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Appeals to individual responsibility for health--reconsidering the luck egalitarian perspective.

https://arctichealth.org/en/permalink/ahliterature115446
Source
Camb Q Healthc Ethics. 2013 Apr;22(2):146-58
Publication Type
Article
Date
Apr-2013

Care-managers' professional choices: ethical dilemmas and conflicting expectations.

https://arctichealth.org/en/permalink/ahliterature291570
Source
BMC Health Serv Res. 2017 Sep 07; 17(1):630
Publication Type
Journal Article
Date
Sep-07-2017
Author
Siri Tønnessen
Gøril Ursin
Berit Støre Brinchmann
Author Affiliation
University College of Southeast Norway, Campus Vestfold, 3603, Kongsberg, Norway.
Source
BMC Health Serv Res. 2017 Sep 07; 17(1):630
Date
Sep-07-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Case Managers - ethics
Choice Behavior - ethics
Humans
Interviews as Topic
Norway
Personnel Loyalty
Professional Autonomy
Qualitative Research
Social Responsibility
Abstract
Care-managers are responsible for the public administration of individual healthcare decisions and decide on the volume and content of community healthcare services given to a population. The purpose of this study was to investigate the conflicting expectations and ethical dilemmas these professionals encounter in their daily work with patients and to discuss the clinical implications of this.
The study had a qualitative design. The data consisted of verbatim transcripts from 12 ethical reflection group meetings held in 2012 at a purchaser unit in a Norwegian city. The participants consist of healthcare professionals such as nurses, occupational therapists, physiotherapists and social workers. The analyses and interpretation were conducted according to a hermeneutic methodology. This study is part of a larger research project.
Two main themes emerged through the analyses: 1. Professional autonomy and loyalty, and related subthemes: loyalty to whom/what, overruling of decisions, trust and obligation to report. 2. Boundaries of involvement and subthemes: private or professional, care-manager or provider and accessibility.
Underlying values and a model illustrating the dimensions of professional responsibility in the care-manager role are suggested. The study implies that when allocating services, healthcare professionals need to find a balance between responsibility and accountability in their role as care-managers.
Notes
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PubMed ID
28882150 View in PubMed
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Source
Am J Bioeth. 2010 Mar;10(3):56-7
Publication Type
Article
Date
Mar-2010

The case of Samuel Golubchuk and the right to live.

https://arctichealth.org/en/permalink/ahliterature144877
Source
Am J Bioeth. 2010 Mar;10(3):50-3
Publication Type
Article
Date
Mar-2010
Author
Alan Jotkowitz
Shimon Glick
Ari Z Zivotofsky
Author Affiliation
Ben-Gurion University of the Negev, Beer-Sheva, Israel. ajotkowitz@hotmail.com
Source
Am J Bioeth. 2010 Mar;10(3):50-3
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Canada
Choice Behavior - ethics
Cultural Characteristics
Decision Making - ethics
Dissent and Disputes
Enteral Nutrition - ethics
Ethics, Clinical
Ethics, Medical
Freedom
Health Care Rationing - ethics
Humans
Jews
Life expectancy
Life Support Care - ethics
Male
Manitoba
Medical Futility - ethics
Persistent Vegetative State
Personal Autonomy
Physician's Role
Practice Guidelines as Topic
Societies, Medical
Terminal Care - ethics - methods
Terminally ill
Value of Life
Withholding Treatment - ethics
Abstract
Samuel Golubchuk was unwittingly at the center of a medical controversy with important ethical ramifications. Mr. Golubchuk, an 84-year-old patient whose precise neurological level of function was open to debate, was being artificially ventilated and fed by a gastrostomy tube prior to his death. According to all reports he was neither brain dead nor in a vegetative state. The physicians directly responsible for his care had requested that they be allowed to remove the patient from life support against the wishes of the patient's family. Concurrently the Manitoba College of Physicians and Surgeons released a statement which states that the final decision to withdraw life support lies with the physician. In our opinion the statement is ethically problematic for a number of reasons. 1. It is an affront to the guiding principles of Western medical ethics: patient autonomy and human freedom. 2. The position of Samuel Golubchuk's physicians and the new statement lack cultural sensitivity towards other traditions. 3. In modern society there exists an erosion of a basic attitude towards the value of life. 4. The ability of physicians to predict life expectancy in terminally ill patients has been shown repeatedly to be quite limited.
Notes
Comment In: Am J Bioeth. 2010 Mar;10(3):56-720229423
Comment In: Am J Bioeth. 2010 Mar;10(3):54-620229422
Comment In: Am J Bioeth. 2010 Mar;10(3):67-820229429
Comment In: Am J Bioeth. 2010 Mar;10(3):64-520229427
Comment In: Am J Bioeth. 2010 Mar;10(3):61-320229426
Comment In: Am J Bioeth. 2010 Mar;10(3):W6-720229404
Comment In: Am J Bioeth. 2010 Mar;10(3):73-420229432
Comment In: Am J Bioeth. 2010 Mar;10(3):69-7020229430
Comment In: Am J Bioeth. 2010 Mar;10(3):58-920229424
Comment In: Am J Bioeth. 2010 Mar;10(3):65-620229428
Comment In: Am J Bioeth. 2010 Mar;10(3):59-6120229425
Comment In: Am J Bioeth. 2010 Mar;10(3):71-320229431
PubMed ID
20229421 View in PubMed
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Challenging the rhetoric of choice in prenatal screening.

https://arctichealth.org/en/permalink/ahliterature153701
Source
Bioethics. 2009 Jan;23(1):68-77
Publication Type
Article
Date
Jan-2009
Author
Victoria Seavilleklein
Author Affiliation
University of Toronto, Toronto, Ontario, Canada. v.seavilleklein@utoronto.ca
Source
Bioethics. 2009 Jan;23(1):68-77
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Canada
Choice Behavior - ethics
Humans
Informed Consent - ethics - psychology
Mass Screening - ethics - psychology
Parents - psychology
Patient Acceptance of Health Care - psychology
Patient Education as Topic - ethics
Patient Selection - ethics
Personal Autonomy
Prenatal Diagnosis - ethics - psychology
Reproductive Rights - ethics - psychology
Abstract
Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or women's choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women's autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women's autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all.
PubMed ID
19076943 View in PubMed
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Choosing deafness with preimplantation genetic diagnosis: an ethical way to carry on a cultural bloodline?

https://arctichealth.org/en/permalink/ahliterature146578
Source
Camb Q Healthc Ethics. 2010;19(1):86-96
Publication Type
Article
Date
2010
Author
Silvia Camporesi
Author Affiliation
European School of Molecular Medicine, in collaboration with the University of Milan, Italy.
Source
Camb Q Healthc Ethics. 2010;19(1):86-96
Date
2010
Language
English
Publication Type
Article
Keywords
Canada
Choice Behavior - ethics
Deafness - diagnosis - genetics
Disabled Persons
Europe
Female
Humans
Morals
Parents - education
Pregnancy
Preimplantation Diagnosis - ethics
United States
PubMed ID
20025805 View in PubMed
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"Do your homework…and then hope for the best": the challenges that medical tourism poses to Canadian family physicians' support of patients' informed decision-making.

https://arctichealth.org/en/permalink/ahliterature257233
Source
BMC Med Ethics. 2013;14:37
Publication Type
Article
Date
2013
Author
Jeremy Snyder
Valorie A Crooks
Rory Johnston
Shafik Dharamsi
Author Affiliation
Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada. jcs12@sfu.ca.
Source
BMC Med Ethics. 2013;14:37
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Choice Behavior - ethics
Decision Making - ethics
Ethical Analysis
Female
Focus Groups
Humans
Informed Consent - ethics - standards
Male
Medical Tourism - ethics - legislation & jurisprudence - trends
Middle Aged
Physician's Role
Physician-Patient Relations - ethics
Physicians, Family - ethics - standards - trends
Social Responsibility
Abstract
Medical tourism-the practice where patients travel internationally to privately access medical care-may limit patients' regular physicians' abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors' typical involvement in patients' informed decision-making is challenged when their patients engage in medical tourism.
Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants' perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians' abilities to support medical tourists' informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance.
Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician's role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician's reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians' concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy.
Medical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad.
Notes
Cites: Can Fam Physician. 2013 Dec;59(12):1314-924336547
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Cites: Camb Q Healthc Ethics. 2013 Apr;22(2):170-8023507179
Cites: J Health Polit Policy Law. 2004 Jun;29(3):359-9615328871
PubMed ID
24053385 View in PubMed
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Ethically difficult situations in hemodialysis care - Nurses' narratives.

https://arctichealth.org/en/permalink/ahliterature278835
Source
Nurs Ethics. 2015 Sep;22(6):711-22
Publication Type
Article
Date
Sep-2015
Author
Catarina E C Fischer Grönlund
Anna I S Söderberg
Karin M Zingmark
S Mikael Sandlund
Vera Dahlqvist
Source
Nurs Ethics. 2015 Sep;22(6):711-22
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Choice Behavior - ethics
Ethics, Nursing
Female
Humans
Interviews as Topic
Male
Renal Dialysis - nursing
Sweden
Abstract
Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose.
This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses' experiences of being in ethically difficult situations that give rise to a troubled conscience.
This study has a phenomenological hermeneutic approach.
Narrative interviews were carried out with 10 registered nurses working in dialysis care.
The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University.
One theme, 'Calling for a deliberative dialogue', and six sub-themes emerged: 'Dealing with patients' ambiguity', 'Responding to patients' reluctance', 'Acting against patients' will', 'Acting against one's moral convictions', 'Lacking involvement with patients and relatives' and 'Being trapped in feelings of guilt'.
In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience.
In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.
PubMed ID
25106455 View in PubMed
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Source
Laeknabladid. 2007 Jul-Aug;93(7-8):543-51
Publication Type
Article
Author
Sveinsson Olafur Arni
Author Affiliation
Laeknir og Heimspekingur. olafursv@landspitali.is
Source
Laeknabladid. 2007 Jul-Aug;93(7-8):543-51
Language
Icelandic
Publication Type
Article
Keywords
Choice Behavior - ethics
Euthanasia - ethics - legislation & jurisprudence
Hippocratic Oath
Humans
Morals
Netherlands
Palliative Care - ethics - legislation & jurisprudence
Patient Rights
Personal Autonomy
Physician's Role
Physician-Patient Relations
Abstract
Euthanasia has been heatedly discussed in Western countries over the last years. Only a few nations have legalized euthanasia or physician assisted suicide with the Dutch at the forefront of that field. Proponents of euthanasia mostly argue for euthanasia on two grounds. Firstly, that the patient has a right to die and secondly, that there is no substantial difference between euthanasia and palliative care. In this paper I will argue against both of the above. I discuss the arguments against euthanasia which are in principle four. Firstly, it is held by many that taking a human life is wrong under all circumstances. Secondly, that it is an unjustifiable demand to ask a person to take another person's life. In relation to that argument, euthanasia is not in accordance with the basic principles of medicine and nursing as they have evolved over the years and could therefore easily disrupt the therapeutic relationship. Thirdly, as shown from Holland there is empirical evidence that euthanasia is not under good enough surveillance and therefore invites misuse. Fourthly, even though euthanasia might possibly be justifiable under certain circumstances, legalisation might well invite abuse because of the message and pressure that the option places on both patients and professionals in terminal care. My answer to the euthanasia demand is palliative care, where dialogue between the patient and doctor is central. But the dialogue cannot be effective, unless both partners are willing and able to engage in sincere and frank conversations.
PubMed ID
17823497 View in PubMed
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Exploring how IBCLCs manage ethical dilemmas: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature122371
Source
BMC Med Ethics. 2012;13:18
Publication Type
Article
Date
2012
Author
Joy Noel-Weiss
Betty Cragg
A Kirsten Woodend
Author Affiliation
School of Nursing, University of Ottawa, 451 Smyth RGN3051, Ottawa, ON, Canada K1H 8M5. Joy.Noel-Weiss@uottawa.ca
Source
BMC Med Ethics. 2012;13:18
Date
2012
Language
English
Publication Type
Article
Keywords
Breast Feeding
Canada
Certification
Choice Behavior - ethics
Consultants
Decision Making - ethics
Governing Board
Humans
Interviews as Topic
Lactation
Moral Obligations
Mothers - psychology
Narration
Patient-Centered Care
Power (Psychology)
Qualitative Research
Trust
Abstract
Professional health care practice should be based on ethical decisions and actions. When there are competing ethical standards or principles, one must choose between two or more competing options. This study explores ethical dilemmas experienced by International Board Certified Lactation Consultants.
The investigator interviewed seven International Board Certified Lactation Consultants and analyzed the interviews using qualitative research methods.
"Staying Mother-Centred" emerged as the overall theme. It encompassed six categories that emerged as steps in managing ethical dilemmas: 1) recognizing the dilemma; 2) identifying context; 3) determining choices; 4) strategies used; 5) results and choices the mother made; and 6) follow-up. The category, "Strategies used", was further analyzed and six sub-themes emerged: building trust; diffusing situations; empowering mothers; finding balance; providing information; and setting priorities.
This study provides a framework for understanding how International Board Certified Lactation Consultants manage ethical dilemmas. Although the details of their stories changed, the essence of the experience remained quite constant with the participants making choices and acting to support the mothers. The framework could be the used for further research or to develop tools to support IBCLCs as they manage ethical dilemmas and to strengthen the profession with a firm ethics foundation.
Notes
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Cites: Am J Nurs. 2006 Sep;106(9):5716954766
Cites: Am J Health Syst Pharm. 1998 Jan 1;55(1):849437480
PubMed ID
22824376 View in PubMed
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19 records – page 1 of 2.