Health Care Analysis最新文献_第4页

System's Crisis Resilience as a Societal Crisis: Knowledge Structure and Gaze of the Finnish Health Care System. 作为社会危机的系统危机复原力：芬兰医疗保健系统的知识结构与目光。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2024-01-22 DOI: 10.1007/s10728-023-00479-3

Matias Heikkilä, Ossi Heino, Pauli Rautiainen

{"title":"System's Crisis Resilience as a Societal Crisis: Knowledge Structure and Gaze of the Finnish Health Care System.","authors":"Matias Heikkilä, Ossi Heino, Pauli Rautiainen","doi":"10.1007/s10728-023-00479-3","DOIUrl":"https://doi.org/10.1007/s10728-023-00479-3","url":null,"abstract":"The crisis resilience of vital social systems is currently the target of constant development efforts in Finland, as their drifting into crisis would weaken societies' functional abilities, safety, and security. This is also the case regarding the Finnish health care system. In an attempt to move beyond existing frameworks of crisis imagination, this article takes an unconventional stance by elucidating endogenous crisis dynamics present in the Finnish health care system. Delphi process was conducted for top experts in Finnish health care and crisis management. With a dissensus-seeking orientation, our aim was to fertilize disagreements among panelists to reveal key vulnerabilities in the health system. Despite our efforts to evoke dissensus, the panelists ended up generating a consensus that aims to protect the underlying assumptions of the health system's knowledge structure. Through inductive analysis of expert discourses, the data was analyzed through our research question \"what constitutes a crisis-proof health system and a crisis-prone health system\". What is framed as a strength of the system by our panelists, namely the ability to maintain legitimacy, improve efficiency, and guarantee continuity, can still have questionable implications that are left ungrasped. A system's theory approach illustrates how such effects can develop and escalate beyond the reach of social interventions, and thus be predisposed to cause objectionable yet concealed social crises. The discussion illustrates how these endogenous crisis dynamics could be seen to materialize in real-life cases.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139513821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

The Doctor-Patient Relationship, Partnership Theory, and the Patient as Partner: Finding a Balance Between Domination and Partnership 医患关系、伙伴关系理论和作为合作伙伴的患者：在支配与合作之间寻求平衡

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2024-01-20 DOI: 10.1007/s10728-023-00473-9

Charles J. Kowalski, Richard W. Redman, Adam J. Mrdjenovich

引用次数: 0

The Lifeworld of the Complex Care Hospital Doctor: A Complex Adaptive Phenomenological Study. 复杂护理医院医生的生活世界：复杂适应现象学研究》。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2024-01-19 DOI: 10.1007/s10728-023-00474-8

Felice Borghmans, Stella Laletas, Harvey Newnham, Venesser Fernandes

{"title":"The Lifeworld of the Complex Care Hospital Doctor: A Complex Adaptive Phenomenological Study.","authors":"Felice Borghmans, Stella Laletas, Harvey Newnham, Venesser Fernandes","doi":"10.1007/s10728-023-00474-8","DOIUrl":"https://doi.org/10.1007/s10728-023-00474-8","url":null,"abstract":"The ever-increasing prevalence of chronic conditions over the last half century has gradually altered the demographic of patients admitted to acute care settings; environments traditionally associated with episodic care rather than chronic and complex healthcare. In consequence, the lifeworld of the hospital medical doctor often entails healthcare for a complex, multi-morbid, patient cohort. This paper examines the experience of providing complex healthcare in the pressurised and fast-paced acute care setting. Four medical doctors from two metropolitan health services were interviewed and their data were analysed using a combinatorial framework of phenomenology and complexity theory. The horizon of complex care revealed itself as dynamic, expansive, immersive, and relational, entailing a specialised kind of practice that is now common in acute care settings. Yet this practice has made inroads largely without heralding the unique nature and potential of its ground. Herein lies opportunity for complex care clinicians to expand notions of health and illness, and to shape research, practice, and system design, for a future in which care for health complexity is optimised, irrespective of care settings.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139491661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Flourishing, Mental Health Professionals and the Role of Normative Dialogue. 幸福、心理健康专业人员和规范性对话的作用。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2024-01-12 DOI: 10.1007/s10728-023-00478-4

Hazem Zohny, Julian Savulescu, Gin S Malhi, Ilina Singh

引用次数: 0

A Qualitative Research Survey on Cardiologist’s Ethical Stance in Cases of Moral Dilemmas in Cardiology Clinics 关于心脏病医生在心脏病诊所道德困境中的伦理立场的定性研究调查

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2024-01-03 DOI: 10.1007/s10728-023-00476-6

Banu Buruk, Perihan Elif Ekmekci, Aksüyek Savaş Çelebi, Begüm Güneş

{"title":"A Qualitative Research Survey on Cardiologist’s Ethical Stance in Cases of Moral Dilemmas in Cardiology Clinics","authors":"Banu Buruk, Perihan Elif Ekmekci, Aksüyek Savaş Çelebi, Begüm Güneş","doi":"10.1007/s10728-023-00476-6","DOIUrl":"https://doi.org/10.1007/s10728-023-00476-6","url":null,"abstract":"This study sought to determine cardiologists’ degrees of ethical awareness and preferred courses of action for ethical dilemmas frequently encountered in clinical settings. For this evaluation, an online survey was created and sent to cardiologists affiliated with various academic posts in Ankara, Turkey. The survey included ten cases with various ethical considerations selected from our book, “Clinic Ethics with Cases from Cardiology.” Four possible action choices were defined for each case. Participants were asked to choose one or more of these preferences. In addition, a fictional change was made in each case’s context without changing the original ethical issue, and participants were asked whether an attitude different from the first chosen one was preferred. The participation ratio was 49/185 (26%), consent ratio 47/185 (25,4%), and completion ratio 44/185 (23,7%). Nine of the ten scenario changes did not change participants’ preferred action. For most questions, action preferences were concentrated between the two options. Although legal regulations did not reduce ethical dilemmas, they clarified physicians’ action preferences. Similarly, as an obscure moral issue gained prominence, physicians were forced to draw clearer lines in their actions. External factors such as healthcare emergencies can change physicians’ ethical dilemma-solving attitudes.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"3 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139082851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

An Egalitarian Perspective on Information Sharing: The Example of Health Care Priorities 信息共享的平等主义视角：以医疗保健优先事项为例

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-12-30 DOI: 10.1007/s10728-023-00475-7

{"title":"An Egalitarian Perspective on Information Sharing: The Example of Health Care Priorities","authors":"","doi":"10.1007/s10728-023-00475-7","DOIUrl":"https://doi.org/10.1007/s10728-023-00475-7","url":null,"abstract":"<h3>Abstract</h3> In health care, the provision of pertinent information to patients is not just a moral imperative but also a legal obligation, often articulated through the lens of obtaining informed consent. Codes of medical ethics and many national laws mandate the disclosure of basic information about diagnosis, prognosis, and treatment alternatives. However, within publicly funded health care systems, other kinds of information might also be important to patients, such as insights into the health care priorities that underlie treatment offers made. While conventional perspectives do not take this as an obligatory part of the information to be shared with patients, perhaps through viewing it as clinically “non-actionable,” we advocate for a paradigm shift. Our proposition diverges from the traditional emphasis on actionability. We contend that honoring patients as equal moral agents necessitates, among other principles, a commitment to honesty. Withholding specific categories of information pertinent to patients’ comprehension of their situation is inherently incompatible with this principle. In this article, we advocate for a recalibration of the burden of proof. Rather than requiring special justifications for adding to the standard set of information items, we suggest that physicians should be able to justify excluding relevant facts about the patient’s situation and the underlying considerations shaping health care professionals’ choices. This perspective prioritizes transparency and empowers patients with a comprehensive understanding, aligning with the ethos of respect for the patient as person.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"26 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139068209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

The Effects of Introducing a Harm Threshold for Medical Treatment Decisions for Children in the Courts of England & Wales: An (Inter)National Case Law Analysis 英格兰和威尔士法院在儿童医疗决定中引入伤害阈值的影响：国家间判例法分析

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-12-18 DOI: 10.1007/s10728-023-00472-w

Veronica M. E. Neefjes

{"title":"The Effects of Introducing a Harm Threshold for Medical Treatment Decisions for Children in the Courts of England & Wales: An (Inter)National Case Law Analysis","authors":"Veronica M. E. Neefjes","doi":"10.1007/s10728-023-00472-w","DOIUrl":"https://doi.org/10.1007/s10728-023-00472-w","url":null,"abstract":"The case of Charlie Gard sparked an ongoing public and academic debate whether in court decisions about medical treatment for children in England & Wales the best interests test should be replaced by a harm threshold. However, the literature has scantly considered (1) what the impact of such a replacement would be on future litigation and (2) how a harm threshold should be introduced: for triage or as standard for decision-making. This article directly addresses these gaps, by first analysing reported cases in England & Wales about medical treatment in the context of a S31 order, thus using a harm threshold for triage and second comparing court decisions about medical treatment for children in England & Wales based on the best interest test with Dutch and German case law using a harm threshold. The investigation found that whilst no substantial increase of parental discretion can be expected an introduction of a harm threshold for triage would change litigation. In particular, cases in which harm is limited, currently only heard when there are concerns about parental decision-making, may be denied a court hearing as might cases in which the child has lost their capacity to suffer. Applying a harm threshold for triage in decisions about withholding or withdrawing life-sustaining treatment might lead to a continuation of medical treatment that could be considered futile.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"235 2 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138744904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

What’s Good About Inclusion? An Ethical Analysis of the Ideal of Social Inclusion for People with Profound Intellectual and Multiple Disabilities 包容有什么好处？对严重智障和多重残疾人士社会包容理想的伦理分析

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-12-11 DOI: 10.1007/s10728-023-00470-y

Simon van der Weele, Femmianne Bredewold

{"title":"What’s Good About Inclusion? An Ethical Analysis of the Ideal of Social Inclusion for People with Profound Intellectual and Multiple Disabilities","authors":"Simon van der Weele, Femmianne Bredewold","doi":"10.1007/s10728-023-00470-y","DOIUrl":"https://doi.org/10.1007/s10728-023-00470-y","url":null,"abstract":"‘Social inclusion’ is the leading ideal in services and care for people with intellectual disabilities in most countries in the Global North. ‘Social inclusion’ can refer simply to full equal rights, but more often it is taken to mean something like ‘community participation’. This narrow version of social inclusion has become so ingrained that it virtually goes unchallenged. The presumption appears to be that there is a clear moral consensus that this narrow understanding of social inclusion is good. However, that moral consensus is not clear in the case of people with profound intellectual and/or multiple disabilities (PIMD), who are not able to express their needs and preferences verbally. Moreover, social inclusion has proven to be difficult to conceptualize and implement for people with PIMD. Therefore, it becomes imperative to ask about the ethical rationale of the narrow understanding of social inclusion. For what reasons do we think social inclusion is good? And do those reasons also apply for people with PIMD? This article addresses these questions by providing an ethical analysis of the ideal of social inclusion for people with PIMD. It discusses four ethical arguments for social inclusion and probes their relevance for people with PIMD. The article argues that none of these arguments fully convince of the value of the narrow understanding of social inclusion for people with PIMD. It ends with advocating for an ethical space for imagining a good life for people with PIMD otherwise.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"6 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138576430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Blacklisting Health Insurance Premium Defaulters: Is Denial of Medical Care Ethically Justifiable? 将医疗保险费拖欠者列入黑名单:拒绝医疗服务是否合乎道德?

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-12-01 Epub Date: 2023-07-27 DOI: 10.1007/s10728-023-00464-w

Hanna Glaus, Daniel Drewniak, Julian W März, Nikola Biller-Andorno

{"title":"Blacklisting Health Insurance Premium Defaulters: Is Denial of Medical Care Ethically Justifiable?","authors":"Hanna Glaus, Daniel Drewniak, Julian W März, Nikola Biller-Andorno","doi":"10.1007/s10728-023-00464-w","DOIUrl":"10.1007/s10728-023-00464-w","url":null,"abstract":"Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a particularly drastic measure to sanction defaulting insurance payers is employed. Since 2012, Swiss cantons - who have to cover most of the bills of defaulting payers - are allowed by federal law to blacklist them and to restrict their access to medical care to emergencies.In our paper, we briefly describe blacklisting in the context of the Swiss healthcare system before we examine the ethical issues involved in light of what is known about its social and health impacts. We found no evidence that blacklisting serves as an effective way of recovering unpaid health insurance contributions or of strengthening solidarity within the health insurance system. Furthermore, the ambiguous definitions of what constitutes an emergency treatment and the incompatibility of the denial of medical care with the obligation to provide professional assistance complicate the implementation of blacklists and expose care providers to enormous pressure.Therefore, we conclude that blacklists and the (partial) denial of medical care not only pose profound ethical problems but are also unsuitable for fulfilling the purpose for which they were introduced.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"156-168"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Uninformed Origins: Should We Be Advising Parents on the Source of Medicines and Therapies? 不知情的来源:我们应该就药物和疗法的来源向父母提出建议吗?

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-12-01 Epub Date: 2023-08-03 DOI: 10.1007/s10728-023-00458-8

Tara E Ness, Zachary J Tabb, Janet Malek, Frank X Placencia

引用次数: 0