Journal articles on the topic 'Resource allocation Moral and ethical aspects'
To see the other types of publications on this topic, follow the link: Resource allocation Moral and ethical aspects.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Resource allocation Moral and ethical aspects.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Del Pilar De Antueno, Maria, Gabriela Peirano, Isabel Pincemin, Maria Isabel Iñigo Petralanda, and Eduardo Bruera. "Bioethical perspective for decision making in situations of scarcity of resources during the COVID-19 pandemic." Medicina e Morale 71, no. 1 (April 14, 2022): 25–38. http://dx.doi.org/10.4081/mem.2022.1197.
Full textAbstract:
Lack of resources available in intensive care units (ICU) during the COVID-19 pandemic requires bioethical guidance to respond to dilemmas presented in health teams. A person-centered ethical analysis (PCEA) for ICU clinicians, becomes the best alternative to morally justify extreme decision-making in the scarcity of available resources. The goal is to make a selection based on bioethical and clinical criteria, considering a holistic view of the person, and not just a utilitarian or first-come, first-served criterion as the one set out by colleagues from Oxford University, known as RAPR (Resource Adjusted Probability Ratio) ethical algorithm for rationing life-sustaining treatment during the COVID-19 pandemic. For this reason, fundamental bioethical principles emphasizing therapeutic proportionality and how to make an appropriate moral judgment that conveys to a sensible decision-making ethically grounded are explained, considering a flow chart proposed by colleagues from the Pontifical Catholic University of Chile. In this paper we propose the PCEA Algorithm to assist ICU teams in decision making regarding fair resource allocation and care delivery during an overwhelming pandemic scenario.
2
Fallucchi, Francesco, Marco Faravelli, and Simone Quercia. "Fair allocation of scarce medical resources in the time of COVID-19: what do people think?" Journal of Medical Ethics 47, no. 1 (October 12, 2020): 3–6. http://dx.doi.org/10.1136/medethics-2020-106524.
Full textAbstract:
The COVID-19 pandemic has placed an enormous burden on health systems, and guidelines have been developed to help healthcare practitioners when resource shortage imposes the choice on who to treat. However, little is known on the public perception of these guidelines and the underlying moral principles. Here, we assess on a sample of 1033 American citizens’ moral views and agreement with proposed guidelines. We find substantial heterogeneity in citizens’ moral principles, often not in line with the guidelines recommendations. As the guidelines are likely to directly affect a considerable number of citizens, our results call for policy interventions to inform people on the ethical rationale behind physicians or triage committees decisions to avoid resentment and feelings of unfairness.
3
Baxter, Rosario, Ann Long, and David Sines. "The Legal and Ethical Status of Children in Health Care in the UK." Nursing Ethics 5, no. 3 (May 1998): 189–99. http://dx.doi.org/10.1177/096973309800500302.
Full textAbstract:
Ethical issues about children’s rights in respect of matters concerning resource allocation or treatment opportunities are now a matter for public consumption and concern. Alongside this exists a long-frustrated desire by children’s nurses to promote children’s health. Long-held assumptions about the legal and moral status of children within the health care system in this country are now rightly scrutinized and challenged. Those of us who claim to represent children now possess an opportunity to exploit public attention for the benefit of these children. This article will explore selected major relevant legal and moral concepts that relate to children with the aim of making transparent some of the important and often confusing information available. It is anticipated that debates about the legal and ethical status of children may be stimulated and fuelled from the following discussion. It is strongly recommended that entering into dialogue with families and children about their perceived needs will go a long way towards advancing thoughtful nursing care of individual children, their families and the general population.
4
Fan, Ruiping. "Reconstructionist Confucianism and Health Care: An Asian Moral Account of Health Care Resource Allocation." Journal of Medicine and Philosophy 27, no. 6 (December 1, 2002): 675–82. http://dx.doi.org/10.1076/jmep.27.6.675.13795.
Full text
5
Rie, Michael A. "The Oregonian ICU: Multi-Tiered Monetarized Morality in Health Insurance Law." Journal of Law, Medicine & Ethics 23, no. 2 (1995): 149–66. http://dx.doi.org/10.1111/j.1748-720x.1995.tb01345.x.
Full textAbstract:
Resource finitude, cost containment, and a purchaser monopsony market have created public concern-about the moral and legal responsibility for quality assurance in health plans. Resource allocation and standards of care represent a clash of moral values in intensive care treatment. This essay advances a procedural model, based on legislation passed in Oregon, that could govern the incorporation of private sector health insurance plans in Oregon to assure democratic input from consumers, providers, and employers into a limited vision of individual entitlement to consume futile or inappropriate care in intensive care units (ICUs). The model, which I call the Oregonian ICU, presumes that rationing of care is implicit and not publicly disclosed under managed care. It focuses on maximizing the quality of limited benefits available in the basic managed care insurance tier. Limitations to futile and inappropriate care are developed on the basis of morally weighted prognostic scoring systems that inform the creation of negotiated private sector contracts.
6
Letov, O. V. "Some issues of biomedical ethics in a pandemic (review)." Philosophy of Science and Technology 26, no. 2 (2021): 158–64. http://dx.doi.org/10.21146/2413-9084-2021-26-1-158-164.
Full textAbstract:
The article is an analytical review of English-language articles devoted to modern problems of biomedical ethics. The article considers such ethical categories as respect for the freedom of the patient, paternalism, protection of the patient’s interests, the principle of sustainability, justified allocation of resources, etc. It is noted, in particular, that, according to the principle of equitable distribution of medical resources, everyone receives what they deserve, in accordance with the needs of health and no one is discriminated against because of individual characteristics such as gender, socioeconomic status or age. Under the principle of patient freedom, people have the right to make informed decisions of their own, including with regard to voluntary vaccination programs, and can act according to their norms, desires and beliefs. This review presents articles that, for the first time, consider the ethical aspects of dealing with the consequences of coronavirus infection. In particular, it is indicated that decisions on the priority of vaccination should be based on such principles as: a) equal moral value of each person, b) available knowledge to maximize public health by preventing COVID-19. An open and transparent dialogue with the public is needed to ensure and, in the long term, increase public confidence and justification for the adoption of a vaccination strategy. It should contain information on the current state of knowledge about the vaccine itself and about political decision-making processes, including the underlying ethical arguments.
7
Goodwin, Michele. "Vulnerable Subjects: Why Does Informed Consent Matter?" Journal of Law, Medicine & Ethics 44, no. 3 (2016): 371–80. http://dx.doi.org/10.1177/1073110516667935.
Full textAbstract:
This special issue of the Journal Law, Medicine & Ethics takes up the concern of informed consent, particularly in times of controversy. The dominant moral dilemmas that frame traditional bioethical concerns address medical experimentation on vulnerable subjects; physicians assisting their patients in suicide or euthanasia; scarce resource allocation and medical futility; human trials to develop drugs; organ and tissue donation; cloning; xenotransplantation; abortion; human enhancement; mandatory vaccination; and much more. The term “bioethics” provides a lens, language, and guideposts to the study of medical ethics. It is worth noting, however, that medical experimentation is neither new nor exclusive to one country. Authors in this issue address thorny subjects that span borders and patients: from matters dealing with children and vaccination to the language and perception of consent.
8
Chen, Donna T., Lois Shepherd, Jordan Taylor, and Mary Faith Marshall. "Who will receive the last ventilator: why COVID-19 policies should not prioritise healthcare workers." Journal of Medical Ethics 47, no. 9 (June 25, 2021): 599–602. http://dx.doi.org/10.1136/medethics-2021-107248.
Full textAbstract:
Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: (1) instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and (2) reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked.
9
Battisti, Davide, and Mario Picozzi. "Deciding the Criteria Is Not Enough: Moral Issues to Consider for a Fair Allocation of Scarce ICU Resources." Philosophies 7, no. 5 (August 24, 2022): 92. http://dx.doi.org/10.3390/philosophies7050092.
Full textAbstract:
During the first wave of the COVID-19 pandemic in Italy, practitioners had to make tragic decisions regarding the allocation of scarce resources in the ICU. The Italian debate has paid a lot of attention to identifying the specific regulatory criteria for the allocation of resources in the ICU; in this paper, however, we argue that deciding such criteria is not enough for the implementation of fair and transparent allocative decisions. In this respect, we discuss three ethical issues: (a) in the Italian context, the treating physician, rather than a separate committee, was generally the one responsible for the allocation decision; (b) although many allocative guidelines have supported moral equivalence between withholding and withdrawing treatments, some health professionals have continued to consider it a morally problematic aspect; and (c) the health workers who have had to make the aforementioned decisions or even only worked in ICU during the pandemic often experienced moral distress. We conclude by arguing that, even if these problems are not directly related to the above-mentioned issues of distributive justice, they can nevertheless directly affect the quality and ethics of the implementation of allocative criteria, regardless of those chosen.
10
Bissell, Gavin. "Spencer’sPrinciples of Psychologyand the Decline of Utilitarian Premises in British psychology." History & Philosophy of Psychology 10, no. 1 (2008): 1–8. http://dx.doi.org/10.53841/bpshpp.2008.10.1.1.
Full textAbstract:
Despite the revival of interest in nineteenth century psychology and ethics in Britain during the 1980s, and the current debate around Utilitarian ethics in medicine (Buckle, 2005) and care (Offer, 2004), Utilitarian premises, understood as a psychological theory rather than as a moral philosophy, remain largely dormant in contemporary British Psychology. This is so despite their apparent survival in Behaviourism (Plaud & Vogeltanz, 1994).This article examines aspects of their decline within Victorian psychology, by focussing upon the relatively neglected psychological writings of Herbert Spencer. In doing so, it seeks to make a modest contribution to unravelling the complex changes in the nature of nineteenth-century psychology. In particular it is argued that, whilst some explanations of the decline of Utilitarian premises in the Victorian development of psychology focus upon the later part of the century and cultural or institutional factors, an examination of Spencer’s works at the mid-century supports the view that changes were under way earlier. Whilst several explanations might be offered for this, changes in economic organisation and in the experience of individual agency are highlighted.The relation between Utilitarian psychology and Utilitarian ethics will then be considered. Finally, at this stage it should be possible to comment upon the significance of the marginalization of Utilitarian premises within the development of Victorian psychology for the contemporary debate about health resource allocation.
11
Farroni, Jeffrey S., and Emma Tumilty. "4453 Public Health Ethics: Utilizing open education methods to foster interprofessional learning and practices." Journal of Clinical and Translational Science 4, s1 (June 2020): 65. http://dx.doi.org/10.1017/cts.2020.220.
Full textAbstract:
OBJECTIVES/GOALS: Innovative educational approaches and training modalities are important for training a diverse workforce in the authentic skills needed to advance all phases of clinical and translational research. Endeavors to study and develop policies that promote the translational science spectrum are steeped in value judgments. Learning how to navigate moral ambiguity and ethical reasoning enlightens our understanding of stakeholder obligations, roles and responsibilities. Ethics education can be challenging if learners are insufficiently engaged in the necessary critical reflection. In this course, decision-making in public health is informed through the analysis of the ethical issues, developing alternative courses of action and providing justification for actions taken in response to real-world dilemmas. The course is provided to students with a variety of backgrounds (science, health, policy) in a Master of Public Health degree program. Course objective were to: 1) Identify ethical issues in public health policy, practice, and research using appropriate concepts and terms; 2) Recognize the full spectrum of determinants of health and related information needed to resolve ethical conflicts in public health policy, practice, and research; 3) Present varied and complex information in written and oral formats; 4) Assess potential solutions to ethical conflicts in public health policy, practice, and research and 5) Decide ethical courses of action for public health policy, practice, and research. We adopted an open pedagogy as a guiding praxis to inform public health ethics discourse amongst our learners. In this way, learner agency was maximized to develop course materials within a generalized framework and shared with each other through the perspectives of each individual. The goal was to not only analyze complex ethical dimensions of public health issues but also gain insights into the disciplinary lenses of one’s peers. METHODS/STUDY POPULATION: Each week was divided into two sessions, a seminar and workshop. Course instructors introduce topics in a one-hour session and then allow students to decide what information is needed for a second session where the ethical issues of the topic will be discussed. Information-gathering tasks are then distributed amongst students in areas that are not their specialty, e.g. social history to be researched by learner with a biology background. The second session then involves the reporting back of background information by each student and a discussion of the ethical issues that arise. Through this process, the ability to communicate with others in different disciplines is supported, while exploring other disciplines and then engaging in ethical discussion and reasoning. Topics were introduced during the seminar session each week over the span of five weeks: 1) global public health, 2) disease prevention & control, 3) environmental & occupational public health, 4) resource allocation & priority setting and 5) research ethics. Learners were tasked with identifying the needed information to address the ethical, policy, and research aspects of the public health question(s) presented in these seminars. Students independently submitted resources they discovered to course instructors prior to the workshop. The following session began with a workshop where learners briefly presented their findings and deliberated on specific facets of the public health issue from that previous seminar while discussing a specific case. Students were assessed on their preparation (submission of identified resources), workshop presentation and participation. Research Preparation: In each seminar, the class decided what key information would be required to support the discussion at the workshop, which revolved around a relevant case study on that week’s topic. Course instructors facilitated the groups identification of material to be researched and the delegation of tasks within the group. Each student submitted a summary document (template provided) to course instructors prior to class for their area of research related to the case. Research Presentation: At the beginning of each workshop, each student was asked to present the research work to the rest of the class so that everyone has the same information for the case study discussion. These short (5-10 minutes) presentations followed the format of the preparation summary. Participation/collaboration: Both the seminar and the workshop asked students to be active learners within the class, participating in discussion, strategizing for information-gathering tasks, presenting researched material and arguments to others, and participating in case study discussion. Participation was assessed in relation to the value of the contributions made by students. RESULTS/ANTICIPATED RESULTS: The open pedagogy allowed the learners to construct the necessary materials to discuss issues with each other and develop not only a deeper understanding of the ethical dimension of public health issues but a shared understanding of each other’s disciplinary lenses. Course feedback was generally very positive, with learners either agreeing (33%) or strongly agreeing (67%) that the course was effective overall. In asking what learners liked best about the course, some indicated the “open pedagogy learning style” and “I liked the discussion format.” The positive comments mostly highlighted the discussion format. Areas for improvement noted by the learners included wanting “a longer course to cover more topics” and that the material was covered in “too short a time frame.” Other comments included that the course “was a bit disorganized” or that “the discussions were not very structured.” While the discussions by their very nature were unstructured, there is opportunity to refine this pedagogy to find right balance of learner agency. DISCUSSION/SIGNIFICANCE OF IMPACT: The goal of this teaching method was to empower the learner with the important critical thinking skills to navigate challenging ethical dilemmas in public health they may encounter in their careers. These skills include the identification of the ethical or moral conflict(s), collecting the necessary information to examine/resolve the dilemma, think creatively about the information that is unavailable and how to discuss/disseminate information to a broad constituency. This an educational model that is easily adaptable for learners working in other areas of the translational research spectrum, e.g. basic, pre-clinical, clinical and implementation sciences.
12
Friesen, Phoebe. "Personal responsibility within health policy: unethical and ineffective." Journal of Medical Ethics 44, no. 1 (September 22, 2016): 53–58. http://dx.doi.org/10.1136/medethics-2016-103478.
Full textAbstract:
This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the debate to also include socially accepted behaviours or to provide an alternative explanation of the narrowly focused discussion. Second, a critical response is offered to arguments that claim that policies based on personal responsibility would lead to several positive outcomes including healthy behaviour change, better health outcomes and decreases in healthcare spending. It is argued that using individual responsibility as a basis for resource allocation in healthcare is unlikely to motivate positive behaviour changes, and is likely to increase inequality which may lead to worse health outcomes overall. Finally, the case of West Virginia's Medicaid reform is examined, which raises a worry that policies focused on personal responsibility have the potential to lead to increases in medical spending overall.
13
Bosanquet, Nick, and Anna Zajdler. "Psychopharmacology and the Ethics of Resource Allocation." British Journal of Psychiatry 162, no. 1 (January 1993): 29–32. http://dx.doi.org/10.1192/s000712500013168x.
Full textAbstract:
Economists in the UK have developed a particular view of ethical choice which puts the main focus on short-term, static decisions. As resources are scarce, decisions have to compete (O'Donnell et al, 1988). Although economists have also stressed the moral imperative of improving efficiency, the theme of choice as inexorable has come through much more strongly. Economists in the UK have been more hesitant about giving any clear advice on how to deal with the special problems of supply efficiencies and professional monopoly in health services.
14
Bulgakova, Elena, and Konstantin Lidin. "Urban infrastructure modeling: Ethical and aesthetic aspects." проект байкал, no. 70 (December 17, 2021): 84–89. http://dx.doi.org/10.51461/projectbaikal.70.1894.
Full textAbstract:
In modern urban planning discourse, ethical issues, primarily the fairness of resource allocation, are being discussed more and more persistently. The city's infrastructure is considered here as an expression of the principles of social philosophy. The article raises the problem of modeling the ethical and aesthetic aspects of urban infrastructure using artificial intelligence as part of the general trend in the development of modern architecture.
15
Pauls, Merril, Connie LeBlanc, and Sam Campbell. "Ethics in the trenches: preparing for ethical challenges in the emergency department." CJEM 4, no. 01 (January 2002): 45–48. http://dx.doi.org/10.1017/s1481803500006059.
Full textAbstract:
ABSTRACTEthical issues can be more difficult to address in the emergency department than in other settings. We present two cases, with the goal of stimulating moral reflection and encouraging emergency physicians to gain a better understanding of two important ethical issues: advance directives and resource allocation decisions.Understanding the legal and ethical basis for advance directives allows emergency physicians to determine when the directives should be followed and when they should be questioned. Resource allocation decisions are among the toughest decisions emergency physicians make. Although patients or substitute decision-makers define the value of a treatment goal, emergency physicians must ensure that this goal does indeed represent the patient’s wishes, that it is achievable, and that competing claims for the same resource are considered.Learning from others’ experiences and preparing for ethical problems in advance will help physicians feel more comfortable in dealing with ethical issues.
16
Lucia, Irccs S. "Ethical Aspects of Brain Research." European Journal of Health Law 1, no. 4 (1994): 427–29. http://dx.doi.org/10.1163/157180994x00105.
Full textAbstract:
AbstractTheme I: Health and Human Rights. Health and human rights in relation to children and other vulnerable groups - for example, ethnic minorities and migrants; the role of health professionals in promoting respect for human rights; discrimination on the basis of health status. Theme II: The Death Debates. Cross-cultural and comparative religion perspectives on dying; euthanasia; nurse-assisted and physician-assisted suicide; the futility debate; advance directives; transplantation ; procuring organs from heart-beating donors or anencephalic infants. Theme III: Genetics and Reproductive Technology. The nature of human identity; genome mapping; genetic manipulation and counselling ; embryo research; preimplantation and prenatal diagnosis; the legal status of embryos, fetuses, infants, and families created by assisted reproduction; fetal tissue transplants; eugenics; population ethics. Theme IV: Health, Ecology, Persons and Planet. The connections between human health and ecological health, including how concepts developed in medicine, ethics, and law might be applicable in the promotion of ecological health, and vice versa. These include resource allocation; justice (including intergenerational justice) in health care; open and closed legal systems; and concepts of trust, covenant, and quality of life.
17
Hirskyj, Peter. "QALY: An Ethical Issue that Dare Not Speak its Name." Nursing Ethics 14, no. 1 (January 2007): 72–82. http://dx.doi.org/10.1177/0969733007071360.
Full textAbstract:
The current British Government's policy towards resource allocation for health care has been informed by the commissioned Wanless Report. This makes a case for the use of quality adjusted life years (QALYs) to form a rationale for resourcing health care and has implications for the staff and patients who work in and use the health service. This article offers a definition of the term ‘QALY’ and considers some of the strengths and weaknesses of this approach to resource distribution. An account is also given of an alternative formula, the DALY (disability adjusted life years), which can address some of the problems that are associated with QALYs. The values of the public, patients and nurses are identified and linked to the potential effect of a QALY formula. The implications of QALY use are applied to the health care of patients and a discussion is offered with regard to whether this method of resource allocation can be considered as just.
18
Boakye, Priscilla N., Elizabeth Peter, Anne Simmonds, and Solina Richter. "An examination of the moral habitability of resource-constrained obstetrical settings." Nursing Ethics 28, no. 6 (March 11, 2021): 1026–40. http://dx.doi.org/10.1177/0969733020988311.
Full textAbstract:
Background: While there have been studies exploring moral habitability and its impact on the work environments of nurses in Western countries, little is known about the moral habitability of the work environments of nurses and midwives in resource-constrained settings. Research objective: The purpose of this research was to examine the moral habitability of the work environment of nurses and midwives in Ghana and its influence on their moral agency using the philosophical works of Margaret Urban Walker. Research design and participants: A critical moral ethnography was conducted through the analysis of interviews with 30 nurses and midwives, along with observation, and documentary materials. Ethical considerations: After receiving ethics approval, signed informed consent was obtained from participants before data collection. Results: Five themes were identified: (1) holding onto the values, identities, and responsibilities of being a midwife/nurse; (2) scarcity of resources as limiting capacity to meet caring responsibilities; (3) gender and socio-economic inequities shaping the moral-social context of practice; (4) working with incoherent moral understandings and damaged identities in the context of inter- and intra-professional relationships; and (5) surviving through adversity with renewed commitment and courage. Discussion: The nurses and midwives were found to work in an environment that was morally uninhabitable and dominated by the scarcity of resources, overwhelming and incoherent moral responsibilities, oppressive conditions, and workplace violence. These situations constrained their moral agency and provoked suffering and distress. The nurses and midwives negotiated their practice and navigated through morally uninhabitable work environment by holding onto their moral values and commitments to childbearing women. Conclusion: Creating morally habitable workplaces through the provision of adequate resources and instituting interprofessional practice guidelines and workplace violence prevention policies may promote safe and ethical nursing and midwifery practice.
19
Villanueva, Angela Guadalupe, and Alina Bennett. "Insights from Blood Products Management for Pre-Crisis Ethical Resource Allocation." American Journal of Bioethics 21, no. 8 (July 27, 2021): 42–45. http://dx.doi.org/10.1080/15265161.2021.1940366.
Full text
20
Scott, P. Anne, Clare Harvey, Heike Felzmann, Riitta Suhonen, Monika Habermann, Kristin Halvorsen, Karin Christiansen, Luisa Toffoli, and Evridiki Papastavrou. "Resource allocation and rationing in nursing care: A discussion paper." Nursing Ethics 26, no. 5 (April 1, 2018): 1528–39. http://dx.doi.org/10.1177/0969733018759831.
Full textAbstract:
Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource.
21
Guidolin, Keegan, Jennifer Catton, Barry Rubin, Jennifer Bell, Jessica Marangos, Ann Munro-Heesters, Terri Stuart-McEwan, and Fayez Quereshy. "Ethical decision making during a healthcare crisis: a resource allocation framework and tool." Journal of Medical Ethics 48, no. 8 (May 21, 2021): 504–9. http://dx.doi.org/10.1136/medethics-2021-107255.
Full textAbstract:
The COVID-19 pandemic has strained healthcare resources the world over, requiring healthcare providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped-down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave, we sought to make such ramp down decisions more prudently and ethically. We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that a diverse range of stakeholder perspectives were represented in this development process. This team, called the clinical activity recovery team, established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria by using a variation on the well-known accountability for reasonableness ethical framework. The result of this is a stepwise, semiquantitative, ethical decision tool that can be applied to resource allocation challenges in order to reach fair and ethically defensible decisions. This ethical decision tool can be applied in various contexts and may prove useful at both the institutional and the departmental level; indeed this is how it is applied at our centre. As the second wave of COVID-19 strains healthcare resources, this tool can help clinical leaders to make fair decisions.
22
Fredwall, Terje Emil, and Inger Beate Larsen. "Textbook descriptions of people with psychosis – some ethical aspects." Nursing Ethics 26, no. 5 (April 29, 2018): 1554–65. http://dx.doi.org/10.1177/0969733017753742.
Full textAbstract:
Background: Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field. Objectives: This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis. Research design: We used qualitative content analysis. Ethical considerations: The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required. Findings: The analysis shows that all 12 textbooks describe and present people who are considered as psychotic from a ‘perspective from above’. In this perspective, the readers are learning about psychosis in the professional’s language and from the author’s viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a ‘perspective from within’. Here, the readers are learning about psychosis from the patients’ own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person. Discussion and conclusion: Drawing partly on Rita Charon’s writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients’ own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness.
23
Asgary, Ramin, and Katharine Lawrence. "Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers." BMJ Open 10, no. 9 (September 2020): e039463. http://dx.doi.org/10.1136/bmjopen-2020-039463.
Full textAbstract:
IntroductionData regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited.MethodsWe conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations.Results61% were female; average age was 41.8 years; 500 collective years of humanitarian experience (11.8 average) working with diverse major international non-governmental organisations. Important themes included; allocation schemes and integrity of the humanitarian industry, including resource allocation and fair access to and use of services; staff or organisational competencies and aid quality; humanitarian process and unintended consequences; corruption, diversion, complicity and competing interests, and intentions versus outcomes; professionalism and interpersonal and institutional responses; and exposure to extreme inequities and emotional and moral distress. Related concepts included broader industry context and allocations; decision-making, values, roles and sustainability; resource misuse at programme, government and international agency levels; aid effectiveness and utility versus futility, and negative consequences. Multiple contributing, confounding and contradictory factors were identified, including context complexity and multiple decision-making levels; limited input from beneficiaries of aid; different or competing social constructs, values or sociocultural differences; and shortcomings, impracticality, or competing philosophical theories or ethical frameworks.ConclusionsEthical situations are overarching and often present themselves outside the exclusive scope of moral reasoning, philosophical views, professional codes, ethical or legal frameworks, humanitarian principles or social constructivism. This study helped identify a common instinct to uphold fairness and justice as an underlying drive to maintain humanity through proximity, solidarity, transparency and accountability.
24
Aitamaa, Elina, Helena Leino-Kilpi, Pauli Puukka, and Riitta Suhonen. "Ethical problems in nursing management: The role of codes of ethics." Nursing Ethics 17, no. 4 (July 2010): 469–82. http://dx.doi.org/10.1177/0969733010364896.
Full textAbstract:
The aim of this study was to identify the ethical problems that nurse managers encounter in their work and the role of codes of ethics in the solutions to these difficulties. The data were collected using a structured questionnaire and analysed statistically. The target sample included all nurse managers in 21 specialized health care or primary health care organizations in two hospital districts in Finland (N = 501; response rate 41%). The most common ethical problems concerned resource allocation as well as providing and developing high quality care. This was the case in different managerial positions as well as in types of organization. Professional codes of ethics were used more often for problems related to patients’ care compared with issues of resource allocation. Nurse managers at middle or strategic management levels used codes of ethics more often than those in charge of a ward. More research is required to investigate ethical decision making in nursing management, especially with regard to problem solving. In addition, new guidelines and continuing education in ethics are important for management personnel.
25
Denburg, Avram. "Social values and cancer funding priorities: Empirical evidence for cancer policy." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18352-e18352. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18352.
Full textAbstract:
e18352 Background: Achieving value in health care requires knowledge of public values and priorities. To better understand public values for resource allocation on cancer care, we conducted a population-based stated preference survey with a nested randomized controlled moral reasoning intervention. Our objective was to generate evidence to inform economic evaluation and policymaking on cancer care priority-setting and payment reform in developed health systems. Methods: We conducted a population-based stated preference survey of societal views on the prioritization of health resources between children and adults, administered to a nationally representative sample (n = 1,556) of Canadian adults. Allocative preferences were elicited across a range of hypothetical treatment scenarios and scored on a visual analogue scale. Participants were randomized to a moral reasoning intervention (n = 773) or a control group (n = 783). Those randomized to the intervention group were exposed to a moral reasoning exercise prior to each choice task. The exercise presented participants with a list of ethical principles relevant to health care resource allocation and tasked them to select the top principles guiding their choice. The main outcomes were the difference in mean preference scores by group, scenario, and participant demographics. Results: Multiple regression analyses demonstrated a consistent aggregate preference by participants to allocate scarce health system resources to children. Exposure to the moral reasoning exercise weakened but did not eliminate allocative preference for children, as compared to control (difference 0.72, SE 0.14, p < 0.0001). Younger respondent age (-0.71, SE 0.14, p < 0.0001) and parenthood (-0.40, SE 0.11, p < 0.0002) were associated with greater preference for children. The top three principles guiding participants’ allocative decisions were treat equally (54.3-63.9%), relieve suffering (39.6-66.1%), and rescue those at risk of dying (37-40.8%). Conclusions: Our results demonstrate a significant preference by participants to allocate health care resources to children, but one attenuated by exposure to a range of ethical principles to guide decision-making. It also evinced strong support for humanitarian principles to guide health care resource allocation. Definitions of value in health care based primarily on the magnitude of clinical benefit and cost-effectiveness may exclude moral considerations that the public values.
26
Kulkarni, Rajesh K., and Aarti A. Kinikar. "Ethics and the COVID-19 pandemic; A clinician’s perspective." Journal of Nepal Paediatric Society 40, no. 2 (September 11, 2020): 146–47. http://dx.doi.org/10.3126/jnps.v40i2.29409.
Full textAbstract:
The COVID-19 pandemic has raised exigent medical, ethical and organizational challenges. While some excellent articles have been published about the ethical aspects of pandemics from a bioethicist’s perspective , there is meager published literature on clinician’s perspective. The issues important from a clinician’s point of view are duty to treat, personal safety, safety of family, safety of colleagues, resource allocation, care for non COVID-19 patients and research.
27
Hyder, Adnan A., Abbas Rattani, and Bridget Pratt. "Research Capacity Strengthening in Low- and Middle-Income Countries: Ethical Explorations." Journal of Law, Medicine & Ethics 45, no. 1 (2017): 129–37. http://dx.doi.org/10.1177/1073110517703106.
Full textAbstract:
With developed country governments and high resource institutions engaging in research in low- and middle-income countries (LMIC), we argue that these entities have a moral obligation to help build and strengthen research infrastructure and capacity so local scientists and institutions can adequately conduct studies to understand and resolve the health burdens in low and middle income countries. We explore the moral justifications and motivations behind engaging in research capacity strengthening in the health sector in LMIC at multiple levels. In highlighting these issues, this paper aims to initiate a global discourse around why capacity development in LMIC has a moral basis at the individual, institutional and system levels.
28
Mishra, Priyanka, and Amborish Nath MCH. "Who Deserves a Ventilator Amidst the Covid-19 Pandemic? Sorting the Moral, Ethical and Legal Dilemma in Indian Scenario." International Journal of Clinical Case Reports and Reviews 8, no. 4 (September 30, 2021): 01–03. http://dx.doi.org/10.31579/2690-4861/158.
Full textAbstract:
The novel coronavirus disease (COVID-19) has rampaged into a second wave and shook the health infrastructure of several countries with India being among one of the worst-hit nations. In consideration of the current immense scarcity of ventilators in India, cautious resource allocation is the need of the hour. Hence, the Intensive care units and the ventilator allocation triage need to be formulated by a central public policy. This is due to the clinical implications, subjective judgments, ethical controversy, evidentiary weaknesses, and organizational complexities. This article suggests few approaches to suitably acknowledge everyone’s rights and judiciously allocate the ventilators for maximum benefit. This will ensure that the “maximum life years” are saved and no patient dies unlawfully.
29
Vincent, Jean-Louis. "Ethical Lessons from an Intensivist’s Perspective." Journal of Clinical Medicine 11, no. 6 (March 15, 2022): 1613. http://dx.doi.org/10.3390/jcm11061613.
Full textAbstract:
Intensive care units (ICUs) around the world have been hugely impacted by the SARS-CoV-2 pandemic and the vast numbers of patients admitted with COVID-19, requiring respiratory support and prolonged stays. This pressure, with resulting shortages of ICU beds, equipment, and staff has raised ethical dilemmas as physicians have had to determine how best to allocate the sparse resources. Here, we reflect on some of the major ethical aspects of the COVID-19 pandemic, including resource allocation and rationing, end-of-life decision-making, and communication and staff support. Importantly, these issues are regularly faced in non-pandemic ICU patient management and useful lessons can be learned from the discussions that have occurred as a result of the COVID-19 situation.
30
Rupp, Deborah E., and Chris M. Bell. "Extending the Deontic Model of Justice: Moral Self-Regulation in Third-Party Responses to Injustice." Business Ethics Quarterly 20, no. 1 (January 2010): 89–106. http://dx.doi.org/10.5840/beq20102017.
Full textAbstract:
AbstractThe deontic model of justice and ethical behavior proposes that people care about justice simply for the sake of justice. This is an important consideration for business ethics because it implies that justice and ethical behavior are naturally occurring phenomena independent of system controls or individual self-interest. To date, research on the deontic model and third-party reactions to injustice has focused primarily on individuals’ tendency topunishtransgressors. This research has revealed that witnesses to injustice will consider sacrificing their own resources if it is the only way to sanction an observed transgressor. In this paper we seek to extend this model by arguing that punishment may not be the only “deontic” reaction, and that in fact, third-party observers of injustice may engage in moral self-regulation that would lead them to conclude that the most ethical response is to do nothing. We provide preliminary evidence for our propositions using voiced cognitions data collected during a resource allocation task. Results indicate that deonance may be more complex than originally thought, and previous tests of the model conservative in nature.
31
Racine, Eric, Catherine Rodrigue, James L. Bernat, Richard Riopelle, and Sam D. Shemie. "Observations on the Ethical and Social Aspects of Disorders of Consciousness." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 37, no. 6 (November 2010): 758–68. http://dx.doi.org/10.1017/s0317167100051416.
Full textAbstract:
AbstractThe care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. We provide updates on major controversies surrounding disorders of consciousness. Issues such as withdrawal of artificial nutrition and hydration – which had been considered “settled” by many in the medical, legal and ethical communities – have resurfaced under the pressure of social groups and religious authorities. Some assumptions about the level of awareness and the prognosis of vegetative state and minimal conscious patients are questioned by advances in clinical care because of insights produced by neuroscience research techniques, particularly functional neuroimaging. Both the clinical and neuroscience dimensions of disorders of consciousness raise complex issues such as resource allocation and high levels of diagnostic inaccuracies (at least, for the vegetative state). We conclude by highlighting areas needing further research and collaboration.
32
Panizza, Silvia. "Exploring Ethical Assumptions and Bias in Medical Ethics Teaching." Teaching Ethics 19, no. 2 (2019): 233–44. http://dx.doi.org/10.5840/tej20209875.
Full textAbstract:
This paper is a reflection on an experiment undertaken during a Medical Ethics lecture delivered to a group of medical students in the UK as part of a project for a programme in Higher Education Practice. The aim of the project, following Paulo Freire’s idea of ‘liberating education,’ was to identify students’ ethical assumptions and biases in relation to a problem of resource allocation in healthcare, and their role in decision-making. The experiment showed the importance placed by medical students on disputed values such as free will, desert, social worth and body image, and highlighted the difficulty and importance of bringing students’ process of moral decision-making to awareness in ethics teaching, in order to a) decrease the role of implicit bias in students’ decision making and b) allow students to decide whether they in fact agree with assumed values and ethical frameworks that influence their thinking.
33
Knight, Selena, Benedict WJ Hayhoe, Lucy Frith, Mark Ashworth, Imran Sajid, and Andrew Papanikitas. "Ethics education and moral decision-making in clinical commissioning: an interview study." British Journal of General Practice 70, no. 690 (December 17, 2019): e45-e54. http://dx.doi.org/10.3399/bjgp19x707129.
Full textAbstract:
BackgroundClinical commissioning involves ethically challenging decisions about health resource allocation. However, commissioners come from a range of professional backgrounds with varying levels of training and expertise in ethical decision-making. Hence, they may lack the relevant training and resources to feel fully prepared for this increasingly demanding role.AimThis study aims to provide insight into how prepared commissioners feel in making ethical decisions; what ethics learning needs they might have; and how these might be addressed.Design and settingThis qualitative interview study explored the experiences of commissioners working for clinical commissioning groups (CCGs) in England.MethodEighteen participants were interviewed between December 2017 and July 2018 using a purposive sampling approach to participant selection. Transcriptions were coded and analysed using the constant comparative method of thematic analysis.ResultsMost participants had not received ethics training in preparation for, or during, their commissioning role, and reported difficulties identifying and analysing ethical issues. Participants often felt uncomfortable about decisions they were involved in, attributing this to a number of factors: a sense of moral unease; concerns that CCGs’ decision-making processes were not sufficiently transparent; and that CCGs were not fully accountable to the population served.ConclusionCommissioners face complex decisions involving ethical issues, and associated moral unease is exacerbated by a lack of ethics training and lack of confidence in identifying and analysing these. This study shows a clear need for additional support and ethics training for commissioners to support them in this area of decision-making.
34
Carson, Rachel C., Brian Forzley, Sarah Thomas, Nina Preto, Gaylene Hargrove, Alice Virani, John Antonsen, et al. "Balancing the Needs of Acute and Maintenance Dialysis Patients during the COVID-19 Pandemic." Clinical Journal of the American Society of Nephrology 16, no. 7 (February 8, 2021): 1122–30. http://dx.doi.org/10.2215/cjn.07460520.
Full textAbstract:
The COVID-19 pandemic continues to strain health care systems and drive shortages in medical supplies and equipment around the world. Resource allocation in times of scarcity requires transparent, ethical frameworks to optimize decision making and reduce health care worker and patient distress. The complexity of allocating dialysis resources for both patients receiving acute and maintenance dialysis has not previously been addressed. Using a rapid, collaborative, and iterative process, BC Renal, a provincial network in Canada, engaged patients, doctors, ethicists, administrators, and nurses to develop a framework for addressing system capacity, communication challenges, and allocation decisions. The guiding ethical principles that underpin this framework are (1) maximizing benefits, (2) treating people fairly, (3) prioritizing the worst-off individuals, and (4) procedural justice. Algorithms to support resource allocation and triage of patients were tested using simulations, and the final framework was reviewed and endorsed by members of the provincial nephrology community. The unique aspects of this allocation framework are the consideration of two diverse patient groups who require dialysis (acute and maintenance), and the application of two allocation criteria (urgency and prognosis) to each group in a sequential matrix. We acknowledge the context of the Canadian health care system, and a universal payer in which this framework was developed. The intention is to promote fair decision making and to maintain an equitable reallocation of limited resources for a complex problem during a pandemic.
35
Strauss, Ronald P. "Health Policy and Craniofacial Care: Issues in Resource Alllocation." Cleft Palate-Craniofacial Journal 31, no. 1 (January 1994): 78–80. http://dx.doi.org/10.1597/1545-1569_1994_031_0078_hpacci_2.3.co_2.
Full textAbstract:
The distribution of health care services, including craniofacial services in the United States, is examined. The U.S. has a unique health care financing and organizational system in which persons are most commonly covered by health Insurance as a benefit of their employment. Current estimates are that nearly 40 million Americans have no health insurance (Himmelsteln et al., 1992). Approximately half of the uninsured persons are in low-wage employment that does not provide health insurance benefits nor allow them to qualify for Medicaid (Pepper Commission, 1990). Personal health care costs now exceed 11% of the U.S. gross domestic product, a significantly higher percentage than that found in other Industrialized nations (Consumer Reports, 1990b). Within the current system, is health care distributed in a fair or moral manner? What are the effects of the allocation scheme? Possible changes in health care financing and delivery are examined and basic ethical and social issues associated with a changing U.S. health care delivery system are explored.
36
Nichol, Ariadne A., and Annick Antierens. "Ethics of emerging infectious disease outbreak responses: Using Ebola virus disease as a case study of limited resource allocation." PLOS ONE 16, no. 2 (February 2, 2021): e0246320. http://dx.doi.org/10.1371/journal.pone.0246320.
Full textAbstract:
Emerging infectious diseases such as Ebola Virus Disease (EVD), Nipah Virus Encephalitis and Lassa fever pose significant epidemic threats. Responses to emerging infectious disease outbreaks frequently occur in resource-constrained regions and under high pressure to quickly contain the outbreak prior to potential spread. As seen in the 2020 EVD outbreaks in the Democratic Republic of Congo and the current COVID-19 pandemic, there is a continued need to evaluate and address the ethical challenges that arise in the high stakes environment of an emerging infectious disease outbreak response. The research presented here provides analysis of the ethical challenges with regard to allocation of limited resources, particularly experimental therapeutics, using the 2013–2016 EVD outbreak in West Africa as a case study. In-depth semi-structured interviews were conducted with senior healthcare personnel (n = 16) from international humanitarian aid organizations intimately engaged in the 2013–2016 EVD outbreak response in West Africa. Interviews were recorded in private setting, transcribed, and iteratively coded using grounded theory methodology. A majority of respondents indicated a clear propensity to adopt an ethical framework of guiding principles for international responses to emerging infectious disease outbreaks. Respondents agreed that prioritization of frontline workers’ access to experimental therapeutics was warranted based on a principle of reciprocity. There was widespread acceptance of adaptive trial designs and greater trial transparency in providing access to experimental therapeutics. Many respondents also emphasized the importance of community engagement in limited resource allocation scheme design and culturally appropriate informed consent procedures. The study results inform a potential ethical framework of guiding principles based on the interview participants’ insights to be adopted by international response organizations and their healthcare workers in the face of allocating limited resources such as experimental therapeutics in future emerging infectious disease outbreaks to ease the moral burden of individual healthcare providers.
37
Colaco, Keith A., Alanna Courtright, Sandra Andreychuk, Andrea Frolic, Ji Cheng, and April Jacqueline Kam. "Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs." Journal of Medical Ethics 44, no. 1 (July 27, 2017): 13–20. http://dx.doi.org/10.1136/medethics-2016-103531.
Full textAbstract:
ObjectiveWe sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments (EDs) in order to build ethics capacity and provide a foundation for the development of an ethics education programme.MethodsThis was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity.ResultsOf the 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress (16%), conflict management with patients or families (16%) and resource issues (15%). Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams (42%) was the most desired method.ConclusionsNurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists.
38
Winters, Niall, Sridhar Venkatapuram, Anne Geniets, and Emma Wynne-Bannister. "Prioritarian principles for digital health in low resource settings." Journal of Medical Ethics 46, no. 4 (January 16, 2020): 259–64. http://dx.doi.org/10.1136/medethics-2019-105468.
Full textAbstract:
This theoretical paper argues for prioritarianism as an ethical underpinning for digital health in contexts of extreme disadvantage. In support of this claim, the paper develops three prioritarian principles for making ethical decisions for digital health programme design, grounded in the normative position that the greater the need (of the marginalised), the stronger the moral claim. The principles are positioned as an alternative view to the prevailing utilitarian approach to digital health, which the paper argues is not sufficient to address the needs of the worst off. As researchers of digital health, we must ensure that the most globally marginalised are not overlooked by overtly technocentric implementation practices. Consequently, the paper concludes by advocating for use of the three principles to support stronger critical reflection on the ethics involved in the design and implementation of digital health programmes.
39
Passaro, Elvira, and Mario Picozzi. "The persuasion of vaccine allocation models during Covid-19. Rhetoric, ethics and science." Medicina e Morale 70, no. 4 (December 21, 2021): 447–68. http://dx.doi.org/10.4081/mem.2021.951.
Full textAbstract:
The swift development of effective vaccines against the new coronavirus was an unprecedented scientific achievement. In this paper, we discuss what models have been proposed for distributing vaccines locally and globally through the application of Aristotelian rhetoric. This discussion, therefore, focuses on a specific question: how are the different models of vaccine administration and distribution justified on an ethical-argumentative level? This report also examines what has come to be known as “vaccine nationalism” through the lens of the early experience with the COVID- 19 vaccination process. To this end, this report proceeds as follows: Section I explains the rhetorical method applied to ethical principles, and Section II explains the chosen criteria for the analysis. Section III looks at the Fair Priority Model; Section IV examines the COVAX and GAVI model; Section V presents the weighted lottery model. Section VI proposes a summary table of the analysis of the proposed models and Section VII focuses on the ethical problem of vaccine nationalism and its implications in relation to the models, that were taken into consideration during the previous sections. Section VIII offers brief conclusions; solidarity conceived as an argument of reciprocity should be, according to this analysis, the guiding value to address ethical problems in the area of resource allocation.
40
Peetz, Allan, Marie Kuzemchak, Catherine Hammack, Oscar D. Guillamondegui, Bradley M, Dennis, Shannon Eastham, Keith Meador, Laura Beskow, and Mayur Patel. "Trauma Surgeons’ Perceptions of Resuscitating Lethally Injured Patients for Organ Preservation." American Surgeon 88, no. 4 (December 28, 2021): 663–67. http://dx.doi.org/10.1177/00031348211065100.
Full textAbstract:
Background Trauma surgeons face a challenge when deciding whether to resuscitate lethally injured patients whose organ donor status is unknown. Data suggests practice pattern variability in this setting, but little is known about why. Materials and Methods We conducted semi-structured interviews with trauma surgeons practicing in Level 1 or 2 trauma centers in Tennessee. Interviews focused on ethical dilemmas and resource constraints. Analysis was performed using inductive thematic analysis. Results Response rate was 73% (11/15). Four key themes emerged. All described resuscitating patients to buy time to collect more definitive clinical information and to identify family. Some acknowledged this served the secondary purpose of organ preservation. 11/11 participants felt a primacy of obligation to the patient in front of them even after it became apparent, they could not personally benefit. For 9/11 (82%), the moral obligation to consider organ preservation was secondary/balancing; 2/11 (18%) felt it was irrelevant/immoral. Resource allocation was commonly considered. All participants expressed some limitation to resources they would allocate. All participants conveyed clear moral agency in determining resuscitation extent when the goal was to save the patient’s life, however this was less clear when resuscitating for organ preservation. Across themes, perceptions of a “standard practice” existed but the described practices were not consistent across interviewees. Discussion Widely ranging perceptions regarding ethical and resource considerations underlie practices resuscitating toward organ preservation. Common themes suggest a lack of consensus. Despite expressed beliefs, there is no identifiable standard of practice amongst trauma surgeons resuscitating in this setting.
41
Torabizadeh, Camellia, Leyla Homayuni, and Marzieh Moattari. "Impacts of Socratic questioning on moral reasoning of nursing students." Nursing Ethics 25, no. 2 (September 30, 2016): 174–85. http://dx.doi.org/10.1177/0969733016667775.
Full textAbstract:
Background: Nurses are often faced with complex situations that made them to make ethical decisions; and to make such decisions, they need to possess the power of moral reasoning. Studies in Iran show that the majority of nursing students lack proper ethical development. Socratic teaching is a student-centered method which is strongly opposed to the lecturing method. Objectives: This study was conducted to evaluate the impacts of Socratic questioning on the moral reasoning of the nursing students. Research design: In a quasi-experimental study, Crisham’s Nursing Dilemma Test was used to evaluate the results of three groups before, immediately after, and 2 months after intervention. The data were analyzed using the SPSS statistical software (v 15). Participants and research context: Through random allocation, 103 nursing students were divided into three groups. In experiment group 1 (37 students), intervention consisted of Socratic questioning-based sessions on ethics and how to deal with moral dilemmas; experiment group 2 (33 students) attended a 4-h workshop; and the control group (33 students) was not subject to any interventions. Signed informed consent forms: This research was approved by the Ethics Committee of the University. All the participants signed written informed consents. Findings: There were significant differences between experiment group 1 and experiment group 2’s pre-test and post-test scores on moral reasoning (p ≤ 0.001, p ≤ 0.001), nursing principled thinking (p ≤ 0.001, p ≤ 0.001), and practical considerations (p ≤ 0.001, p ≤ 0.031). Discussion: Both the teaching approaches improved the subjects’ moral reasoning; however, Socratic questioning proved more effective than lecturing. Compared to other similar studies in Iran and other countries, the students had inadequate moral reasoning competence. Conclusion: This study confirms the need for the development of an efficient course on ethics in the nursing curriculum. Also, it appears that Socratic questioning is an effective method to teach nursing ethics and develop nursing students’ competence of moral reasoning.
42
BRUNO, BETHANY, HEATHER MCKEE HURWITZ, MARYBETH MERCER, HILARY MABEL, LAUREN SANKARY, GEORGINA MORLEY, PAUL J. FORD, CRISTIE COLE HORSBURGH, and SUSANNAH L. ROSE. "Incorporating Stakeholder Perspectives on Scarce Resource Allocation: Lessons Learned from Policymaking in a Time of Crisis." Cambridge Quarterly of Healthcare Ethics 30, no. 2 (March 25, 2021): 390–402. http://dx.doi.org/10.1017/s0963180120000924.
Full textAbstract:
AbstractThe coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work.
43
Bidabad, Bijan, and Mahshid Sherafati. "Operational ethical banking in Rastin Banking." International Journal of Law and Management 58, no. 4 (July 11, 2016): 416–43. http://dx.doi.org/10.1108/ijlma-07-2015-0037.
Full textAbstract:
Purpose This paper aims to discuss some of the operational Islamic banking features considered in ethical banking as the aspects of Rastin Banking. Ethical banking is a branch of “ethic economics” and a narrow expression of a number of Islamic banking aspects. Design/methodology/approach These features are often involved in the discussions under the topic of internal control and describe the operational characteristics of ethical banking within the framework of Rastin Banking. Findings This study refers to the principles of Rastin Banking, including operational, financial, economic, ethical, social, legal, international and organizational principles. Additionally, it takes into account some of the internal control systems. Research limitations/implications Converting ethical codes into executable laws and regulations needs sophistication, and the art of codification in this subject can be observed in the present paper. Practical implications As far as the ethical behaviour of the assessor and trustee is concerned, the necessities of honesty, belief, virtuosity, rectitude and compliance with moral values, as well as reward and punishment mechanisms, are operationally examined. Transparency, governance and disclosure of information are the other components. The methods of auditing, accounting, inspection and preservation of Rastin Banking achievements are amongst the other matters of concern. Social implications An assiduous attention to the operational details of each of the above-said discussions revealed that the Islamic banking components are capable of covering the topics and discussions beyond ethical banking. Originality/value This paper fulfils an identified need to solve the practical ethical problem in operational banking.
44
Bunch, Eli Haugen. "Hidden and Emerging Drama in a Norwegian Critical Care Unit: ethical dilemmas in the context of ambiguity." Nursing Ethics 8, no. 1 (January 2001): 57–67. http://dx.doi.org/10.1177/096973300100800107.
Full textAbstract:
The study presented in this article is based on field observations over one year on a critical care unit in Norway. Data were analysed according to Glaser’s grounded theory and generated a theory of hidden and emerging drama in the context of ambiguity while the nurses routinized the handling of complex technology. To the untrained eye the unit presented a picture of calm competence, while under the surface one finds hidden drama full of difficult interacting clinical and ethical problems. The nurses identified six ethical dilemmas: (1) end of life issues; (2) whether there should be an age limit for coronary surgery; (3) distributing limited resources; (4) resource allocation in terms of better staffing; (5) situations in which is it more harmful than beneficial to continue treatment; and (6) transferring patients to other facilities. The six problems overlap and have clinical as well as ethical components, but it was the ethical dimensions that the nurses identified and discussed. The significance for nursing is the importance of well-educated and well-qualified nurses and how they find viable solutions to complex ethical and clinical problems.
45
Arie, Fumie. "Ethical Issues of Transplant Coordinators in Japan and the Uk." Nursing Ethics 15, no. 5 (September 2008): 656–69. http://dx.doi.org/10.1177/0969733008092874.
Full textAbstract:
Ethical problems surrounding organ donation have been discussed since before technologies supported the procedure. In addition to issues on a societal level (e.g. brain-stem death, resource allocation), ethical concerns permeate the clinical practice of health care staff. These latter have been little studied. Using qualitative methods, this study, focused on transplant co-ordinators and their descriptions of dilemmas, ethical concerns and actions in response to them. Interviews with three co-ordinators in Japan and two in the UK revealed five areas in which dilemmas occurred: aspects of discrimination; conditions placed on who should be the recipient and the related issues of directed donation; respect for a person's right to make a decision and the extent of information provided and understood by donors and recipients; potential issues of coercion, compensation and rewards in live-related and live-unrelated donations; and potential conflicts in duties. This study describes the dilemma areas revealed. Their meaning for co-ordinators will be presented in a subsequent report.
46
Ryus, Caitlin, and Jay Baruch. "The Duty of Mind: Ethical Capacity in a Time of Crisis." Disaster Medicine and Public Health Preparedness 12, no. 5 (November 2, 2017): 657–62. http://dx.doi.org/10.1017/dmp.2017.120.
Full textAbstract:
AbstractIn a disaster, physicians are forced to make challenging and heartbreaking ethical decisions under conditions of physical and emotional exhaustion. Evidence shows that the conditions of stress that mark disasters can undermine the process of ethical decision-making. This results in biased allocation of scarce resources, fewer utilitarian and altruistic decisions, and a wider variation in decisions. Stress also predisposes clinicians to decision strategy errors, such as premature closure, that lead to poor outcomes. The very ability to make sound and ethical decisions is thus a scarce resource. Ethical frameworks underpinning disaster protocols enumerate many physician obligations, but seldom articulate the risk posed by having decisions made ad hoc by decision-makers who are compromised by the stress of the concurrent crisis. We propose, therefore, that a “duty of mind”—the obligation to make critical decisions under the clearest possible state of thought—be added to ethical frameworks for disaster response. Adding the duty of mind to the pillars on which planning is based would force attention to a moral imperative to include decision support tools in disaster planning. By moving the consideration of possible choices to a moment when time and consultation facilitate clear and considered thought, the duty of mind is upheld. (Disaster Med Public Health Preparedness. 2018;12:657–662)
47
Kam, Joseph KM, Eric Chan, Albert Lee, Vivian WI Wei, Kin On Kwok, Dominic Lui, and Robert KN Yuen. "Student nurses’ ethical views on responses to the severe acute respiratory syndrome outbreak." Nursing Ethics 27, no. 4 (March 27, 2020): 924–34. http://dx.doi.org/10.1177/0969733019895804.
Full textAbstract:
Background Fifteen years have passed since the outbreak of severe acute respiratory syndrome in Hong Kong. At that time, there were reports of heroic acts among professionals who cared for these patients, whose bravery and professionalism were highly praised. However, there are concerns about changes in new generation of nursing professionals. Objective We aimed to examine the attitude of nursing students, should they be faced with severe acute respiratory syndrome patients during their future work. Research design A questionnaire survey was carried out to examine the attitude among final-year nursing students to three ethical areas, namely, duty of care, resource allocation, and collateral damage. Ethical considerations This study was carried out in accordance with the requirements and recommendations of the Central Research and Ethics Committee, School of Health Sciences at Caritas Institute of Higher Education. Findings Complete responses from 102 subjects were analyzed. The overwhelming majority (96.1%) did not agree to participate in the intubation of severe acute respiratory syndrome patients if protective measures, that is, N95 mask and gown, were not available. If there were insufficient N95 masks for all the medical, nursing, and allied health workers in the hospital (resource allocation), 37.3% felt that the distribution of N95 masks should be by casting lot, while the rest disagreed. When asked about collateral damage, more than three-quarters (77.5%) said that severe acute respiratory syndrome patients should be admitted to intensive care unit. There was sex difference in nursing students’ attitude toward severe acute respiratory syndrome care during pregnancy and influence of age in understanding intensive care unit care for these patients. Interestingly, 94.1% felt that there should be a separate intensive care unit for severe acute respiratory syndrome patients. Conclusion As infection control practice and isolation facilities improved over the years, relevant knowledge and nursing ethical issues related to infectious diseases should become part of nursing education and training programs, especially in preparation for outbreaks of infectious diseases or distress.
48
Miljeteig, Ingrid, Ingeborg Forthun, Karl Ove Hufthammer, Inger Elise Engelund, Elisabeth Schanche, Margrethe Schaufel, and Kristine Husøy Onarheim. "Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway." Nursing Ethics 28, no. 1 (January 12, 2021): 66–81. http://dx.doi.org/10.1177/0969733020981748.
Full textAbstract:
Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval granted by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms.
49
Ohnishi, Kayoko, Teresa E. Stone, Takashi Yoshiike, and Kazuyo Kitaoka. "The role of online ethics consultation on mental health." Nursing Ethics 27, no. 5 (April 23, 2020): 1261–69. http://dx.doi.org/10.1177/0969733020906596.
Full textAbstract:
Background Nurses experience moral distress when they cannot do what they believe is right or when they must do what they believe is wrong. Given the limited mechanisms for managing ethical issues for nurses in Japan, an Online Ethics Consultation on mental health (OEC) was established open to anyone seeking anonymous consultation on mental health practice. Research objective To report the establishment of the Online Ethics Consultation and describe and evaluate its effectiveness. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki. Research design This evaluation describes the outcomes of 5 years of operation of the Online Ethics Consultation on mental health in Japan Participants The Online Ethics Consultation received 12 emails requesting consultation. Consultees included mental health nurses, psychiatrists, and service users. Findings The most common questions directed to the service were about seclusion and physical restraint. Response time from receipt of email to sending a reply was between 1 and 14 days. Despite the disappointing number of consultations, feedback has been positive. Discussion The Online Ethics Consultation was established to assist morally sensitive nurses in resolving their ethical problems through provision of unbiased and encouraging advice. Mental health care in Japan has been less than ideal: long-term social hospitalization, seclusion, and restraint are common practices that often lead to moral distress in nurses and the questions received reflected this. The head of the Online Ethics Consultation sent a supportive, facilitative response summarizing the opinions of several consultants. Conclusion This study provides key information for the establishment of an online ethics resource the adoption of which has the potential to improve the experience of nurses, allied health and clients of mental health services. This paper has implications for services concerned with improving patient care, managing nurses’ moral distress, building ethics into decision-making.
50
Epanomeritakis, Ilias Ektor. "Moral ambivalence towards the Cancer Drugs Fund." Journal of Medical Ethics 45, no. 9 (July 16, 2019): 623–26. http://dx.doi.org/10.1136/medethics-2019-105416.
Full textAbstract:
The UK’s Cancer Drugs Fund (CDF) was introduced in 2010 following the Conservative Party’s promise to address the fact that numerous efficacious cancer drugs were not available because of their cost ineffectiveness, as deduced by the National Institute of Health and Care Excellence. While, at face value, this policy appears only to promote the UK’s public welfare, a deeper analysis reveals the ethically unjustifiable inconsistencies that the CDF introduces; where is the analogous fund for other equally severe diseases? Have the patients without cancer been neglected simply due to the fear-inducing advertising and particularly ferocious speech which surrounds cancer? The CDF is unjustifiable when challenged by such questions. However, it is troubling to think that the CDF might be repealed in order to abolish these ethical concerns. Intuitively, one feels uncomfortable stripping the cancer patient of their benefits just so that they might be on an equally pessimistic footing with others. In the present essay, I argue that, although there are no ethically justifiable grounds for the CDF’s introduction, its removal would be inappropriate. Following this realisation, I investigate whether the procedural steps of the CDF itself—theoretically removed from the context of resource distribution for all disease types—represent an ethically justifiable system. I believe that the answer is yes, given the CDF’s conformity to accountability for reasonableness, a robust framework of procedural justice, which continuously improves the ethical and epistemological standards of the policies to which it is applied.