IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-05-24 DOI: 10.1007/s10730-024-09530-9

Pascal René Marcel Kubin

{"title":"Vaccine Impact Bonds: An Alternative Way of Allocating the Economic Risks of Mass Vaccination Programs.","authors":"Pascal René Marcel Kubin","doi":"10.1007/s10730-024-09530-9","DOIUrl":"10.1007/s10730-024-09530-9","url":null,"abstract":"Vaccines can be an appropriate tool for combating pandemics. Accordingly, expectations were high when the first Covid-19 vaccines were administered. However, even though the vaccines have not met these high initial expectations, vaccine manufacturers and their investors were making large profits, while most of the associated economic risks have remained with the taxpaying public. Thus, this paper applies the concept of social impact bonds to mass vaccination programs by conceptualizing vaccine impact bonds (VIBs) as an alternative to the advance purchase agreements (APAs) for Covid-19 vaccines. Rather than rewarding vaccine manufacturers and their investors based on the quantity of doses distributed, VIBs intend to link the real-world vaccine impact to the financial returns of vaccine manufacturers and their investors. This paper indicates that VIBs can theoretically shift the economic risks of mass vaccination programs from the taxpaying public to private investors, thereby aligning commercial and public interests. However, it also identifies several major weaknesses such as the complexity of defining and evaluating the vaccine impact as well as the inherent trade-off between relieving taxpayers (through VIBs) and allowing innovation. As these substantial drawbacks outweigh the theoretical strengths of VIBs, this paper calls for further research in order to identify better alternatives to the Covid-19 vaccine contracts.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"127-142"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Canada's Medical Assistance in Dying System can Enable Healthcare Serial Killing. 加拿大的临终医疗协助系统可以实现医疗保健连环杀人。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-08-02 DOI: 10.1007/s10730-024-09528-3

Christopher Lyon

{"title":"Canada's Medical Assistance in Dying System can Enable Healthcare Serial Killing.","authors":"Christopher Lyon","doi":"10.1007/s10730-024-09528-3","DOIUrl":"10.1007/s10730-024-09528-3","url":null,"abstract":"The Canadian approach to assisted dying, Medical Assistance in Dying (MAiD), as of early 2024, is assessed for its ability to protect patients from criminal healthcare serial killing (HSK) to evaluate the strength of its safeguards. MAiD occurs through euthanasia or self-administered assisted suicide (EAS) and is legal or considered in many countries and jurisdictions. Clinicians involved in HSK typically target patients with the same clinical features as MAiD-eligible patients. They may draw on similar rationales, e.g., to end perceived patient suffering and provide pleasure for the clinician. HSK can remain undetected or unconfirmed for considerable periods owing to a lack of staff background checks, poor surveillance and oversight, and a failure by authorities to act on concerns from colleagues, patients, or witnesses. The Canadian MAiD system, effectively euthanasia-based, has similar features with added opportunities for killing afforded by clinicians' exemption from criminal culpability for homicide and assisted suicide offences amid broad patient eligibility criteria. An assessment of the Canadian model offers insights for enhancing safeguards and detecting abuses in there and other jurisdictions with or considering legal EAS. Short of an unlikely recriminalization of EAS, better clinical safeguarding measures, standards, vetting and training of those involved in MAiD, and a radical restructuring of its oversight and delivery can help mitigate the possibility of abuses in a system mandated to accommodate homicidal clinicians.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"65-105"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

On Seeing Long Shadows: Is Academic Medicine at its Core a Practice of Racial Oppression? 看见长长的阴影：学术医学的核心是种族压迫吗？

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-05-10 DOI: 10.1007/s10730-024-09529-2

Thomas S Huddle

{"title":"On Seeing Long Shadows: Is Academic Medicine at its Core a Practice of Racial Oppression?","authors":"Thomas S Huddle","doi":"10.1007/s10730-024-09529-2","DOIUrl":"10.1007/s10730-024-09529-2","url":null,"abstract":"Suggestions that academic medicine is systemically racist are increasingly common in the medical literature. Such suggestions often rely upon expansive notions of systemic racism that are deeply controversial. The author argues for an empirical concept of systemic racism and offers a counter argument to a recent suggestion that academic medicine is systemically racist in its treatment of medical trainees: Anderson et al.'s (Academic Medicine, 98(8S), S28-S36, 2023) \"The Long Shadow: a Historical Perspective on Racism in Medical Education.\" Contra the authors of \"The Long Shadow,\" the author argues that racial performance disparities in medical education cannot be validly attributed to racism without careful empirical confirmation; he further argues that standards of assessment in medical education cannot be properly deemed racist merely because minority trainees are disproportionately disadvantaged by them. Furthermore, the history of medicine and society in the Anglo-European West is not, as argued by the authors of \"The Long Shadow,\" best viewed as one long tale of racial oppression culminating in the present day pervasive racism of academic medicine in the United States. Racism is a deplorable stain on our history and our present but it is not the historical essence of Christianity, European civilization, Western medicine, or contemporary academic medical institutions.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"107-125"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Specific Trends in Pediatric Ethical Decision-Making: An 18-Year Review of Ethics Consultation Cases in a Pediatric Hospital. 儿科伦理决策的具体趋势：一家儿科医院伦理咨询案例的 18 年回顾。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-02-28 DOI: 10.1007/s10730-024-09524-7

Yaa Bosompim, Julie Aultman, John Pope

引用次数: 0

Can We Be Creative with Communication? Assessing Decision-Making Capacity in an Adult with Selective Mutism. 我们能创造性地进行交流吗？评估患有选择性缄默症的成年人的决策能力。

IF 1.3 4区哲学

Hec Forum Pub Date : 2025-03-01 Epub Date: 2024-02-05 DOI: 10.1007/s10730-024-09523-8

Nicholas R Mercado

引用次数: 0

What's Left of Moral Bioenhancement? Reviewing a 15-Year Debate. 道德生物强化还剩下什么？回顾15年的辩论。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-27 DOI: 10.1007/s10730-024-09545-2

Hunter Bissette, Dario Cecchini, Ryan Sterner, Elizabeth Eskander, Veljko Dubljević

引用次数: 0

Surrogate Wars: The "Best Interest Values" Hierarchy & End-of-Life Conflicts with Surrogate Decision-Makers. 代理战争：“最佳利益价值”等级制度和与代理决策者的临终冲突。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-26 DOI: 10.1007/s10730-024-09546-1

Autumn Fiester

{"title":"Surrogate Wars: The \"Best Interest Values\" Hierarchy & End-of-Life Conflicts with Surrogate Decision-Makers.","authors":"Autumn Fiester","doi":"10.1007/s10730-024-09546-1","DOIUrl":"https://doi.org/10.1007/s10730-024-09546-1","url":null,"abstract":"Conflicts involving end-of-life care between healthcare providers (HCPs) and surrogate decision-makers (SDMs) have received sustained attention for more than a quarter of a century, with early studies demonstrating a frequency of HCP-SDM conflict in ICUs ranging from 32-78% of all admissions (Abbott et al. 2001; Breen et al. 2001; Studdert et al. 2003; Azoulay et al. 2009). More recent studies not only acknowledge the persistence of clinical conflict in end-of-life care (Leland et al. 2017), but they have begun to focus on the ways in which these conflicts escalate to verbal or physical violence in the ICU (Slack et al. 2023; Bass et al. 2024; Berger et al. 2024; Sjöberg et al. 2024). I will argue that part of the explanation for the persistence-and even escalation-of ICU disputes is the incommensurable value systems held by many conflicting HCPs and SDMs. I will argue that a common value system among HCPs can be understood as a \"Best Interest Values\" (BIV) hierarchy, which I will argue is irreconcilable with the set of \"Life-Continuation Values\" (LCV) held by a sizable minority of families in the United States. I argue this values-conflict undergirds many ICU disputes. If I am correct that an incommensurable value system underlies many ICU conflicts, then it is not just ineffectual for HCPs to impose their BIV system on LCV families, but also wrong given the American commitment to values pluralism. I conclude that the way to navigate continuous ICU surrogate wars is for BIV-focused healthcare institutions to engage more constructively with LCV stakeholders.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical Assistance in Dying, Slippery Slopes, and Availability of Care: A Reply to Koch. 死亡中的医疗援助、滑坡和护理的可用性：对科赫的回复。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-09 DOI: 10.1007/s10730-024-09543-4

Don A Merrell

引用次数: 0

Creating Barriers to Healthcare and Advance Care Planning by Requiring Hospitals to Ask Patients About Their Immigration Status. 通过要求医院询问患者的移民身份，为医疗保健和提前护理计划制造障碍。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-07 DOI: 10.1007/s10730-024-09542-5

Cathy L Purvis Lively

{"title":"Creating Barriers to Healthcare and Advance Care Planning by Requiring Hospitals to Ask Patients About Their Immigration Status.","authors":"Cathy L Purvis Lively","doi":"10.1007/s10730-024-09542-5","DOIUrl":"https://doi.org/10.1007/s10730-024-09542-5","url":null,"abstract":"Florida is currently collecting data on the \"costs of uncompensated care for aliens who are not lawfully present in the U.S.\" (Statutes of Florida, 2023). The Florida data collection law, enacted in 2023, is part of aggressive anti-immigrant legislation. Hospitals accepting Medicaid must inquire about patients' immigration status and submit de-identified reports. In August 2024, the Governor of Texas signed an Executive Order comparable to the Florida statute. Although presented as a data-collection measure, the legal requirements have far-reaching consequences. The potential adverse impacts on immigrants' health pose bioethical concerns. Immigration-related inquiries create barriers to healthcare access and advance care planning, exacerbating healthcare disparities and presenting ethical concerns. This article examines the effects on immigrants and the resulting ethical challenges, including respect for persons, beneficence, non-maleficence, and justice. The article proposes recommendations for mitigating these challenges, including community outreach, patient education, policy development, in-service education, and advocacy. While the legal requirements apply specifically to Florida and Texas, the ethical issues have nationwide relevance.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Organizational Ethics in Healthcare: A National Survey. 医疗保健领域的组织伦理：全国调查。

IF 1.3 4区哲学

Hec Forum Pub Date : 2024-12-01 Epub Date: 2024-01-17 DOI: 10.1007/s10730-023-09520-3

Kelly Turner, Tim Lahey, Becket Gremmels, Jason Lesandrini, William A Nelson

{"title":"Organizational Ethics in Healthcare: A National Survey.","authors":"Kelly Turner, Tim Lahey, Becket Gremmels, Jason Lesandrini, William A Nelson","doi":"10.1007/s10730-023-09520-3","DOIUrl":"10.1007/s10730-023-09520-3","url":null,"abstract":"Organizational ethics-defined as the alignment of an institution's practices with its mission, vision, and values-is a growing field in health care not well characterized in empirical literature. To capture the scope and context of organizational ethics work in United States healthcare institutions, we conducted a nationwide convenience survey of ethicists regarding the scope of organizational ethics work, common challenges faced, and the organizational context in which this work is done. In this article, we report substantial variability in the structure of organizational ethics programs and the settings in which it is conducted. Notable findings included disagreement about the activities that comprise organizational ethics and a lack of common metrics used to assess organizational ethics activities. A frequently cited barrier to full engagement in these activities was poor institution-wide understanding about the role and function of organizational ethics resources. These data suggest a tension in the trajectory of organizational ethics' professionalization: while some variability is appropriate to the field's relative youth, inadequate attention to definitions of organizational ethics practice and metrics for success can impede discussions about appropriate institutional support, leadership context, and training for practitioners.","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"559-570"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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