RSS 1.0Health Ethics
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Including more than 50'000 documents - as well as 500 doctoral theses - the Globethics 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.
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Ethics Simulation in Global Health Training (ESIGHT)IntroductionMany health care trainees and providers have reported feeling unprepared for the ethical dilemmas they faced while practicing in global health. Simulation is an effective teaching modality in the training of health care professionals. This resource describes the development, implementation, and assessment of an innovative simulation training program for global health ethics.MethodsWe conducted simulation training with trainees and professionals from various health care disciplines. After a didactic component in which general ethical principles were introduced, participants acted as either lead or observer in four simulations representing different ethical challenges. Participants interacted with simulated patients within a set designed to resemble a resource-constrained environment. Data on the participants' experiences and evaluations of the program's effectiveness were collected through pre-/postsession surveys and focus groups.ResultsAll 53 participants (100%) agreed that the simulations "effectively highlighted ethical dilemmas I could face abroad," and 98% agreed that the content "was useful in my preparation for an international elective." Responses from surveys and focus groups stressed the importance of the realistic and emotional nature of the simulation in increasing confidence and preparedness, as well as a preference for simulation as the modality for teaching global health ethics.DiscussionSimulation for global health ethics training can help to raise awareness of the complex ethical challenges one may face abroad. Incorporating simulation training within broader global health curricula can improve trainee preparedness and confidence in appropriately and effectively identifying, strategizing, and navigating through ethical dilemmas in the field.
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Validation of the Policy Advocacy Engagement Scale for frontline healthcare professionalsBackgroundNurses, 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 objectiveTo 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 designCross-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 (N = 295) 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.FindingsResults 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.DiscussionThe 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.ConclusionThe 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.
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Material Cultures of PsychiatryIn the past, our ideas of psychiatric hospitals and their history have been shaped by objects like straitjackets, cribs, and binding belts. These powerful objects were often used as a synonym for psychiatry and the way psychiatric patients were treated, yet very little is known about the agency of these objects and their appropriation by staff and patients. By focusing on material cultures, this book offers a new perspective on the history of psychiatry: it enables a narrative in which practicing psychiatry is part of a complex entanglement in which power is constantly negotiated. Scholars from different academic disciplines show how this material-based approach opens up new perspectives on the agency and imagination of men and women inside psychiatry.
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A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource SettingBackground: Guidelines recommend the prompt surgical removal of any ectopic pregnancy (EP) in the presence of a vital embryo. This treatment impacts future fertility, particularly in low-resource settings where access to assisted reproductive techniques is limited. In addition, growing evidence is reporting live births after conservative management of initially undiagnosed abdominal pregnancies. Therefore, the discussion on the acceptability of expectant management in selected cases has been recently raised. Case: We present and discuss the case of a woman with vital first trimester EP who refused surgical treatment at Princess Christian Maternity Hospital, Freetown, Sierra Leone. She was initially diagnosed with a 12 week pregnancy located in the left adnexal region without hemoperitoneum. She refused both surgical treatment and hospital admission and did not come back to the hospital for antenatal care until 26 weeks of gestational age. Therefore, she was admitted and finally delivered, at 34 weeks of gestation, a 1.9 kg healthy baby which was alive. To disentangle the potential conflict between the ethical principles of medical treatment’s beneficence and the patient’s autonomy, we provide an update on counselling for a patient with early vital EP in a resource-limited setting and discuss the knowledge gap in this area. Conclusions: Limited access to fertility treatment in low- and middle-income countries may justify the discussion of expectant management as an option in selected cases of uncomplicated vital EP.
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Ethics in theory and practice in Spanish healthcare community interpretingLos intérpretes de servicios públicos desarrollan su profesión en distintas situaciones contextuales, siguiendo códigos éticos específicos, al mismo tiempo que se enfrentan a conflictos y dilemas comunicativos en los que las responsabilidades éticas pueden superponerse a sus tareas profesionales. El objetivo de este artículo es comprender la importancia de las cuestiones éticas en la interpretación sanitaria española y determinar hasta qué punto la interpretación ‘no ética’ puede convertirse en una barrera o un puente para hacer la comunicación efectiva. Exploramos los desafíos, conflictos y dilemas de un grupo de traductores e intérpretes de servicios públicos en el ámbito sanitario en Madrid y examinamos las creencias de estos profesionales en cuanto a su conocimiento de los códigos de ética y su implementación, para mostrar que las percepciones de los participantes sobre los códigos éticos no eran tan imparciales como creían, al asumir funciones que los códigos de ética no consideran apropiadas.
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Doctor-patient interactions in the age of AI: navigating innovation and expertiseThe integration of artificial intelligence (AI) in healthcare has the capacity to transform medical practice. Despite its revolutionary potential, the influence of AI may affect the physician-patient interaction and presents ethical challenges that will need to be carefully considered. This article discusses how patients may interact with this technology, considers how emerging technologies may alter the dynamics of the physician-patient relationship, and reviews some of the limitations that continue to exist. We identify potential challenges that may arise with the integration of AI into medical settings and propose solutions to help mitigate these issues.
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Community, Public Policy, and Recovery from Mental IllnessThis commentary examines the roles that communities and public policies play in the definition and processes of recovery for adults with mental illness. Policy, clinical, and consumer definitions of recovery are reviewed, which highlight the importance of communities and policies for recovery. This commentary then presents a framework for the relationships between community-level factors, policies, and downstream mental health outcomes, focusing on macroeconomic, housing, and health care policies; adverse exposures such as crime victimization; and neighborhood characteristics such as social capital. Initiatives that address community contexts to improve mental health outcomes are currently under way. Common characteristics of such initiatives and select examples are discussed. This commentary concludes with a discussion of providers', consumers', and other stakeholders' roles in shaping policy reform and community change to facilitate recovery.
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Watson, autonomy and value flexibility : revisiting the debateMany ethical concerns have been voiced about Clinical Decision Support Systems (CDSSs). Special attention has been paid to the effect of CDSSs on autonomy, responsibility, fairness and transparency. This journal has featured a discussion between Rosalind McDougall and Ezio Di Nucci that focused on the impact of IBM’s Watson for Oncology (Watson) on autonomy. The present article elaborates on this discussion in three ways. First, using Jonathan Pugh’s account of rational autonomy we show that how Watson presents its results might impact decisional autonomy, while how Watson produces knowledge might affect practical autonomy. Second, by drawing an analogy with patient decision aids we identify an empirical way of estimating Watson’s impact on autonomy (ie, value-congruence). Lastly, McDougall introduced the notion of value-flexible design as a way to account for the diverging preferences patients hold. We will clarify its relation with the established domain of value-sensitive design. In terms of the tripartite methodology of value-sensitive design, we offer a conceptual clarification using Pugh’s account of rational autonomy, an empirical tool to evaluate Watson’s impact on autonomy and situate a group of technical options to incorporate autonomy in Watson’s design.
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Ethics of care in public health educative actions - a literature reviewThis paper analyses ethical aspects of care within the context of public health educative actions by highlighting the practice of nursing professionals from reflections and inquiries regarding the ethical dimension of care. The ethical relations of care imply human relationships and, consequently, complex relations. Therefore, it is necessary that each subject be respected and welcome according to his/her needs what requires the construction of ties, between the professional and the patient, regulated by ethics and respect. Finally, it is pointed out that ethics in nursing pervades a holistic view of the human being what allows the nurse to recognize his/her competences and responsibilities with the patients. It is up to these professionals to take over their commitment as health educators within this process of social reconstruction by struggling for the fulfillment of public health policies and by overcoming the assistance practice and by rescuing the quality in the attendance of the population by means of competent, responsible and humanized nursing care.
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The post-antibiotic era: An existential threat for humanityCurrently, mankind is facing the risk of running out of working antibiotics. Such a post-antibiotic era bears tremendous risks such as globally spread or even pandemic bacterial infections. These infections become thus untreatable and possibly lethal, particularly endan-gering the health (care) of future generations. This paper discusses this acute concern for humanity in three main steps. After first elaborating on the role of antibiotics and the occur-ring resistance in modern medicine, the focus will be on the current scope of the problem of antibiotics and the prognosis of its future escalation. Then the possibility of a way out and its obstacles will be addressed, before finally assessing the existential threat of a post-antibiotic era.
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Analysis of ethics dumping and proposed solutions in the field of biomedical research in ChinaAs international academic exchanges and cooperation deepen, China has actively engaged in international biomedical research collaboration and achieved significant success. However, these accomplishments have been accompanied by ethical controversies and issues, with ethics dumping being a recurrently discussed focus among scholars. This paper reviews ethics dumping incidents in China’s biomedical research field and analyzes the underlying causes to answer why China is often susceptible to ethics dumping. We argue that the primary reasons include weak ethical awareness among some researchers, an oversimplified research evaluation system, gaps in relevant ethics governance and oversight mechanisms, and limited capabilities of certain ethics committees. To address these issues, we propose five ethics governance recommendations: establishing refined ethics committees at various levels and types; advancing theoretical and practical research on science and technology ethics governance; strengthening legislation and regulation related to emerging science and technology; emphasizing self-regulation and capacity building of research institutions; and providing special protection and healthcare for victims of ethics dumping. The aim is to enhance China’s research supervision system and prevent similar ethics dumping incidents from recurring.
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A charter for biomedical research ethics in a progressive, caring societyBackground: Given that advances in research continuously raise new ethical issues, a multidisciplinary working group of investigators involved in biomedical research has gathered to discuss and compare ethical viewpoints in their daily practice.Methods: The working group has drafted a Charter for Ethics in Biomedical Research that encompasses all the steps in the research process, i.e. from the initial idea to analysis and publication of the results.Results: Based on key principles for ethically responsible research, the Charter may serve as a tool for performing research, discussing research issues and training researchers.Conclusions: The Charter should stimulate researchers to think about their responsibility for research in a progressive, caring society.
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A Mixed-Method Study of the Views of Women, in a General Practice (Primary) Health Care Setting, Regarding Intrauterine ContraceptionMixed methodology can be an appropriate methodology in healthcare settings, particularly where the focus of interest is on the opinions, feelings and experiences of healthcare users. This case outlines the use of a sequential exploratory mixed methods approach, used to examine the views of women, recruited in a primary care setting, regarding intra-uterine contraception. This case study will consider why a mixed-methods approach was chosen for this research. It will also describe the practical considerations involved in the recruitment and consent of participants, which are relevant in the healthcare context. It describes the gathering and analysis of both qualitative and quantitative data, and how each set of data can be used to answer the research problem. It will provide some tips for minimizing common research pitfalls, and highlight some areas for discussion and decision, for new researchers who are undertaking this kind of research for the first time.
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PREparedness, REsponse and SySTemic transformation (PRE-RE-SyST): a model for disability-inclusive pandemic responses and systemic disparities reduction derived from a scoping review and thematic analysisBackground People with disabilities (PwD) have been facing multiple health, social, and economic disparities during the COVID-19 pandemic, stemming from structural disparities experienced for long time. This paper aims to present the PREparedness, RESponse and SySTemic transformation (PRE-RE-SyST): a model for a disability-inclusive pandemic responses and systematic disparities reduction. Methods Scoping review with a thematic analysis was conducted on the literature published up to mid-September 2020, equating to the initial stages of the COVID-19 pandemic. Seven scientific databases and three preprint databases were searched to identify empirical or perspective papers addressing health and socio-economic disparities experienced by PwD as well as reporting actions to address them. Snowballing searches and experts' consultation were also conducted. Two independent reviewers made eligibility decisions and performed data extractions on any action or recommended action to address disparities. A thematic analysis was then used for the model construction, informed by a systems-thinking approach (i.e., the Iceberg Model). Results From 1027 unique references, 84 were included in the final analysis. The PRE-RE-SyST model articulates a four-level strategic action to: 1) Respond to prevent or reduce disability disparities during a pandemic crisis; 2) Prepare ahead for pandemic and other crises responses; 3) Design systems and policies for a structural disability-inclusiveness; and 4) Transform society's cultural assumptions about disability. 'Simple rules' and literature-based examples on how these strategies can be deployed are provided. Conclusion The PRE-RE-SyST model articulates main strategies, 'simple rules' and possible means whereby public health authorities, policy-makers, and other stakeholders can address disability disparities in pandemic crises, and beyond. Beyond immediate pandemic responses, disability-inclusiveness is needed to develop everyday equity-oriented policies and practices that can transform societies towards greater resiliency, as a whole, to pandemic and other health and social emergencies.
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PREparedness, REsponse and SySTemic transformation (PRE-RE-SyST): a model for disability-inclusive pandemic responses and systemic disparities reduction derived from a scoping review and thematic analysisBackground People with disabilities (PwD) have been facing multiple health, social, and economic disparities during the COVID-19 pandemic, stemming from structural disparities experienced for long time. This paper aims to present the PREparedness, RESponse and SySTemic transformation (PRE-RE-SyST): a model for a disability-inclusive pandemic responses and systematic disparities reduction. Methods Scoping review with a thematic analysis was conducted on the literature published up to mid-September 2020, equating to the initial stages of the COVID-19 pandemic. Seven scientific databases and three preprint databases were searched to identify empirical or perspective papers addressing health and socio-economic disparities experienced by PwD as well as reporting actions to address them. Snowballing searches and experts' consultation were also conducted. Two independent reviewers made eligibility decisions and performed data extractions on any action or recommended action to address disparities. A thematic analysis was then used for the model construction, informed by a systems-thinking approach (i.e., the Iceberg Model). Results From 1027 unique references, 84 were included in the final analysis. The PRE-RE-SyST model articulates a four-level strategic action to: 1) Respond to prevent or reduce disability disparities during a pandemic crisis; 2) Prepare ahead for pandemic and other crises responses; 3) Design systems and policies for a structural disability-inclusiveness; and 4) Transform society's cultural assumptions about disability. 'Simple rules' and literature-based examples on how these strategies can be deployed are provided. Conclusion The PRE-RE-SyST model articulates main strategies, 'simple rules' and possible means whereby public health authorities, policy-makers, and other stakeholders can address disability disparities in pandemic crises, and beyond. Beyond immediate pandemic responses, disability-inclusiveness is needed to develop everyday equity-oriented policies and practices that can transform societies towards greater resiliency, as a whole, to pandemic and other health and social emergencies.
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Aligning patient’s ideas of a good life with medically indicated therapies in geriatric rehabilitation using smart sensorsNew technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values.
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Harmonising the human biobanking consent process: an Irish experience [version 3; peer review: 2 approved]Biobanks are repositories of human biological samples and data. They are an important component of clinical research in many disease areas and often represent the first step toward innovative treatments. For biobanks to operate, researchers need human participants to give their samples and associated health data. In Ireland, research participants must provide their freely given informed consent for their samples and data to be taken and used for research purposes. Biobank staff are responsible for communicating the relevant information to participants prior to obtaining their consent, and this communication process is supported by the Participant Information Leaflets and Informed Consent Form (PI/ICFs). PILs/ICFs should be concise, intelligible, and contain relevant information. While not a substitute for layperson and research staff discussions, PILs and ICFs ensure that a layperson has enough information to make an informed choice to participate or not. However, PILs/ICFs are often lengthy, contain technical language and can be complicated and onerous for a layperson to read. The introduction of the General Data Protection Regulation and the related Irish Health Research Regulation presented additional challenges to the Irish biobank community. In May 2019, the National Biobanking Working Group (NBWG) was established in Ireland. It consists of members from diverse research backgrounds located in universities, hospitals and research centres across Ireland and a public/patient partner. The NBWG aimed to develop a suite of resources for health research biobanks via robust and meaningful patient engagement, which are accessible, General Data Protection Regulation/Health Research Regulation-compliant and could be used nationally, including a PIL/ICF template. This open letter describes the process whereby this national biobank PIL/ICF template was produced. The development of this template included review by the Patient Voice in Cancer Research, led by Professor Amanda McCann at University College Dublin and the Health Research Data Protection Network.