Health Care Analysis最新文献_第7页

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

Balancing Intelectual Property Protection and Legal Risk Assessment in Registration of Covid-19 Vaccines in Malaysia. 在马来西亚Covid-19疫苗注册中平衡知识产权保护和法律风险评估。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-12-01 Epub Date: 2023-07-21 DOI: 10.1007/s10728-023-00465-9

Haniff Ahamat, Hairanie Sa'ban, Nazura Abdul Manap

{"title":"Balancing Intelectual Property Protection and Legal Risk Assessment in Registration of Covid-19 Vaccines in Malaysia.","authors":"Haniff Ahamat, Hairanie Sa'ban, Nazura Abdul Manap","doi":"10.1007/s10728-023-00465-9","DOIUrl":"10.1007/s10728-023-00465-9","url":null,"abstract":"The seriousness of the COVID-19 pandemic requires a look into the implementation of drug registration rules for COVID-19 vaccines. Amidst the surrounding exigencies, vaccines being a biological product, require comprehensive and continuing pre and post registration rules to ensure their safety and efficacy. The study focuses on Malaysia which has rules on drug registration that have been successfully applied to vaccines. The study shows that the rules have been tailor-made to emergency situations. At the moment, special rules have been introduced including to allow use of COVID-19 vaccines as unregistered product. Recognition of COVID-19 Vaccines Global Access (COVAX) facility and requirement for government sale only, are among the safety valves. The study shows that these however are temporary measures against the backdrops of possible entry of private players in the vaccination process. Therefore, regulatory responses to intellectual property (IP) related conditions underlying drug registration, and measures to ensure risk management involved in vaccine production, approval and administration are needed in the progressive rules pending further development of research in the area.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"196-207"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10223220","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

Should Severity Assessments in Healthcare Priority Setting be Risk- and Time-Sensitive? 医疗保健优先级设置中的严重程度评估是否应具有风险和时间敏感性?

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-12-01 Epub Date: 2023-08-01 DOI: 10.1007/s10728-023-00460-0

Lars Sandman, Jan Liliemark

{"title":"Should Severity Assessments in Healthcare Priority Setting be Risk- and Time-Sensitive?","authors":"Lars Sandman, Jan Liliemark","doi":"10.1007/s10728-023-00460-0","DOIUrl":"10.1007/s10728-023-00460-0","url":null,"abstract":"Background: Severity plays an essential role in healthcare priority setting. Still, severity is an under-theorised concept. One controversy concerns whether severity should be risk- and/or time-sensitive. The aim of this article is to provide a normative analysis of this question.Methods: A reflective equilibrium approach is used, where judgements and arguments concerning severity in preventive situations are related to overall normative judgements and background theories in priority-setting, aiming for consistency. Analysis, discussion, and conclusions: There is an argument for taking the risk of developing a condition into account, and we do this when we consider the risk of dying in the severity assessment. If severity is discounted according to risk, this will 'dilute' severity, depending on how well we are able to delineate the population, which is dependent on the current level of knowledge. This will potentially have a more far-reaching effect when considering primary prevention, potentially the de-prioritisation of effective preventive treatments in relation to acute, less-effective treatments. The risk arguments are dependent on which population is being assessed. If we focus on the whole population at risk, with T0 as the relevant population, this supports the risk argument. If we instead focus on the population of as-yet (at T0) unidentified individuals who will develop the condition at T1, risk will become irrelevant, and severity will not be risk sensitive. The strongest argument for time-sensitive severity (or for discounting future severity) is the future development of technology. On a short timescale, this will differ between different diagnoses, supporting individualised discounting. On a large timescale, a more general discounting might be acceptable. However, we need to also consider the systemic effects of allowing severity to be risk- and time-sensitive.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"169-185"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10287438","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

Exploring the Decision-Making Process of People Living with HIV Enrolled in Antiretroviral Clinical Trials: A Qualitative Study of Decisions Guided by Trust and Emotions. 艾滋病毒感染者参与抗逆转录病毒临床试验的决策过程探索:信任和情绪引导下的决策定性研究

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-12-01 Epub Date: 2023-07-21 DOI: 10.1007/s10728-023-00461-z

Maria Feijoo-Cid, Antonia Arreciado Marañón, Ariadna Huertas, Amado Rivero-Santana, Carina Cesar, Valeria Fink, María Isabel Fernández-Cano, Omar Sued

{"title":"Exploring the Decision-Making Process of People Living with HIV Enrolled in Antiretroviral Clinical Trials: A Qualitative Study of Decisions Guided by Trust and Emotions.","authors":"Maria Feijoo-Cid, Antonia Arreciado Marañón, Ariadna Huertas, Amado Rivero-Santana, Carina Cesar, Valeria Fink, María Isabel Fernández-Cano, Omar Sued","doi":"10.1007/s10728-023-00461-z","DOIUrl":"10.1007/s10728-023-00461-z","url":null,"abstract":"The informed consent is an ethical and legal requirement for potential participants to enroll in a study. There is ample of evidence that understanding consent information and enrollment is challenging for participants in clinical trials. On the other hand, the reasoning process behind decision-making in HIV clinical trials remains mostly unexplored. This study aims to examine the decision-making process of people living with HIV currently participating in antiretroviral clinical trials and their understanding of informed consent. We conducted a qualitative socio-constructivist study using semi-structured interviews. Eleven participants were selected by purposive sampling in Argentina until data saturation was reached. A content analysis was performed. The findings highlight the fact that some participants decided to enroll on the spot, while others made the decision a few days later. In all cases, the decision was based on different aspects of trust (in doctors, in the clinical research site, in the clinical trials system) but also on emotions associated with HIV and/or treatment. Moreover, while people living with HIV felt truly informed after the consent dialogue with a researcher, consent forms were unintelligible and unfriendly. The immediacy of patient decision-making has rarely been described before. Enrollment in an HIV clinical trial is mainly a trust-based decision but this does not contradict the ethical values of autonomy, voluntariness, non-manipulation, and non-exploitation. Thus, trust is a key issue to be included in reshaping professional practices to ensure the integrity of the informed consent process.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"135-155"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9851393","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

Improvidence, Precaution, and the Logical-Empirical Disconnect in UK Health Policy. 英国卫生政策中的疏忽、预防和逻辑-经验脱节。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-06-01 DOI: 10.1007/s10728-022-00450-8

Jordan A Parsons

{"title":"Improvidence, Precaution, and the Logical-Empirical Disconnect in UK Health Policy.","authors":"Jordan A Parsons","doi":"10.1007/s10728-022-00450-8","DOIUrl":"https://doi.org/10.1007/s10728-022-00450-8","url":null,"abstract":"The last decade has seen significant developments in UK health policy, with are largely claimed to be evidence based. However, such a characterisation ought, in many cases, to be questioned. Policies can be broadly understood as based primarily on either a logical or empirical case. In the absence of relevant empirical evidence, policymakers understandably appeal to logical cases. Once such evidence is available, however, it can inform policy and enable the logical case to be set aside. Such a linear policy process is not always the reality, and logical cases often continue to guide policy decisions in direct opposition to empirical evidence. In this paper, I discuss two recent examples of this disconnect between logical and empirical cases in UK health policy. The first-organ donation-illustrates an example of a significant policy change being made in opposition to the evidence. I refer to this as the improvidence approach. The second-abortion-provides an example of policymakers not making a change that has extensive supporting data. I refer to this using the more recognisable language of the precautionary approach. Ultimately, I argue that both the improvidence and precautionary approaches are examples of problematic public policy where policymakers provide no explicit justification for going against the evidence.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"31 2","pages":"114-133"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9791148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9339523","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

Development of the Inclination Toward Conscientious Objection Scale for Physicians. 医师良心拒服兵役倾向量表的编制。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2023-06-01 DOI: 10.1007/s10728-022-00452-6

Şükrü Keleş, Osman Dağ, Murat Aksu, Gizem Gülpinar, Neyyire Yasemin Yalım

{"title":"Development of the Inclination Toward Conscientious Objection Scale for Physicians.","authors":"Şükrü Keleş, Osman Dağ, Murat Aksu, Gizem Gülpinar, Neyyire Yasemin Yalım","doi":"10.1007/s10728-022-00452-6","DOIUrl":"https://doi.org/10.1007/s10728-022-00452-6","url":null,"abstract":"This study aims to develop a valid and reliable scale to assess whether a physician is inclined to take conscientious objection when asked to perform medical services that clash with his/her personal beliefs. The scale, named the Inclination toward Conscientious Objection Scale, was developed for physicians in Turkey. Face validity, content validity, criterion-related validity, and construct validity of the scale were evaluated in the development process. While measuring criterion-related validity, Student's t-test was used to identify the groups that did and did not show inclination toward conscientious objection. There were 126 items in the initial item pool, which reduced to 42 after content validity evaluation by five experts. After necessary adjustments, the scale was administered to 224 participants. Both exploratory and confirmatory factor analyses were performed to investigate factor structure. The split-half method was employed to assess scale reliability, and the Spearman-Brown coefficient was calculated. Cronbach's alpha reliability coefficient was used to estimate the internal consistency of the scale items. The distinctiveness of the items was evaluated using Student's t-test. The lower and upper 27% groups were compared to assess the distinctiveness of the scale. The items were loaded on four factors that explained 85.46% of the variance: \"Conscientious Objection - Medical Profession Relationship,\" \"Conscientious Objection in Medical Education and Medical Practice,\" \"Conscientious Objection with regard to the Concept of Rights\" and \"Conscientious Objection - Physician's Professional Identity and Role.\" The final scale has 40 items, and was found to be valid and reliable with high internal consistency.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"31 2","pages":"81-98"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9402383","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