This results in limited data to improve designs and, we argue, this is pragmatically and ethically problematic. This paper presents results of a survey we conducted in 2017 with people with upper limb difference in Australia. The survey sought to further knowledge about preferences surrounding prosthetics and understanding of how preferences relate to user experience, perspective, and context. Survey responses demonstrated variety in the uptake, use and type of prostheticand that use of, preferences about, and impacts of prosthetics rely not just on design factors but on various contextual factors bearing on identity and social understandings of disability and prosthetic use. From these results, we argue that non-use of prosthetics could be usefully reframed as an issue of understanding how prosthetics can best support users autonomy. This supports the claim that there is a need to incorporate user engagement into design processes for prosthetic limbs, though further work is needed on methods for doing so.
  • Unconventional practice, 'innovative' interventions and the national law

    Stewart, C; Kerridge, I; Waldby, C; Lipworth, W; Munsie, M; Lysaght, T; Rudge, C; Ghinea, N; Eckstein, L; Neilsen, J (Lawbook Co., 2020)
    This column explores a recent health profession disciplinary case which throws light on the problems of unconventional interventions by medical practitioners under the Health Practitioner Regulation National Law Act 2009 (Qld). The case involved "innovative" practices which were later found to have been scientifically unsupported, dangerous to patients and grounds for cancelling the health practitioner's registration. This column looks at common features of these kinds of cases in Australia and then examines recent attempts by the Medical Board of Australia to draft policy guidance around the use of unconventional practice in medicine. This column concludes with a number of changes to improve the effectiveness of the proposed policy.
  • To Have and to Hold?

    Rae, Scott B. (Digital Commons @ Biola, 1999-09-30)
    I want to shift gears a little bit for a few minutes this morning and talk about bioethics at the beginning of life.
  • Contaminants of Emerging Concern: Reconsidering Our Paradigm of Water Pollution

    Gunasti, Jonathan (Scholarship @ Claremont, 2020-01-01)
    In this senior thesis, I explore contaminants of emerging concern (CECs) and endocrine disrupting compounds (EDCs) and discuss the ways in which these novel contaminants defy traditional notions of pollution. I discuss the history and “emergence” of CECs and EDCs in scientific and public spheres and outline ongoing challenges to recognizing, prioritizing, and understanding the action of these contaminants. I position EDCs within the framework of environmental injustice and health disparities and suggest that these compounds could reinforce multigenerational health inequities. Finally, I perform a pilot analysis of the EDC bisphenol A (BPA) in Mt. Baldy Creek, the Los Angeles River, the Tijuana River, and tap water.
  • Ethics in Telehealth : Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems.

    Kuziemsky, C.E.; Hunter, I.; Gogia, S.B.; Iyenger, S.; Kulatunga, G.; Rajput, V.; Subbian, V.; John, O.; Kleber, A.; Mandirola, H.F. (Georg Thieme Verlag KG, 2020-06-17)
    OBJECTIVES:To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives. METHODS:We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth. RESULTS:Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts. CONCLUSIONS:Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.
  • Man, medicine, and morality

    Internet Archive; Clark-Kennedy, Archibald Edmund, 1893- (Hamden, Conn., Archon Books, 1969-01-01)

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