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Abortion and neonaticide: ethics, practice, and policy in four nations.

https://arctichealth.org/en/permalink/ahliterature58480
Source
Bioethics. 2002 Jun;16(3):202-30
Publication Type
Article
Date
Jun-2002
Author
Michael L Gross
Author Affiliation
Department of Political Science, The University of Haifa, Mt. Carmel, Haifa, Israel. mgross@poli.haifa.ac.il
Source
Bioethics. 2002 Jun;16(3):202-30
Date
Jun-2002
Language
English
Publication Type
Article
Keywords
Abnormalities
Abortion, Eugenic
Abortion, Legal
Adult
Comparative Study
Decision Making
Denmark
Developed Countries
Ethical Analysis
Euthanasia, Passive
Female
Fetus
Great Britain
Health Care Rationing
Homicide
Humans
Infant, Newborn
Infant, Premature
Internationality
Israel
Parents
Personhood
Pregnancy
Pregnancy Trimester, Third
Public Policy
Quality of Life
Resuscitation
Social Values
United States
Value of Life
Withholding Treatment
Abstract
Abortion, particularly later-term abortion, and neonaticide, selective non-treatment of newborns, are feasible management strategies for fetuses or newborns diagnosed with severe abnormalities. However, policy varies considerably among developed nations. This article examines abortion and neonatal policy in four nations: Israel, the US, the UK and Denmark. In Israel, late-term abortion is permitted while non-treatment of newborns is prohibited. In the US, on the other hand, later-term abortion is severely restricted, while treatment to newborns may be withdrawn. Policy in the UK and Denmark bridges some of these gaps with liberal abortion and neonatal policy. Disparate policy within and between nations creates practical and ethical difficulties. Practice diverges from policy as many practitioners find it difficult to adhere to official policy. Ethically, it is difficult to entirely justify perinatal policy in these nations. In each nation, there are elements of ethically sound policy, while other aspects cannot be defended. Ethical policy hinges on two underlying normative issues: the question of fetal/newborn status and the morality of killing and letting die. While each issue has been the subject of extensive debate, there are firm ethical norms that should serve as the basis for coherent and consistent perinatal policy. These include 1) a grant of full moral and legal status to the newborn but only partial moral and legal status to the late-term fetus 2) a general prohibition against feticide unless to save the life of the mother or prevent the birth of a fetus facing certain death or severe pain or suffering and 3) a general endorsement of neonaticide subject to a parent's assessment of the newborn's interest broadly defined to consider physical harm as well as social, psychological and or financial harm to related third parties. Policies in each of the nations surveyed diverging from these norms should be the subject of public discourse and, where possible, legislative reform.
PubMed ID
12211246 View in PubMed
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Accessibility, continuity and appropriateness: key elements in assessing integration of perinatal services.

https://arctichealth.org/en/permalink/ahliterature183622
Source
Health Soc Care Community. 2003 Sep;11(5):397-404
Publication Type
Article
Date
Sep-2003
Author
Danielle D'Amour
Lise Goulet
Jean-François Labadie
Liette Bernier
Raynald Pineault
Author Affiliation
Faculté des sciences infirmières and Groupe de recherche interdisciplinaire en santé (GRIS), Université de Montréal, Montreal, Quebec, Canada. Danielle.damour@umontreal.ca
Source
Health Soc Care Community. 2003 Sep;11(5):397-404
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Continuity of Patient Care - statistics & numerical data
Delivery of Health Care, Integrated - statistics & numerical data
Female
Health Care Rationing - statistics & numerical data
Health Services Accessibility - statistics & numerical data
House Calls - statistics & numerical data
Humans
Infant, Newborn
Length of Stay
Patient Education as Topic - standards
Perinatal Care - statistics & numerical data
Postnatal Care - statistics & numerical data
Pregnancy
Quebec
Regional Health Planning - methods
Telemedicine - statistics & numerical data
Abstract
A trend toward the reduction in the length of hospital stays has been widely observed. This increasing shift is particularly evident in perinatal care. A stay of less than 48 hours after delivery has been shown to have no negative effects on the health of either the mother or the baby as long as they receive an adequate follow-up. This implies a close integration between hospital and community health services. The present article addresses the following questions: To what extent are postnatal services accessible to mothers and neonates? Are postnatal services in the community in continuity with those of the hospital? Are the services provided by the appropriate source of care? The authors conducted a telephone survey among 1158 mothers in a large urban area in the province of Quebec, Canada. The results were compared to clinical guidelines widely recognised by professionals. The results show serious discrepancies with these guidelines. The authors found a low accessibility to services: less than half of the mothers received a home visit by a nurse. In terms of continuity of care, less than 10% of the mothers received a follow-up telephone call within the recommended time frame and only 18% benefited from a home visit within the recommended period. Finally, despite guidelines to the contrary, hospitals continue to intervene after discharge. This results in a duplication of services for 44.7% of the new-borns. On the other hand, 40.7% are not seen in the recommended period after hospital discharge at all. These results raise concerns about the integration of services between agencies. Following earlier work, the present authors have grouped explanatory factors under four dimensions: the strategic dimension, particularly leadership; the structural dimension, including the size of the network; the technological dimension, with respect to information transmission system; and the cultural dimension, which concerns the collaboration process and the development of relationships based on trust.
PubMed ID
14498836 View in PubMed
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Access to adult liver transplantation in Canada: a survey and ethical analysis.

https://arctichealth.org/en/permalink/ahliterature212821
Source
CMAJ. 1996 Feb 1;154(3):337-42
Publication Type
Article
Date
Feb-1-1996
Author
M A Mullen
N. Kohut
M. Sam
L. Blendis
P A Singer
Author Affiliation
University of Toronto Joint Centre for Bioethics, Ont.
Source
CMAJ. 1996 Feb 1;154(3):337-42
Date
Feb-1-1996
Language
English
Publication Type
Article
Keywords
Adult
Canada
Data Collection
Health Care Rationing - organization & administration
Health Services Accessibility - organization & administration
Humans
Liver Transplantation
Organizational Policy
Patient Selection
Resource Allocation
Waiting Lists
Abstract
To describe the substantive and procedural criteria used for placing patients on the waiting list for liver transplantation and for allocating available livers to patients on the waiting list; to identify principal decision-makers and the main factors limiting liver transplantation in Canada; and to examine how closely cadaveric liver allocation resembles theoretic models of source allocation.
Mailed survey.
Medical directors of all seven Canadian adult liver transplantation centres, or their designates. Six of the questionnaires were completed.
Relative importance of substantive and procedural criteria used to place patients in the waiting list for liver transplantation and to allocate available livers. Identification of principal decision-makers and main limiting factors to adult liver transplantation.
Alcoholism, drug addiction, HIV positivity, primary liver cancer, noncompliance and hepatitis B were the most important criteria that had a negative influence on decisions to place patients on the waiting list for liver transplantation. Severity of disease and urgency were the most important criteria used for selecting patients on the waiting list for transplantation. Criteria that were inconsistent across the centres included social support (for deciding who is placed on the waiting list) and length of time on the waiting list (for deciding who is selected from the list). Although a variety of people were reported as being involved in these decisions, virtually all were reported to be health to be health care professionals. Thirty-seven patients died while waiting for liver transplantation in 1991; the scarcity of cadaveric livers was the main limiting factor.
Criteria for resource allocation decisions regarding liver transplantation are generally consistent among the centres across Canada, although some important inconsistencies remain. Because patients die while on the waiting list and because the primary limiting factor is organ supply, increased organ acquisition efforts are needed.
Notes
Cites: Psychosomatics. 1993 Jul-Aug;34(4):314-238351306
Cites: Arch Intern Med. 1990 Mar;150(3):523-72178581
Cites: BMJ. 1990 Jul 7;301(6742):15-72383700
Cites: N Engl J Med. 1991 Oct 24;325(17):1243-61845039
PubMed ID
8564903 View in PubMed
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Accounting for vulnerability to illness and social disadvantage in pandemic critical care triage.

https://arctichealth.org/en/permalink/ahliterature96997
Source
J Clin Ethics. 2010;21(1):23-9
Publication Type
Article
Date
2010
Author
Chris Kaposy
Author Affiliation
Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada. christopher.kaposy@med.mun.ca
Source
J Clin Ethics. 2010;21(1):23-9
Date
2010
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Critical Care
Cultural Characteristics
Disaster Planning - trends
Disease Outbreaks
Health Care Rationing - ethics
Health Policy - trends
Humans
Indians, North American - statistics & numerical data
Influenza A Virus, H1N1 Subtype - isolation & purification
Influenza, Human - ethnology - mortality - virology
Intensive Care Units - organization & administration - standards
Inuits - statistics & numerical data
Newfoundland and Labrador - epidemiology
Patient Selection - ethics
Prognosis
Risk assessment
Social Class
Triage - methods - organization & administration - standards - trends
Vulnerable Populations
Abstract
In a pandemic situation, resources in intensive care units may be stretched to the breaking point, and critical care triage may become necessary. In such a situation, I argue that a patient's combined vulnerability to illness and social disadvantage should be a justification for giving that patient some priority for critical care. In this article I present an example of a critical care triage protocol that recognizes the moral relevance of vulnerability to illness and social disadvantage, from the Canadian province of Newfoundland and Labrador.
PubMed ID
20465071 View in PubMed
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Action ethical dilemmas in surgery: an interview study of practicing surgeons.

https://arctichealth.org/en/permalink/ahliterature51843
Source
BMC Med Ethics. 2005 Jul 4;6:E7
Publication Type
Article
Date
Jul-4-2005
Author
Kirsti Torjuul
Ann Nordam
Venke Sørlie
Author Affiliation
Sør-Trøndelag University College, Faculty of Nursing, Trondheim, Norway. kirsti.torjuul@hist.no.
Source
BMC Med Ethics. 2005 Jul 4;6:E7
Date
Jul-4-2005
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Ethics, Clinical
Health Care Rationing - ethics
Humans
Informed Consent - ethics
Interprofessional Relations
Interviews
Narration
Norway
Physician Impairment
Physician-Patient Relations - ethics
Physicians - ethics - psychology
Resuscitation Orders - legislation & jurisprudence
Surgery - ethics
Waiting Lists
Withholding Treatment - ethics
Abstract
BACKGROUND: The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice. METHODS: Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. RESULTS: No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests. CONCLUSION: The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.
PubMed ID
15996268 View in PubMed
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Activity-based costing in radiology. Application in a pediatric radiological unit.

https://arctichealth.org/en/permalink/ahliterature32870
Source
Acta Radiol. 2000 Mar;41(2):189-95
Publication Type
Article
Date
Mar-2000
Author
J. Laurila
I. Suramo
M. Brommels
E M Tolppanen
P. Koivukangas
P. Lanning
G. Standertskjöld-Nordenstam
Author Affiliation
Department of Radiology, Oulu University Hospital, Finland.
Source
Acta Radiol. 2000 Mar;41(2):189-95
Date
Mar-2000
Language
English
Publication Type
Article
Keywords
Child
Cost Savings
Costs and Cost Analysis
Health Care Rationing - economics
Hospital Costs - statistics & numerical data
Humans
Pediatrics - economics
Radiology Department, Hospital - economics
Time and Motion Studies
Abstract
PURPOSE: To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. MATERIAL AND METHODS: A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. RESULTS: The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. CONCLUSION: Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.
PubMed ID
10741796 View in PubMed
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Admission waiting times: a national survey.

https://arctichealth.org/en/permalink/ahliterature103208
Source
Dimens Health Serv. 1990 Feb;67(1):32-4
Publication Type
Article
Date
Feb-1990

Age-related discrimination in the use of fibrinolytic therapy in acute myocardial infarction in Norway.

https://arctichealth.org/en/permalink/ahliterature54778
Source
Age Ageing. 1995 May;24(3):198-203
Publication Type
Article
Date
May-1995
Author
K I Pettersen
Author Affiliation
National Institute of Public Health, Oslo, Norway.
Source
Age Ageing. 1995 May;24(3):198-203
Date
May-1995
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Geriatric Assessment
Health Care Rationing - trends
Health Services for the Aged - trends
Humans
Male
Medical Audit
Middle Aged
Myocardial Infarction - drug therapy - mortality
Norway - epidemiology
Patient Selection
Prejudice
Research Support, Non-U.S. Gov't
Sex Factors
Thrombolytic Therapy - contraindications - utilization
Abstract
Age-related use of fibrinolytic therapy in acute myocardial infarction was studied for patients admitted to the intensive care unit in four hospitals comprising 10% of the national hospital bed capacity in Norway. Altogether, 446 patients were included. All had validated acute myocardial infarction or acute ischaemic coronary heart disease treated with fibrinolytic medication. The fibrinolytic treatment rate decreased linearly from 74% among patients younger than 50 years to 15% among those older than 80 (p
PubMed ID
7645438 View in PubMed
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542 records – page 1 of 55.