Dissertations / Theses on the topic 'Health Care Ethics'

Humanitarian emergencies and natural disasters can overwhelm the capacity of local and national agencies to respond to the needs of affected populations. In such cases, international relief organizations are frequently involved in the provision of emergency assistance. Health care professionals play a key role in these interventions. This practice environment is significantly different from the context of health care delivery in the home countries of expatriate health care professionals. Clinicians who travel from a developed nation to a resource-poor setting where a humanitarian crisis has occurred experience a shift of professional, social, cultural and regulatory environments. In this dissertation I examine the ethics of health care practice in humanitarian work. I evaluate the literature of global bioethics, global health ethics and the ethics of humanitarian assistance, and consider the contributions of various ethics frameworks and normative approaches. I also develop a set of questions to guide health care professionals as they address ethically complex issues arising in clinical practice during humanitarian crises. In the empirical component of this research program I use Interpretive Description methodology to examine the moral experience of health care professionals in humanitarian relief work, and clinician experiences of resources and constraints for addressing ethical issues in humanitarian settings. Building upon the inductively derived findings, I argue for strategies and approaches that humanitarian organizations, project teams, and health care professionals can adopt to respond to the ethics of this field of practice. I also provide a critical review of Interpretive Description methodology. The research presented in this dissertation makes an important contribution to the ethical analysis of health care practice in humanitarian work.
En contexte d’urgences humanitaires et de sinistres naturels, la capacité des agences locales et nationales à répondre aux besoins des populations affectées est lourdement entravée. Dans ces situations de crise, des organismes internationaux d'aide humanitaire sont souvent impliqués pour offrir leur assistance. Les professionnels des soins de santé jouent un rôle important dans ces interventions. Ces contextes singuliers de pratique pour ces professionnels de la santé expatriés diffèrent beaucoup de l’environnement familier dans lequel ils évoluent dans leur pays d’origine. Les cliniciens qui sont transportés d’un pays développé à des régions dévastées par des crises humanitaires vivent des changements d’environnement professionnel, social, culturel et juridique souvent drastiques. Dans ce projet de thèse, j'examine l'éthique de la pratique en santé dans des zones de crises humanitaires. En premier lieu, j’effectue une recension critique de la littérature consacrée à la bioéthique globale, à l’éthique de la santé globale et à l’éthique humanitaire en vue d’identifier la contribution de certains modèles éthiques et d’approches normatives sur les problèmes qui me préoccupent. Je développe également une série de questions destinée aux professionnels de la santé pour les aider à mieux analyser la nature des enjeux moraux auxquels ils sont confrontés, de même que pour orienter leur processus décisionnel face aux dilemmes rencontrés. Le volet empirique de ce programme de recherche examine l’expérience morale des professionnels des soins de santé en contexte de travail humanitaire, ainsi que les expériences des cliniciens des ressources et des contraintes pour aborder les enjeux moraux en situation de crise humanitaire. Je propose des stratégies et des approches que les organismes humanitaires, les équipes locales d’intervenants, ainsi que les professionnels de la santé peuvent développ

In 1999 New York enacted Kendra's Law, in memory of Kendra Webdale, a young woman who was pushed to her death in front of an oncoming train by a man with untreated schizophrenia. Under Kendra's Law a court can order a person with a mental illness to participate in an "assisted outpatient treatment" (AOT) program. Kendra's Law includes a number of procedural due process protections including the right to a hearing and the right to counsel. Still critics argue that people with mental illnesses are routinely ordered to participate in the AOT program based on no more than "a bare recital of the statutory criteria." The first essay in this dissertation, Outpatient Commitment and Procedural Due Process, reports the findings from a study on procedural due process and assisted outpatient treatment hearings under Kendra's Law. Findings from this study suggest that despite the shift from a medical model of civil commitment to a judicial model in the late 1970s, by and large judges continue to accord great deference to clinical testimony. A second paper, Rethinking Kendra's Law, addresses the ethical dilemmas that arise when courts impose AOT over the patient's objection. The third paper of this dissertation, Public Assistance, Drug Testing and the Law, addresses the Fourth Amendment questions that arise when states condition public assistance benefits on passing a suspicionless drug test. To date eight states—including Florida, Georgia and Missouri—condition public assistance benefits on passing a drug test. Proposals to condition public assistance on passing a drug test have also appeared in Congress. However, without a genuine threat to public health or public safety, proposals to condition public assistance on passing a drug test without individualized suspicion of drug use are unreasonable under the Fourth Amendment. Even if the Supreme Court were to recognize special needs beyond a genuine threat to public health or public safety, policies that result in withholding public assistance benefits from people who abuse illegal drugs are likely to make many social problems much worse.

The objectives are to examine the tension between the ethics of care and the ethics of justice, offer critical analysis and develop an amalgam of key elements from both. A more sufficient framework for moral decision-making will be proposed and its validity assessed. Part One investigates the ethics of care, beginning with a critical analysis of Carol Gilligan's approach to the ethics of care and justice, leading to an exploration of the nature and content of care from key authors in the debate. By focusing on nursing the tensions surrounding care are highlighted. Critical analysis draws out key themes from care including persons, relationships, context and responsibilities. Part Two examines the ethics of justice, concentrating on the substantive theories of John Rawls and Alasdair MacIntyre. Through critical analysis the need for minimum standards of protection for the vulnerable in society is highlighted. The thesis emphasises and argues for justice as equality, fairness and equity, the importance of persons, community, rationality, justification, fittingness, morality, duties and obligations. Part Three argues for an amalgam of key themes from both the ethics of care and justice. This model consists of the crucial role of context, persons and relationships, responsibilities, justice and appropriateness in moral decision-making as a framework for a middle way. After arguing for its sufficiency in theory, it is tested in practice by application to the Child B case. The thesis argues a middle way model is more adequate than either the ethics of care or justice alone for critically examining the decisions and justifications offered in this case. In conclusion, critical reflection on the theory and practice of a middle way model is offered, and its potential for further application and development regarding moral decision-making and training for the caring professions explored.

Palliative care provides symptom control, social, psychological and spiritual care for terminally ill patients, and psycho-social support and bereavement care for their families. Ethics is the study of rational processes for determining the best course of action between conflicting values and choices. All medicine is practiced within a defined cultural setting and local beliefs about health and illness may determine particular solutions to ethical problems.
Culturo-religious beliefs and practices in Jamaica are linked historically to its people's African ancestry and to the syncretism of Euro-British values during slavery. The resulting socio-cultural and medical pluralism has presented an ethical dilemma concerning respect for the beliefs and wishes of terminally ill patients to seek care from magico-religious practitioners versus what is in the society's best interest.

Magister Artium (Social Work) - MA(SW)
Primary Health Care (PHC) is the cornerstone of health care globally, nationally and locally and, therefore, should be regarded as the foundation of health care provision. In South Africa, Community Day Clinics (CDCs) are part of the bouquet of services that is being offered at a PHC level. There are various factors that generate inconsistency in the provision of care to people accessing these CDCs. The purpose of this study was to identify and explore how these factors impact on the care practices that health care professional’s provide. Research suggests that the majority of health care workers are women, who play a double role as carers in their professional and private lives. Therefore, the political ethics of care, a feminist theoretical approach, was utilized to understand care practices in these health settings. The aim of the study was to develop an in-depth understanding of the care practices of health care workers at two CDC facilities on the Cape Flats. A qualitative research methodology was used to explore and identify the phenomenon under study. The research project followed an explorative and descriptive research design, as the researcher sought to understand the care practices of health care workers and how their values and ethics further influenced care practices at these two CDC settings. The data was gathered using semi-structured one-on-one interviews, and later analysed using qualitative thematic analysis. The research findings were grouped in terms of the values entrenched in the political ethics ofcare, which are attentiveness, responsibility, competence, responsiveness and trust. The research findings identified various aspects that, either negatively or positively, impact on these values. Finally, recommendations were made to management, as well as care workers. These recommendations were in terms of implementing care services that are attentive to service-users and care-workers; providing a service that takes into consideration the value of responsibility; the provision of competent services; and finally creating trusting relationships within the CDC.

This thesis sets out to examine the place of patient choice in English health care, primarily within the National Health Service and in relationship to English law with regard to (a) informed consents and information and risk disclosure, and (b) confidentiality and privacy in relation to the access to and management of patient information. The analysis in underpinned with a limited review of the associations between choice and respect for individual autonomy. Health policy rhetoric has been laden with references to pro-patient choice in recent years and yet this research re-affirms that in law (still) it is the negative patient choice that carries weight in matters of consent to treatment. There is (still) no place for real demand. Similarly, in individual medical information access and management there is no sanction for demand, even negative patient choice is bounded. In both aspects of health care the ‘choices’ are (rightly) limited and can hardly constitute choice as the consumer-patient might see it. What the three papers contribute is the recognition that restrictions in patient choice are necessary; to be supported and for some individuals should be even more fettered than that of the general public in the interest of that general public. The papers examine the language of choice and find it lacking in transparency, with the reality dissociated from patient engagement, information dissemination and shared decision making; so compromising trust. If the health care system is to genuinely respect the individual autonomy of the capable adult and not utilise choice language as covert method of policy implementation, the language of what is on offer and why, the reasons for information acquisition and use and why, needs to be part of the patient-practitioner discussion as well as clarified in policy.

Evidence available shows that the ethics review process in Malaysia suffers from a range of problems (Kaur, 2011). These problems may be the result of a lack of training given for REC members and relatedly, it may stem from a lack of understanding of the role of RECs. Since Malaysia is striving to promote the country as a research hub for international collaboration, it is important that the ethics review system that is in place is well set up to ensure only ethical research are being approved. The aim of this thesis is to develop three important key elements of a framework that can be used to provide practical guidance for RECs and their governance in Malaysia. These three important elements of the ethics review process are: - the role of RECs, the criteria of REC membership and the acceptability of variation in decisions made between different RECs. These analysis is then applied to the Malaysian context. My initial recommendation is for RECs to adopt the Daniels and Sabin (1997) accountability for reasonableness model to assist with the decision-making process. The adoption of the model helps to clarify the role of RECs and can be used as a basis to develop the criteria for REC membership as well as to provide a better understanding of the acceptability of variation in decisions between different RECs.

Organizational leaders face challenges related to implementing ethical standards, which influence performance, organization sustainability, and culture. The purpose of this single case study was to explore ethics strategies that health care business leaders used to improve employees' ethical conduct. Data were collected through face-to-face, semistructured interviews with a purposive sample of 7 business leaders of a health care organization located in central Georgia and a review of organization documents. The conceptual framework was Brady's Janus-headed model of ethical theory. Using a priori coding during the data analysis process provided 3 thematic categories: policy strategies for the improvement of employee ethical conduct, ethics strategies used to address employee unethical conduct, and strategies to overcome barriers of strategy implementation. Themes that emerged from the data were accountability and responsibility, leadership development, escalating behaviors, and adapting to change. The findings from this study might contribute to social change by providing information about ethical strategies leaders used to improve employee ethical conduct, which can be used to influence individuals' livelihood, stakeholders' comfort level, and the well-being of the community.

Ongoing structural and financial changes in the health care sector have resulted in increased risks for ethical dilemmas and moral distress. It is purported that increased ethical competence will help staff manage ethical dilemmas and hence decrease moral distress. To enhance ethical competence several approaches may be used – theoretical education, and methods focusing on reflection and decision-making abilities.

Ethics rounds are a widespread systematic method hypothesized to improve ethical competence, nurture a reflective climate, and help in ethical decision-making. Despite its popularity, its effects on moral distress have hitherto never been evaluated in a controlled study.

The purpose of this thesis was to evaluate the impact of an intervention, including ethics rounds; the hypothesis being that the intervention would decrease perceived moral distress. An additional aim was exploring the concept of moral distress in various health care establishments, including pharmacies.

Focus groups were conducted to explore the concept of moral distress. To evaluate the intervention a scale assessing staff-perceived moral distress was designed, validated, and implemented.

Results showed that moral distress is evident in diverse health care settings. Some factors associated with this were lack of resources, conflicts of interest, and rules that are incompatible with practice. An expanded definition of moral distress was presented.

The training program was much appreciated by participants. However, no significant effects on perceived moral distress were found. Reasons could be that the intervention was too short or otherwise ineffective, there is no association between ethical competence and moral distress, the assessment scale was not sensitive enough, or management was not sufficiently involved.

There is a need to further refine the various aspects of ethical dilemmas in clinical settings, and to evaluate the most efficient means to enhance skills for dealing with ethical dilemmas, for the benefit of staff, patients, institutions, and society.

Taken on face value the concept of foreign aid seems to imply some level of caring on the part of donors for recipients, but in reality aid is given for all kinds of reasons, many that have nothing to do with care. This project seeks to understand what aid would look like if it was designed and delivered from a caring perspective and how that change would impact aid recipients. Using an ethics of care perspective I examine current thought on our ethical obligations to the poor, demonstrating how the relational perspective of a care approach moves the discussion away from abstract debates to focus on the concrete daily realities of people struggling with poverty and poor health. A care approach helps expose the broader social, political and economic background against which global health and development problems occur. Mainstream approaches to global health that focus on human rights, economic growth and security provide only a partial picture of that background. In contrast a care approach to global health keeps the focus sharply on the targets of aid, working to create space for them to give voice to their experiences and empowering them to create more responsive aid programs. After discussing what a care approach to health would look like at the theoretical level I apply it to the case of global aid for HIV/AIDS. By analyzing three of the largest HIV/AIDS relief efforts, the U.S., U.K. and Global Fund programs, I show both the strengths and weaknesses of these programs as well as how they could be adapted using a care approach to become more responsive to the needs of target communities. A care approach offers scholars of global aid an important critical prescriptive that brings to light aspects of poverty and poor health that can be missed by conventional perspectives and provides policy makers with a tool to build more caring and responsive aid policy, empowering aid recipients as active partners in the aid process.

In this thesis, many topics will be discussed and a variety of philosophers will be mentioned. The main goal of this thesis is to determine a health care plan that fits with the theories of Robert Nozick, Arthur Ripstein, Norman Daniels, and Amartya Sen. I conclude that Ezekiel Emanuel’s health care plan, The Guaranteed Healthcare Access Plan, can be used as a compromise between the views of each of these philosophers. In reaching such a conclusion, I take many steps. I begin with the explanation of theories of justice and their focus. I then turn to the important distinction between rights and ethics. Next, I explain that often closely held values come into conflict with one another. Then, I turn to the specific philosophers and their theories. Beginning with Nozick, I explain the justification for a state and how this justification is important for all four of the philosophers. Afterwards, in turn, I lay out what each philosopher claims in regards to a just society and the role of a state, his justification for such claims, and the results of such claims specifically in regards to health care. Subsequently, I examine the connections between philosophers, which help me understand the ways a health care system could be instituted to appeal to all four of them. After questioning if a just society can really exist in a limited world, I decide what type of health care system such a just society should implement. Finally, I rest on Ezekiel Emanuel’s plan, which I believe should be implemented in a just society and which best demonstrates the common ground between the four philosophers I discuss.

The intimate connection between autonomy and decision-making in applied health care, especially in various kinds of consent and refusal has taken center stage in medical ethics since the Salgo decision in 1957. Prior to that time, the physician’s supposedly moral duty to provide appropriate medical care typically surpassed the legal obligation to respect patient’s autonomy. The Salgo decision concluded that physicians have a legal duty to provide facts necessary for the patient to make an informed decision. "The doctor knows best" long ago was replaced with "The doctor proposes; the patient disposes." There is no legal obligation for the patient’s choice to be palatable to anyone, other than that patient himself/herself. Although Beauchamp and Childress justified the obligation to solicit decisions from patients and potential research subjects by the principle of respect for autonomy, they however, acknowledged that the principle’s precise demands remain unsettled and open to interpretations and specification. This thesis addresses a current debate in the bioethical community on the four-principle approach. Using Tom Beauchamp and James Childress as case study, to discuss mainly the principle of respect for autonomy, I go on to explain their central arguments concerning this principle in relation to decision making in health care ethics. Rather than focus on their respective weaknesses, which many theorist and health care professionals do, I emphasis instead on the contribution the principle of respect for autonomy can make in the process of ethical decision making in health care situation.

The purpose of this dissertation is to develop and test an organizational assessment tool that can used to evaluate primary care services for the homeless. The research evaluates the importance, feasibility, reliability, and validity of organizational processes and structures of primary care services for the homeless. The final product is the validated Primary Care Homeless Organizational Assessment Tool (PC-HOAT). This tool provides stakeholders with information regarding the organizational structures and processes associated with greater quality of primary care for the homeless. This tool will help managers better understand their organization's strengths and weaknesses, guide discussions regarding operations, and provide information to inform future strategies.

The researcher conducted a mixed-method study of key informants and organizations receiving federal health care for the homeless funding. The study used eight key informants to refine the initial PC-HOAT. The researcher distributed the final instrument through a web-based survey to determine reliability and validity of the PC-HOAT. Data analysis included descriptive statistics, factor analysis, and regression analysis.

The study yielded a 7-factor scale, 34-item tool focused on evaluation and delivery of primary care services, organizational structures relevant to effective delivery of care, and patient and family centeredness. In particular, the scale describing access and quality of care provided a positive statistical association with the proportion of patients with controlled hypertension. The study yielded results that provide a better understanding of the vital organizational characteristics that contribute most appropriately to the design of health care for the homeless organization.

Keywords: homeless, primary care, organizational assessment, reliability, validity, factor analysis

While ethical codes have been established for practitioners, there is a possibility that dual loyalty affects occupational medical practitioners’ (OMPs) decisions in determining fitness status of employees. Literature indicates dual loyalty of OMPs leads to ethical dilemmas. The study’s main objective is to determine if dual loyalty participates in OMPs’ decisions and influences OMPs to breach medical ethics required in their profession, resulting in employees unfairly losing their jobs. The study interrogates literature review on dual loyalty and adopts a multi-layered approach focussing on the Constitution; relevant Acts and guidelines; case law and ethical principles. Case studies from the Medical Inspector’s archives are interrogated to determine the influence dual loyalty has on OMPs’ decision-making. Case law indicates that conflict of interest is the source of dual loyalty. Occupational medical practitioners have fiduciary duties and need to serve the best interests of the employees. From case studies discussed, the study shows that OMPs are affected by dual loyalty and tend to disregard medical ethics. They may be conflicted when making decisions concerning employees’ fitness to work, especially when individualised assessments are not conducted. A guideline addressing ethical obligations and human rights should be drafted for OMPs, guiding them on dealing with dual loyalty. Employers will need awareness training in various institutions so that OMPs are supported and encouraged to have sound medical ethics. This will promote best practice in doctor-patient relationships, avoiding dual loyalty dilemmas.
Mini Dissertation (MPhil)--University of Pretoria, 2019.
Public Law
MPhil
Unrestricted

This thesis provides a comprehensive criticism of the current models of understanding and caring for the mentally ill in a western context. I will outline the debates surrounding the conceptualization, diagnosis and treatment of mental illness. The western, psychiatric, biologically based understanding of mental illness is the dominant model of understanding and treating mental illness, despite the evidence that it encompasses an incomplete understanding of the causation and nature of mental illness. I will outline the difficulties in the creation of a cohesive definition of mental illness, including philosophical and cultural perspectives. I will examine the impact of historical, societal and capital pressures on the creation of these definitions. I will describe the practical issues and ethical tensions inherent when a definition or diagnosis of mental illness is created and taken up by mental health practitioners, who use this definition to develop treatment plans for the mentally ill. I will conclude that these issues result in a system of conflicting values which leads to less than ideal care for a uniquely vulnerable population. In this light, I conclude that the exclusive use of the DSM diagnoses as an objective basis for the creation of treatment plans is ethically questionable. I call for a new model of professional practice based on individualized treatment and primarily I call for a reduced focus on diagnosis in the care of the mentally ill.
Cette thèse propose une critique complet des modèles actuels de compréhension et d'empathie pour les malades mentaux dans un contexte occidental. Je vais chercher à décrire la compréhension actuelle de l'Ouest et débats entourant le diagnostic et le traitement de la maladie mentale. Le western, psychiatrique, la compréhension fondée sur la biologie de la maladie mentale est augmentation de la prévalence et de l'influence dans le monde. Cependant, je vais montrer que d'autres modèles et de leurs les traitements associés ont le potentiel, et le font souvent, générer améliorée résultats. Je crois que ce que j'appelle le modèle occidental medical de la maladie mentale englobe une compréhension incomplète de la causalité et le traitement de la maladie mentale. Je vais mettre en lumière les problèmes pratiques et des tensions éthiques inhérentes quand une définition ou le diagnostic de la maladie mentale est créé et utilise par les praticiens de santé mentale , qui utilisent cette définition à élaborer des plans de traitement pour les malades mentaux. Je exposer les difficultés dans la création d'une définition cohérente de la maladie mentale, y compris les perspectives philosophiques et culturels. Je vais examiner l'impact des pressions sociétales sur la création de ces définitions. Je vais conclure que le modèle occidental répandue médical, tout en étant utile en tant qu'outil, est imparfait comme une approche exclusive de soins de santé mentale. Cette faiblesse est observé lorsque l'on prend note de la variation incroyable dans le diagnostic et l'expérience de la maladie mentale chez les individus. Dans cette optique, je conclus que l'exclusivité, l'utilisation aveugle des diagnostics comme une base objective pour la création de plans de traitement est éthiquement discutable. Je suggeste à un nouveau modèle de pratique professionnelle basée sur le traitement individualisé et je demande une moindre accent sur le diagnostic dans la prise en charge des malades mentaux.

Internet technologies are increasingly advocated as a means for transforming health care and improving people’s health. In the field of e-health questions on the health implications of internet use are typically approached through attempts at measuring the effect of internet use on health outcomes. In this, information is usually conceptualised as a form of knowledge/power and online information practices are enrolled in discourses on patient empowerment. Taking the different meanings ascribed to information in these approaches as my point of departure, in this thesis I rethink the implications of internet use on health through an empirical exploration of alternative conceptualisations of the relationship between information and health in the context of contemporary HIV treatment and care. I do this through two analytical moves. First, drawing on the concept of performativity, a concern with what effect internet use has on health is turned into one of how internet use enacts health. Second, rather than treating information as knowledge/power, through an analysis of how a specific group of women ‘living with HIV’ in the UK use the internet, I reconfigure the connections between internet use and health through a conceptualisation of information as care. Drawing on a range of empirical materials – including forty-seven in-depth interviews with patients and internet content providers, non-participant observations, document and website analysis – three areas of health-related internet use are analysed in detail: the seeking out of health-related and specifically biomedical information; the seeking out and sharing of experiential knowledge and narratives about living with HIV; meeting prospective partners and dating. However, rather than studying these areas of internet use in order to interrogate what they can tell us about the internet, I analyse them as part of the ethical regime of ‘living with HIV’, in which the virus, previously thought of as ‘terminal’, becomes, through info and bio technologies, normalised as ‘chronic’. From this perspective, enacting health not only entails working on and with one’s body, but also always invokes its distribution across bodies, to other areas and relations, including internet technologies and the networks of relations established via these technologies.

Thesis (MBA)--Stellenbosch University, 2008.
ENGLISH ABSTRACT: The cost of medical care, in particular the cost of cancer care, has seen significant increases globally in the last few years. These cost increases in part are a result of tremendous advancements in new health technologies to diagnose, treat and care for cancer sufferers. The development of these highly specialised treatment modalities is not expected to slow down in the next few years, as potentially new treatments are already in the pipeline. On the other hand, cancer is becoming more prevalent. affecting more people worldwide. The condition remains life threatening, causing patients to become dependent and desperately hopeful of their requested treatments. Managed care, which includes the processes of rationing, has been implemented by medical aid schemes in the private health care industry in an effort to curtail the escalating costs of health care. Currently medical aids in the country are under immense pressure to comply with financially demanding legislation as well as to increase their membership risk by keeping contributions low and subsequently improve access to private health care in the country. Notwithstanding the fact that rationing might be justified from an economic perspective, the implications of transposing free market principles into an almost sacred health care environment challenges current morals and ethics in this arena. The price consciousness in cancer care is almost creating a scenario where clinical reasons are becoming subservient to fiscal reasons or, put differently, it is placing a price tag on human lives. In its true glory, the rationale of rationing is to challenge the individual patient needs against that of the bigger medical aid society. The distributive justice principles of rationing are creating immense conflict between the virtue-based, principle-based and contemporary ethics, which are currently governing medical practice in the country. As a result rationing creates serious vexing funding decisions with long-ranging effects. Its against this background that the study further consider the implications of managed care and rationing as it creates serious questions about the fairness, decision-making power and authority of managed care organizations. The implication of this is that the treating physician seems to have lost all autonomy and control in trying to treat and care for his cancer patient. Hence the perception that managed care does not act in the best interest of the vulnerable and desperate cancer suffering patient. As a result of th is view of managed care it becomes important to ensure the fairness and or legitimacy of managed care and rationing decisions. Therefore, the final section of the study considers the fair and just rationing of medical care as well as setting limits that are morally and ethically acceptable, in a cancer related setting. The studies of Daniels and Sabin are utilized extensively in particular the suggested criteria required by managed care organisations to ensure their rationing decisions are fair and legitimate. The implications of this and the assurances to cancer sufferers in a medical scheme is that the decisions to fund new health technologies are based on a process that is transparent and collaborative and that cost consideration of treatment has merit if it is made within the confines of this process.
AFRIKAANSE OPSOMMING: Die koste van mediese sorg, en spesifiek die koste van kankersorg, het in die afgelope paar jaar wereldwyd aansienlik toegeneem. Hierdie toename in koste is gedeeltelik die resultaat van geweldige vooruitgang in nuwe gesondheidstegnologiee om kankerlyers te diagnoseer, te behandel en vir hulle te sorgo Daar word nie verwag dat die ontwikkeling van hierdie hoogs gespesialiseerde behandelingsmodaliteite oor die volgende paar jaar sal afneem nie, aangesien nuwe behandelings steeds geregistreer word. Aan die ander kant is die voorkomssyfer van kanker besig om toe te neem, en be"invloed dit mense oor die hele wereld. Die toestand is steeds lewensbedreigend, en veroorsaak dat pasiente afhanklik van en desperaat vol hoop is vir die nodige behandeling. Bestuurde sorg, wat die proses van rantsoenering insluit, is deur mediesefondsskemas in die privaat gesondheidsorgbedryf ge"lmplementeer in 'n poging om die stygende koste van mediese sorg te verminder. Mediese fondse in die land is tans onder geweldige druk om aan finansieel veeleisende wetgewing te voldoen en om hulle lidmaatskaprisiko te verhoog deur bydraes laag te hou en gevolglik toegang tot privaat gesondheidsorg in die land te verbeter. Ondanks die feit dat rantsoenering moontlik vanuit 'n ekonomiese perspektief geregverdig kan word, daag die implikasies van die omsetting van vryemarkbeginsels in 'n amper heilige gesondheidsorgomgewing huidige morele waardes en etiek in hierdie veld uit. Die prysbewustheid in kankersorg skep amper 'n scenario waar kliniese redes ondergeskik aan fiskale redes gestel word of, om dit anders te stel, dit plaas 'n prys op mense se lewens. In sy volle glorie is die rasionaal van rantsoenering om die individuele pasient se behoeftes teenoor die van die groter mediesefondssamelewing te stel. Die beginsels van verdelende regverdigheid van rantsoenering skep enorme konflik tussen die deug..gebaseerde, beginselgebaseerde en kontemporere etiek wat tans die mediese praktyk in die land beheer. Gevolglik skep rantsoenering ernstige, moeilike befondsingsbesluite met effekte oor die lang termyn. Oit is teen hierdie agtergrond dat die studie die verdere implikasies van bestuurde sorg en rantsoenering moet oorweeg, aangesien dit ernstige vrae rondom die billikheid , besluitneming en outoriteit van bestuurde sorg maatskappye lig. By implikasie beteken dit dat die geneesheer wat die pasient behandel, feitlik aile beheer verloor het om die pasient vir aile praktiese doeleindes optimaal te behandel. Oaarom die persepsie dat bestuurde sorg nie in die beste belang van die kwesbare en desperaat kanker pasiente is nie. As gevolg van die persepsie van bestuurde sorg, raak dit meer belangrik om die bilikheid en regverdigheid van gesondheid sorg besluite te verseker. Met dit in ag genome, oorweeg die finale deel van die studie die bilikheid en regverdigheid van mediese rantsoenering so-ook die set van perke wat eties en moreel aanvaarbaar is, in 'n kanker verwante agtergrond. Die werke van Daniels en Sabin word in aansienlike detail hersien in besonder hul voorgestelde kriteria wat vereis word deur bestuurde sorg organisasies om te verseker hul besluite ten opsigte van rantsoenering is redelik en regverdig. Die implikasies hiervan en die versekering tot kanker Iyers in 'n mediese skema is dat die besluite om nuwe gesondheidstegnologiee te befonds, is gebasseer op In deursigtige en samehorende proses en dat aile koste oorwegings vir behandeling meriete het, indien dit is gemaak is binne die raamwerk van hierdie proses.

Thesis (Ed.D.) - Simon Fraser University, 2005.
Theses (Faculty of Education) / Simon Fraser University. Includes bibliographical references leaves 322-244. Also issued in digital format and available on the World Wide Web.

The South African health sector encounters significant challenges of inequality in terms of access to health care services. A ‘quadruplet burden of disease’ does not make access to health any easier. Patient’s access to health care can be hindered by the patient’s residential area. Rural patients are faced with hospitals that do not have specialist care while urban areas are swamped with patient who need specialist care. Medical general practitioners’ scope of practice is limited and that creates challenges when patients need specialised care in a resource constrained environment. The time it takes for the patient in public health sector to access health services may be affected by their locality. The same challenges may be experienced by patient in private sector with medical Aids who are residing in the rural areas. The state’s impression is that demand is more than supply. On the other hand the court pursues justice for people who do not receive timeous access to healthcare. The study will be researching on locality issues that can jeopardise the standard of care. Although The Health Professions Council of South Africa is silent about the Locality Rule but it has unanimously adopted prerequisites and contraindications for using the Locality Rule as a defence. The Council has a duty in terms of Health Professional Act 56 of 1974 to uphold patient safety. The work seeks to understand the origin of the locality rule, its application in terms of the Constitution of the Republic Of South Africa, case law and relevant legislature. The work will also take into consideration the historical background of the South African health system and its responsibility in advancing socioeconomic rights for the citizens of South Africa. The prerequisite for using resource constrains and special circumstances will be discussed.
Dissertation (MPhil)--University Of Pretoria, 2020.
Public Law
MPhil
Unrestricted

The health care system has, in many respects, been developed to oppose suffering. Yet health care’s almost compulsive urge to treat death as the enemy and to battle disease and injury with all available technology unavoidably results in suffering for someone. This paradox and its impact upon the decision-makers in critical care, has attracted some interest overseas, but none to date in Australia. This study sought to understand the interactions between the key stakeholders in end-of-life decision-making in critical care in the interests of developing strategies to ameliorate the avoidable suffering arising from these processes. A modification of Denzin’s Interpretive Interactionism (Denzin, 1989), was developed to apply the epistemological and ontological principles of the critical paradigm while preserving the advantages of Denzin’s design in the investigation of interactions. Semi-structured interviews with relatives, nurses and doctors from a variety of critical care units in South-East Queensland and New South Wales, provided the data that enriches this study. Using the critical lens, analysis focussed on the interactions (and gaps and silences) between the decision-makers at the key moments of decision-making: initiation, maintenance or withdrawal of life-sustaining treatments. A model of 'best practice' with respect to end-of-life decision-making was produced and concrete recommendations made. This project has found that the amelioration of avoidable suffering in the critical care environment related to end-of-life decision-making requires policy and procedural changes at the organisational level.

This dissertation examines end-of-life experiences at a small Zen hospice in the Pacific Northwest region of the United States. Through an exploration of how end-of-life communication, sense-making, decision-making, and care in this setting differ from that of typical clinical settings, this project highlights and interrogates the experiences of dying as spiritually, rhetorically, narratively, relationally, and communally bound events. Keywords: Zen hospice, end of life, narrative sensemaking, medical-ethical decision making, spirituality, healing rhetoric, communities of practice

A Survey of Physical Therapists’ Perceptions of Workplace Ethics in the State of Georgia. Roberto Cantu, 2014: Applied Dissertation, Nova Southeastern University, Abraham S. Fischler School of Education. ERIC Descriptors: Physical Therapy, Ethics, Conflict of Interest, Ethical Instruction, Job Satisfaction.

This study examined how physical therapists in Georgia perceive ethical climates in their workplaces, based on the use of the Ethics Environment Questionnaire (EEQ), and how these perceptions may be different based on the type of workplace, financial status of their workplaces, their respective positions within their organizations, their age, gender, and years in the profession.

Questionnaires were sent to a random sample of 1200 physical therapists in Georgia; 340 surveys were completed and returned. The results suggested that, overall, physical therapists in Georgia are satisfied with the ethical environments of their workplaces. The average score was 3.8, higher than the 3.5 cutoff score that indicates an ethical environment. The only sub-group that scored below 3.5 on the EEQ were those who worked in skilled nursing/assisted living facilities (M = 3.35, SD = .67). There was a statistically significant difference in scores between therapists working in for-profit settings (M = 3.75, SD = .55) and therapists working in not-for-profit settings (M = 3.88, SD = .45; t (335) = -2.21, p = .027). Clinicians had the lowest perceptions of ethical climate (3.73), executives/owners the highest (4.29), with middle managers scoring in between the two groups. There were strong negative correlations between the perception of an ethical environment with burnout and intent to leave the place of employment (r_s = -.66, p < .01; r_s = -.524, p < .01).

Increased governmental/insurance regulation, increased paperwork, decreased reimbursement, and productivity issues were areas of most concern to therapists. Greater communication and dialogue between clinicians and managers was the dominant theme in the recommended solutions to these concerns.

Thesis (M.A.)--Indiana University, 2008.
Includes vitae. Department of Philosophy, Indiana University-Purdue University Indianapolis (IUPUI) Advisor(s): Peter H. Schwartz. Includes bibliographical references (leaves 61-66)

The purpose of this qualitative study was to discover strategies that hospital administrators can use to obtain support from physicians as they pertain to corporate compliance, while still remaining accountable and loyal to healthcare organizations. By interviewing eight physicians and eight hospital administrators, the study sample was used to gather information on behaviors that influence and affect physician participation in corporate compliance programs. Using the grounded theory design of qualitative research was most appropriate for this study. The use of purposive sampling was most appropriate for this study and produced data for a comparative analysis. The comparative analysis allowed for the generation of a grounded theory by first extracting primary themes for the collected data. Twelve primary themes emerged from the content analysis, which produced four categories, producing a grounded theory, The Hospital Compliance Leader Theory. The hospital compliance leader theory indicates that hospital administrators can engage physicians in corporate compliance programs, while maintaining physician loyalty. To accomplish this, the healthcare leaders must incorporate each of the following: (a) use appropriate training programs while understanding the challenges the physicians face; (b) bridge the artificial gap between hospitals and physicians by educating physicians on the potential consequences the hospital faces because of noncompliance; (c) training physicians on corporate compliance, emphasizing the benefits to patient care with full support from the administrative leadership team; and (d) mandating physician compliance training and focusing the training on the greatest compliance risk areas.

Healthcare systems are under pressure to eliminate disparities of care. Communication methods used with Limited English Proficiency (LEP) patients was presented in the literature as an essential component to deliver quality and equal care. Several strategies have been implemented to assess and target the communication methods between patients and health care teams. The challenge for health systems workers is to address communication barriers to eliminate disparities of care and medical errors. The purpose of the present qualitative case study was to explore if communication barriers affect the understanding of LEP research participants while participating in the informed consent process during clinical trials. Communication barriers during the informed consent process may affect clinical trial outcomes. In the study, the use of a triangulation data gathering method was associated with a qualitative case study. Data regarding barriers of communication during the informed consent process were gathered by performing semistructured interviews. The study population included six principal investigators, five interpreters, and nine LEP research participants. Data analysis involved reviewing the emerging themes from participants’ responses. Results indicated four major themes supporting communication challenges. The themes included authority figure, cultural sensitivity, communication barriers, and education. The study suggested the need for further research regarding communication barriers during the clinical trials process.

The presence of art and artists in health care settings raise many questions of an ethical nature. The presence of art in such milieux challenges the manner in which notions of art, persons, health, healing, community, ethics and aesthetics are presently conceptualized. This thesis will argue that art ought properly be considered an essential human need - integral to the health, flourishing and well-being of all persons - particularly those who are sick and suffering. An ethical care of sick persons would demand that both artistic practice and health care practice be revisioned in the light of this different understanding.

The presence of art and artists in health care settings raise many questions of an ethical nature. The presence of art in such milieux challenges the manner in which notions of art, persons, health, healing, community, ethics and aesthetics are presently conceptualized. This thesis will argue that art ought properly be considered an essential human need - integral to the health, flourishing and well-being of all persons - particularly those who are sick and suffering. An ethical care of sick persons would demand that both artistic practice and health care practice be revisioned in the light of this different understanding.

Universidade de Fortaleza
O psicÃlogo assume o desafio de inserÃÃo nos serviÃos pÃblicos de saÃde, mais precisamente nas instituiÃÃes gerais nÃo-psiquiÃtricas caracterizadas como um locus especÃfico de prÃtica e de compreensÃo das questÃes relacionadas ao continuum saÃde-doenÃa. Entretanto, atuar no complexo campo da saÃde coletiva exige desse profissional uma revisÃo de sua prÃtica, um pÃr em xeque os pressupostos tradicionais e, sobretudo, uma discussÃo Ãtica que aponte para uma outra atitude frente ao usuÃrio do serviÃo. O cuidado assume a configuraÃÃo dessa atitude de respeito e de acolhimento do sofrimento do outro, cuja via nÃo mais segue a razÃo, nem a do saber-poder, mas sim a afetaÃÃo e a escuta Ãtica. O objetivo deste estudo à compreender os sentidos atribuÃdos pelo psicÃlogo ao cuidado para com o outro em sua prÃtica na instituiÃÃo pÃblica de saÃde localizada em Fortaleza. De carÃter exploratÃrio, este estudo à qualitativo, numa perspectiva crÃtico-interpretativa de base fenomenolÃgica e adota como suporte metodolÃgico a hermenÃutica filosÃfica. As informantes foram oito psicÃlogas do quadro funcional da rede estadual de saÃde. O instrumento utilizado foi a entrevista nÃo-diretiva, por facilitar o diÃlogo e a livre exposiÃÃo dos cotidianos. A anÃlise em profundidade dos depoimentos de cada informante evidenciou trÃs eixos temÃticos centrais: a inserÃÃo no campo da saÃde coletiva; a prÃtica do psicÃlogo: saberes e fazeres em jogo; e concepÃÃes sobre a dimensÃo Ãtica do cuidado. QuestÃes relacionadas à formaÃÃo acadÃmica, considerada falha quanto à discussÃo da saÃde como uma dimensÃo coletiva, à falta de experiÃncia anterior no campo da saÃde, ao prÃprio processo de profissionalizaÃÃo e Ãs precÃrias condiÃÃes de trabalho sÃo vivenciadas como dificuldades para a atuaÃÃo do psicÃlogo. Esse ainda se pauta pelo modelo da psicologia clÃnica, de postura individualista e isolada, e pela biomedicina, de acentuada presenÃa no contexto cearense, marcada pela verticalizaÃÃo da assistÃncia e interessada mais no outro como um objeto de intervenÃÃo tÃcnica. Portanto, à possÃvel concluir que esse modelo de prÃtica à o de maior predominÃncia entre os psicÃlogos deste estudo, os quais, frente ao usuÃrio, assumem a atitude de cuidado como tÃcnica, ajustamento, controle e de anulaÃÃo da diferenÃa. HÃ, contudo, experiÃncias que ultrapassam a postura clÃnica clÃssica e a Ãnfase na perÃcia para dar conta do encontro intersubjetivo, do diÃlogo, do compartilhar de responsabilidades, do compromisso com a dimensÃo sÃcio-cultural e polÃtica do serviÃo de saÃde e, sobretudo, do outro, reconhecido e respeitado como um sujeito, de quem o psicÃlogo precisa se aproximar para oferecer um espaÃo de escuta de seu sofrimento e acolhimento de sua singularidade.
The psychologist takes up the challenge of fitting into the public health services, more precisely into the general non-psychiatric institutions characterized as an specific locus of practice and comprehension of the issues related to the continuum health-illness. However, acting on the complex field of collective health imposes to this professional a review of his/her practice, a questioning of the traditional presuppositions and, above all, an ethical discussion that leads to another attitude regarding the user of the service. Caring assumes the configuration of this attitude of respect and embracement of the otherâs suffering, whose way does not follow reason any longer, nor the path of knowledge-power, but the affection and the ethical listening. The aim of this study is to understand the meanings attributed by the psychologist to the care for the other in his/her practice in the public health institution in Fortaleza. Having an exploratory character, this study is qualitative, in a critical-interpretative perspective of phenomenological basis, and adopts as methodological underpinning the philosophical hermeneutics. The subjects were eight women-psychologists who are part of the personnel of the public health network. The instrument employed was the non-directive interview, as it facilitates the dialogue and the free expression of the subjectsâ daily living. The in-depth analysis of the accounts of each subject evidenced three central thematic axes: the insertion in the field of public health; the psychologistâs practice: knowing and doing at play; and conceptions on the ethical dimension of care. Issues related to the academic background, considered flawed in what regards the discussion about health as a collective dimension, to the lack of previous experience in the field of health, to the very process of professionalization and to the precarious working conditions, are experienced as difficulties to the psychologistâs practice. This professional, still in line with the clinic psychology model, of individualist and isolated attitude, and with biomedicine, of accentuated presence in the cearense context, marked by the vertical, top-to-bottom character of the hierarchy in charge of the assistance, and interested in the other more as an object of technical intervention. Therefore, it is possible to conclude that this model of practice is the prevalent among the psychologists of this study, who, in face of the user, assume the attitude of care as technique, adjustment, control and nullification of the difference. There are, however, experiences that reach beyond the classic clinic attitude and the emphasis on expertise to manage the intersubjective encounter, the dialogue, the sharing of responsibilities, the committment with the social-cultural and political dimension of the health service and, above all, the other, acknowledged and respected as a subject, whom the psychologist needs to approach in order to provide a space of listening to his/her sufferering and appreciation of his/her singularity.

In England, medical, nursing and other healthcare professions are required by their codes of professional ethics to have a working knowledge of moral principles and to be able to apply them in practice. Little, if anything, is said explicitly by these professions about the virtues. However, much is said about the character of the doctor or the nurse, and their supposed ability to recognise moral issues in their professional work and make morally good decisions. Edmund Pellegrino has questioned the appropriateness of applying moral principles to medical practice in contemporary times without a firm foundation. He attempts to restore the moral foundation of the profession of medicine, by restricting an account of the good to the profession which he claims, unlike ethics in general, there can be agreement on norms. From this position, moral principles in medical ethics can be justified, agreed upon, and provide firm action guidance in practice, as well as provide an independent ground for medical virtues. I will claim that Pellegrino's concern about disagreement and a loss of norms in ethics in general is not resolved in the restricted field of professional medical ethics and that his understanding of principles and the link with virtue is confused. Then, using virtue terms Pellegrino himself thinks necessary for making good decisions in practice, I will show how a certain account of the virtues can provide a plausible account of how we can become good healthcare workers and so support Pellegrino's goal; though it will not support his confidence in supplying both clear, moral, and normative constraints in a code of professional medical ethics and firm decision-making in practice.

The central claim of this thesis is that wonder has the capacity to interrupt the institutional entrancement of the clinician to exert a gravitational pull on her awareness. This can “awaken” her from the normalized perspective of clinical praxis, and a clinical environment that defiles the vulnerable help seeker while contributing to the clinician’s moral disengagement or paralysis. In making this claim, our inquiry revisits many well-rehearsed ethical questions about the therapeutic relationship, the construct of mental illness and its care, the politics of power within the institution of community mental health care, and the supposed and real dangers of emotional intimacy in the clinical relationship. These questions also point uncomfortably—devastatingly—back to why and how the ethics of educated and dedicated clinicians can be diluted, for which the possible “cure” of wonder is being sought here. Wonder represents but one aspect of our ethical analysis in this interdisciplinary study. We turn in equal measure to an emerging strand of moral research, called autoethnography, and to the radical ethical vision of Emmanuel Levinas who informs our final understanding of wonder. In this inquiry, autoethnography takes the form of a short story in chapter 2 and as a series of personal epiphanic vignettes thereafter. Autoethnography affectively illuminates the theory being presented here and evokes the horrifying imperative of our ethical quest that calls for radical institutional change, albeit enigmatically. It is in Levinas’ ethical vision, however, that the clinician may discover the astonishing holiness and relationality at the heart of the clinical relationship and all this implies. This perfection, apprehended through the stunning approach of the vulnerable help seeker, extends an ethical invitation to the beleaguered clinician that she can hardly resist, but that she will almost inevitably fail to answer.

Whether the community is looking for “scapegoats” to blame, or seeking more radical and deeper causes, health care managers are in the firing line whenever there are woes in the health care sector. The public has a right to question whether ethics have much influence on the everyday decision making of health care managers. This thesis explores, through a series of published papers, the influence of ethics and other factors on the decision making of health care managers in Australia. Critical review of over 40 years of research on ethical decision making has revealed a large number of influencing factors, but there is a demonstrable lack of a multidimensional approach that measures the combined influences of these factors on managers. This thesis has developed an instrument, the Managerial Ethical Profile (MEP) scale, based on a multidimensional model combining a large number of influencing factors. The MEP scale measures the range of influences on individual managers, and describes the major tendencies by developing a number of empirical profiles derived from a hierarchical cluster analysis. The instrument was developed and refined through a process of pilot studies on academics and students (n=41) and small-business managers (n=41), and then was administered to the larger sample of health care managers (n=441). Results from this study indicate that Australian health care managers draw on a range of ethical frameworks in their everyday decision making, forming the basis of five MEPs (Knights, Guardian Angels, Duty Followers, Defenders, and Chameleons). Results from the study also indicate that the range of individual, organisational, and external factors that influence decision making can be grouped into three major clusters or functions. Cross referencing these functions and other demographic data to the MEPs provides analytical insight into the characteristics of the MEPs. These five profiles summarise existing strengths and weaknesses in managerial ethical decision making. Therefore identifying these profiles not only can contribute to increasing organisational knowledge and self-awareness, but also has clear implications for the design and implementation of ethics education and training in large scale organisations in the health care industry.