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Abstract: Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of ‘nursing error’, the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of ‘nursing error’ fits with the new ‘system approach’ to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is ‘right’ for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted. [Copyright &y& Elsevier]

The medical metaverse and digital twin are set to revolutionise healthcare. Like all emerging technologies their benefits must be weighed against their ethical and social, impacts. If we consider the advances of medical technology as an expression of our values, such as the pursuit of knowledge, cures and healing, an ethical study allows us to align our values and steer the technology towards an agreed goal. However, to appreciate the long-term consequents of a technology, those consequences must be considered in the context of a society already shaped by that technology. This paper identifies the technologies currently shaping society and considers the ethical, and social consequences of the medical metaverse and digital twin in that future society. [ABSTRACT FROM AUTHOR]

The Sharīʿah affords considerable concern for human emotions, with its rulings seeking to remove the deliberate and accidental types of harm that may be inflicted on individuals or society. The principle of medical confidentiality protects patients' dignity and avoids potential harm if otherwise practised. Texts from the Quran and Sunnah substantiate that unjustified disclosure of secrets is prohibited and whoever breaches confidentiality is to be punished. This paper explores the origins of Islamic ethical framework vis-à-vis dealing with privacy, particularly confidential information acquired by health professionals. For that, this paper attempts to explore various āyāt (Quranic verses) and aḥādīth (Prophetic traditions) related to privacy, and thus to analogically deduct various aspects of confidentiality in the context of medical ethics. As a result, it aims to discourse on key principles of medical confidentiality from an Islamic juristic perspective, discussing its types and conditions. [ABSTRACT FROM AUTHOR]

The medical profession contains five "spheres of morality": clinical care, clinical research, scientific knowledge, population health, and the market. These distinct sets of normative commitments require physicians to act in different ways depending on the ends of the activity in question. For example, a physician-scientist emphasizes patients' well-being in clinic, prioritizes the scientific method in lab, and seeks to maximize shareholder returns as a board member of a pharmaceutical firm. Physicians increasingly occupy multiple roles in healthcare and move between them frequently, creating the possibility of conflict between the ethical obligations of their various roles. This paper examines the entire moral landscape of medicine through the lens of role morality. It develops a novel framework that helps physicians recognize how their moral commitments depend on the nature and context of the situation, clarifies ethical conflicts that physicians face, and concludes with ideas for resolving these conflicts. [ABSTRACT FROM AUTHOR]

Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a particularly drastic measure to sanction defaulting insurance payers is employed. Since 2012, Swiss cantons – who have to cover most of the bills of defaulting payers - are allowed by federal law to blacklist them and to restrict their access to medical care to emergencies. In our paper, we briefly describe blacklisting in the context of the Swiss healthcare system before we examine the ethical issues involved in light of what is known about its social and health impacts. We found no evidence that blacklisting serves as an effective way of recovering unpaid health insurance contributions or of strengthening solidarity within the health insurance system. Furthermore, the ambiguous definitions of what constitutes an emergency treatment and the incompatibility of the denial of medical care with the obligation to provide professional assistance complicate the implementation of blacklists and expose care providers to enormous pressure. Therefore, we conclude that blacklists and the (partial) denial of medical care not only pose profound ethical problems but are also unsuitable for fulfilling the purpose for which they were introduced. [ABSTRACT FROM AUTHOR]

Clinical practice and research are governed by distinct rules and regulations and have different approaches to, for example, consent and providing results. However, genomics is an example of where research and clinical practice have become codependent. The 100 000 genomes project (100kGP) is a hybrid venture where a person can obtain a clinical investigation only if he or she agrees to also participate in ongoing research-including research by industry and commercial companies. In this paper, which draws on 20 interviews with professional stakeholders involved in 100kGP, we investigate the ethical issues raised by this project's hybrid nature. While some interviewees thought the hybrid nature of 100kGP was its vanguard, interviewees identified several tensions around hybrid practice: how to decide who should be able to participate; how to determine whether offering results might unduly influence participation into wide-ranging but often as yet unknown research and how to ensure that patients/families do not develop false expectations about receiving results. These areas require further debate as 100kGP moves into routine healthcare in the form of the national genomic medicine service. To address the tensions identified, we explore the appropriateness of Faden et al.'s framework of ethical obligations for when research and clinical care are completely integrated. We also argue that enabling ongoing transparent and trustworthy communication between patients/families and professionals around the kinds of research that should be permitted in 100kGP will help to understand and ensure that expectations remain realistic. Our paper aims to encourage a focused discussion about these issues and to inform a new 'social contract' for research and clinical care in the health service. [ABSTRACT FROM AUTHOR]

Electronic health records (EHRs) provide benefits for patients, physicians, and clinical teams, but also raise ethical questions. Navigating how to provide care in the digital age requires an assessment of the impact of the EHR on patient care and the patient-physician relationship. EHRs should facilitate patient care and, as an essential component of that care, support the patient-physician relationship. Billing, regulatory, research, documentation, and administrative functions determined by the operational requirements of health care systems, payers, and others have resulted in EHRs that are better able to satisfy such external functions than to ensure that patient care needs are met. The profession has a responsibility to identify and address this mismatch. This position paper by the American College of Physicians (ACP) Ethics, Professionalism and Human Rights Committee does not address EHR design, user variability, meaningful use, or coding requirements and other government and payer mandates per se; these issues are discussed in detail in ACP's Clinical Documentation policy. This paper focuses on EHRs and the patient-physician relationship and patient care; patient autonomy, privacy and confidentiality; and professionalism, clinical reasoning and training. It explores emerging ethical challenges and concerns for and raised by physicians across the professional lifespan, whose ongoing input is crucial to the development and use of information technology that truly serves patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to propose an alternative, interdisciplinary teaching of health, health care and medical care based on three pillars: social economics, the social determinants of health (SDH) and ethics. Based on these three pillars, the global financial crisis is presented as the moment of manifestation of the SDH at individual and aggregate levels that require a critical analysis from a broader perspective that is possible with social economics and ethics. Design/methodology/approach: The author designed a writing-intensive course based on four modules about definition of health, health care, medical care and determinants of health; political economy of financing and organization of medical care; policies including reform proposals; and medical ethics and moral philosophies that reflect back on the previous topics, respectively. Findings: The course attracts students from different disciplines who found it realistic and comprehensive so that it can be related easily to other disciplines owing to its interdisciplinary design. It also helps students to improve their writing skills. Research limitations/implications: The course is taught only in US context and is still open to further development. Practical implications: The theoretical pillars of the course can be adopted and experimented with in different contexts (e.g. wars, plagues, immigration, etc.) and inform the participants about the subject matters from a broader perspective. Originality/value: This paper provides a successful and novel teaching experience of health and medical care by putting social economics, SDH and ethics together. [ABSTRACT FROM AUTHOR]

This paper draws on eighteenth-century British medical ethics to elucidate compassion and empathy and explains how compassion and empathy can be taught, to rectify their frequent conflation. The professional virtue of compassion was first described in eighteenth-century British medical ethics by the Scottish physician-ethicist, John Gregory (1724–1773) who built on the moral psychology of David Hume (1711–1776) and its principle of sympathy. Compassion is the habitual exercise of the affective capacity to engage, with self-discipline, in the experience of the patient and therefore become driven to provide effective care for the patient. Empathy is the habitual exercise of the cognitive capacity to imagine the experience of patient and to have reasons to care for the patient. There are rare clinical circumstances in which empathy should replace compassion, for example, in responding to abusive patients. Because the abstract concepts of medical ethics are translated into clinical practice by medical educators, we identify the pedagogical implications of these results by setting out a process for teaching compassion and empathy. Eighteenth-century British medical ethics provides a clinically applicable, philosophical response to conflation of the moral virtue of compassion and the intellectual virtue of empathy and applying them clinically. [ABSTRACT FROM AUTHOR]

In the medical practice in China, giving and taking "red envelopes" (monetary gifts) is a common phenomenon although few openly admit it. This paper, based on our empirical study including data collected from interviews and questionnaires with medical professionals and patients, attempts to explore why "red envelopes" have become a serious problem in the physician-patient relationship and how the situation can be improved. Previous studies show that scholars tend to correlate the spread of "red envelopes" in health care sector to the commercialization trend, the general erosion of traditional values, and the lowering of the moral level in the medical field. However, in this paper, the authors argue that medical professionals' choice of taking "red envelopes" is actually more a way to compensate for their problematic self-image and marred dignity in real practice. Medical professionals in China as a whole are in an embarrassing situation where the work pressure and income, and the sense of pride that used to be part of their profession are not comparable to each other. Under this circumstance, we believe that the effective way to deal with the "red envelopes" issue does not lie solely in introducing more stringent regulations or granting medical professionals higher payments, but rather in protecting and enhancing the professional dignity of all those working in healthcare. And on top of that, there must also be effort to cultivate a more favorable moral environment. [ABSTRACT FROM AUTHOR]

Philosophers and bioethicists are typically sceptical about invocations of dignity in ethical debates. Many believe that dignity is essentially devoid of meaning: either a mere rhetorical gesture used in the absence of good argument or a faddish term for existing values like autonomy and respect. On the other hand, the patient experience of dignity is a substantial area of research in healthcare fields like nursing and palliative care. In this paper, it is argued that philosophers have much to learn from the concrete patient experiences described in healthcare literature. Dignity is conferred on people when they are treated as having equal status, something the sick and frail are often denied in healthcare settings. The importance of equal status as a unique value has been forcefully argued and widely recognised in political philosophy in the last 15 years. This paper brings medical ethics up to date with philosophical discussion about the value of equal status by developing an equal status conception of dignity. [ABSTRACT FROM AUTHOR]

Pediatric psychologists have much to contribute to growing efforts to mitigate the impact of parent mental and behavioral health problems on children's health and development. However, providing parent-focused psychological services within the pediatric setting brings many new ethical considerations and challenges. Guided by the American Psychological Association's Ethics Code, this paper presents an ethical case for providing these types of services, followed by a comprehensive analysis of the unique ethical challenges likely to be encountered when doing so. Recommendations are offered to support the ethical delivery of parent-focused psychological services in pediatric settings. [ABSTRACT FROM AUTHOR]

It is nearly two decades now since the publication of Godfrey Tangwa's article, 'Bioethics: African Perspective', without a critical review. His article is important because sequel to its publication in Bioethics, the idea of 'African bioethics' started gaining some attention in the international bioethics literature. This paper breaks this relative silence by critically examining Tangwa's claim on the existence of African bioethics. Employing conceptual and critical methods, this paper argues that Tangwa's account of African bioethics has some conceptual, methodic and substantive difficulties, which altogether do not justify the idea of African bioethics, at least for now. Contra Tangwa, this article establishes that while African bioethics remains a future possibility, it is more cogent that current efforts in the name of 'African bioethics' be primarily re-intensified towards 'Healthcare ethics in Africa'. [ABSTRACT FROM AUTHOR]

Today's health care environment requires professionals to pay increasing attention to efficiencies and functional outcomes. Today's patients are hospitalized for short stays, and those needing rehabilitation often have multiple diagnoses and goals. Cost effective strategies support fast paced occupational therapy programs and professionals who are adept multi-task specialists and problem solvers. Practitioners have multiple resources and strategies for clinical reasoning and decision- making; however, ethical decision-making requires use of additional resources and strategies. This paper provides strategies to examine everyday ethical problems and dilemmas, including application of The American Occupational Therapy's Code of Ethics, to support ethical decision-making in practice settings (American Occupational Therapy Association, 2000a). [ABSTRACT FROM PUBLISHER]

Sexual boundary violations can negatively impact the culture of safety within a medical practice or healthcare institution and severely compromise the covenant of care and physician objectivity. Lack of education and training is one factor associated with physician misconduct that leads to high financial and personal cost. This paper presents a follow-up study of physicians referred to a professional development course in 2001 and presents demographic data from 2001 to present. The paper focuses on the education and remediation progress regarding sexual misconduct by physicians. [ABSTRACT FROM AUTHOR]

In a recent article for this journal, Morten Magelssen argues that the right to conscientious objection in healthcare is grounded in the moral integrity of healthcare professionals, a good for both professionals and society. In this paper, I argue that there is no right to conscientious objection in healthcare, at least as Magelssen conceives of it. Magelssen's conception of the right to conscientious objection is too expansive in nature. Although I will assume that there is a right to conscientious objection, it does not extend to objections that are purely religious in nature. i Thus, this right is considerably more restricted than Magelssen thinks. In making my case, I draw on John Rawls's later work in arguing for the claim that conscientious objection based on purely religious considerations fails to benefit society in the appropriate way. [ABSTRACT FROM AUTHOR]

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Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy 'at the bedside'? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions - about what we should do in any given situation - are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case (metaphysics), what it is that we feel we can claim to know (epistemology), as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. [ABSTRACT FROM AUTHOR]

Good care is often positioned as a natural by-product of the widespread availability of good information (‘inform to care’). This paper contests this association through empirical investigation of the information–care relationship in the context of dementia care. It combines critiques of the ‘informatisation’ of care with insights from the epistemological dimension of care ethics to argue that information is better understood as ‘situated knowledge’ and that the relational practices of care involve the mobilisation and negotiation of different types of knowledge that are specific to caring relationships and contexts. The argument is illustrated through the three cases of caring relationships taken from a qualitative evaluation of an information and support course for carers of people with dementia. These cases highlight the specificity of caring relationships and the very different consequences of introducing new forms of knowledge into each relationship and provide evidence for the need for a paradigm shift where the idea of informing to care is replaced by a process of informing with care. In the former, information is understood as separate and outside of care, while nevertheless acting upon it to produce care; in the latter, information is understood as inextricably linked to care (with care) but not in any predetermined or uni-directional sense. The paper identifies key interlinked components of the ‘inform with care’ approach derived from the cases discussed. [ABSTRACT FROM AUTHOR]

Treatment teams providing transgender-affirming medical care are inherently faced with various kinds of moral and ethical dilemmas and questions, which are becoming even more pressing due to increasing treatment numbers and public attention for transgender care. Little is known about what kinds of moral and ethical challenges manifest in clinical practice. The aim of the present research was to map the moral and ethical challenges of healthcare professionals working in a specialized multidisciplinary transgender care center. Over a period of 7 months, during a focused ethnographic study, data were collected through participant observation of multidisciplinary team meetings, observation of individual psychodiagnostic assessment sessions with clients, and analysis of transcripts and reports of a series of moral case deliberations. A thematic content analysis of the data identified various implicit and explicit moral and ethical challenges around the following six themes: (1) assessing eligibility; (2) content of treatment; (3) sequential order of the treatment steps; (4) role of the clinical guidelines; (5) differing notions regarding gender identity, and (6) decision-making process. Our research provides a detailed insight into the way healthcare professionals experience these moral and ethical challenges and how they are related to (local) guidelines, the multidisciplinary character of GD care, and its inherent implicit and explicit gender norms. Our findings suggest that good transgender care may profit from continuous multidisciplinary deliberation of and sensitivity toward the normative dimension of transgender care. The paper ends with recommendations for ethics support mechanisms in transgender care. [ABSTRACT FROM AUTHOR]

Psychologists in academic health centers (AHC) face important ethical issues including confidentiality when working with a multidisciplinary team, sharing of information through the electronic health record, obtaining informed consent in a fast-paced healthcare environment, cultural competency in the medical setting, and issues related to supervision and training. The goal of this paper is to describe ethical issues for psychologists in AHCs in the context of case examples, and to consider ethical decision-making tools to enhance clinical care. Considerations for best practices in integrated care settings will be discussed, and the APA Ethical Standards will be referenced throughout. [ABSTRACT FROM AUTHOR]

To investigate the phenomenon of patient-physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust (particularly physicians' distrust of patients and their relatives) leads to increased levels of fear and self-protection by doctors which exacerbate difficulties in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism-the primacy of patient welfare-as well as the traditional Chinese ideal of "medicine as the art of humanity". Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures. [ABSTRACT FROM AUTHOR]

Trust is indispensable not only for interpersonal relationships and social life, but for good quality healthcare. As manifested in the increasing violence and tension in patient-physician relationships, China has been experiencing a widespread and profound crisis of patient-physician trust. And globally, the crisis of trust is an issue that every society, either developing or developed, has to face in one way or another. Yet, in spite of some pioneering works, the subject of patient-physician trust and mistrust - a crucial matter in healthcare especially because there are numerous ethical implications - has largely been marginalized in bioethics as a global discourse. Drawing lessons as well as inspirations from China, this paper demonstrates the necessity of a trust-oriented bioethics and presents some key theoretical, methodological and philosophical elements of such a bioethics. A trust-oriented bioethics moves beyond the current dominant bioethical paradigms through putting the subject of trust and mistrust in the central agenda of the field, learning from the social sciences, and reviving indigenous moral resources. In order for global bioethics to claim its relevance to the things that truly matter in social life and healthcare, trust should be as vital as such central norms like autonomy and justice and can serve as a potent theoretical framework. [ABSTRACT FROM AUTHOR]

In China's healthcare sector, a popular and socio-culturally distinctive phenomenon known as guanxi jiuyi (medical guanxi), whereby patients draw on their guanxi (personal connections) with physicians when seeking healthcare, is thriving. Integrating anthropological investigation with normative inquiry, this paper examines medical guanxi through the lens of patient-physician trust and mistrust. The first-hand empirical data acquired - on the lived experiences and perspectives of both patients and physicians - is based on six months' fieldwork carried out in a county hospital in Guangdong, southern China, which included in-depth interviews with 20 patients and 20 medical professionals. Patients who emphasized the positive effects of guanxi on patient-physician trust believed that it facilitates access to experienced medical specialists, enhances clinical communication, and reduces the financial and medical risks of over diagnosis and overtreatment by physicians. At the same time, these findings reveal patients' strong sense of mistrust, not only towards individual health professionals but also to the medical profession and China's commercialized healthcare industry. While some health professionals in the study responded favourably to medical guanxi, most were opposed to it on the grounds that it undermines professional standards and equitable healthcare. We found that the practice of medical guanxi is not morally justifiable, chiefly because it reinforces the present high levels of patient-physician mistrust and erodes trust between patients and the medical profession as a whole. In China, both the medical profession and the state need to promote patient-physician trust based on medical professionalism and institutional norms, rather than on guanxi or individual relationships. [ABSTRACT FROM AUTHOR]

Based on two years' ethnographic research on doctor-patient relations in urban China, this paper examines the causes of patients' mistrust of physicians. I identify the major factors at the societal, institutional, and interpersonal levels that lead to patients' mistrust of physicians. First, I set the context by describing the extent of mistrust at the societal level. Then, I investigate the institutional sources of mistrust. I argue that the financing mechanism of public hospitals and physicians' income structures are the most crucial factors in inducing patients' mistrust. Hospitals' heavy reliance on self-finance has basically caused public hospitals to run like private hospitals, resulting in blatant conflicts of interest between hospitals and patients. Related to this is physicians' reliance on bonuses and commissions as part of their regular incomes, which has inevitably resulted in overtreatment and, hence, mistrust from the patients. At the interpersonal level, I describe how individual physicians' attitudes toward and interaction with patients may also affect patients' sense of trust or mistrust in physicians. In conclusion, I discuss the ethical implications of the mistrust problem, and suggest changes at the institutional and interpersonal levels to mitigate the problem. [ABSTRACT FROM AUTHOR]

Focusing on the shared sense of victimization and disadvantage-ness by both patients and doctors/medical workers in cases of medical conflicts, this paper aims to examine the current patient-doctor tensions in the larger context of moral transformation in Chinese society since the 1980s. Although the decline of public trust in certain aspects is closely associated with the impact of commodification and commercialization of medical sector during the past two decades, other factors play important role as well. In the case of patient-doctor tension, mutual disrespect and mistrust also result from the ongoing process of individualization and the remaking of moral self, in which the individual demand for respect, dignity, and trust seem to have unexpectedly and ironically contributed to the rise of tensions and conflicts between patients and doctors as well as other medical workers. [ABSTRACT FROM AUTHOR]

This paper argues that mandatory, government-enforced vaccination can be justified even within a libertarian political framework. If so, this implies that the case for mandatory vaccination is very strong indeed as it can be justified even within a framework that, at first glance, loads the philosophical dice against that conclusion. I argue that people who refuse vaccinations violate the 'clean hands principle', a (in this case, enforceable) moral principle that prohibits people from participating in the collective imposition of unjust harm or risk of harm. In a libertarian framework, individuals may be forced to accept certain vaccines not because they have an enforceable duty to serve the common, and not because cost-benefit analysis recommends it, but because anti-vaxxers are wrongfully imposing undue harm upon others. [ABSTRACT FROM AUTHOR]

Global short-term medical volunteerism is growing, and properly conducted, is a tool in the fight for greater global health equity. It is intrinsically 'ethical' (i.e., it involves ethics at every step) and depends upon ethical conduct for its success. At present, ethical guidelines remain in their infancy, which presents a unique opportunity. This paper presents a set of basic ethical principles, building on prior work in this area and previously developed guidelines for international clinical research. The content of these principles, and the benchmarks used to evaluate them, remain intentionally vague and can only be filled by collaboration with those on-the-ground in local communities where this work occurs. Ethical review must additionally take into consideration the different obligations arising from the type of institution, type of intervention, and type of relationship involved. This paper argues that frequent and formalized ethical review, conducted from the beginning with the local community (where this community helps define the terms of debate), remains the most important ethical safeguard for this work. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to examine the Victorian attitude to the poor by focussing on the health care provided at a large provincial hospital, the Newcastle Infirmary. Design/methodology/approach - The archives of the Newcastle Infirmary are reviewed alongside the local trade directories. These primary sources are examined in conjunction with the writings of contemporary social theorists on poverty. Findings - At a time when poverty was seen as a sin, an act against God, it would be easy to assume that the Victorians faced no moral dilemma in dismissing the poor, particularly what were seen as the "undeserving poor", out of hand. Yet, the paper observes how accounting was used both to persuade the wealthier citizens to contribute funds and to enable the hospital to exercise compassion in treating paupers despite this being prohibited under the hospital's rules. Such a policy conflicted with the dominant utilitarian view of society, which emphasised the twin pillars of economic expediency and self-help. Research limitations/implications - More case studies are needed of other hospitals to ascertain how typical the Newcastle Infirmary was of the voluntary hospital sector as a whole. Originality/value - Although many histories of British hospitals exist and some have examined how accounting was used to manage within these institutions, the concern has not been with accounting as a moral practice. [ABSTRACT FROM AUTHOR]

Some parents of children with cystic fibrosis (CF) do not adhere to treatments recommended by the CF team. This can be a challenging issue for CF clinicians and can create conflict between the parents and treating team. Both parents and treating team believe they are acting in the best interests of the child, but do not share a common opinion as to what that entails. In this paper we present an understanding of the psychological framework of parents' illness representation that may foster a better understanding by CF clinicians of how to approach parents who hold a conflicting opinion regarding optimal care. Continuing to work with families towards optimal care is a moral obligation, but the key ethical decision is when to intervene to protect the child. In this paper we introduce the concept of the zone of parental discretion as an ethical tool to help decide the best way forward when parents do not accept medical advice on the optimal care of their child with CF. [ABSTRACT FROM AUTHOR]

Global health research partnerships are increasingly taking the form of consortia that conduct programs of research in low and middle-income countries (LMICs). An ethical framework has been developed that describes how the governance of consortia comprised of institutions from high-income countries and LMICs should be structured to promote health equity. It encompasses initial guidance for sharing sovereignty in consortia decision-making and sharing consortia resources. This paper describes a first effort to examine whether and how consortia can uphold that guidance. Case study research was undertaken with the Future Health Systems consortium, performs research to improve health service delivery for the poor in Bangladesh, China, India, and Uganda. Data were thematically analysed and revealed that proposed ethical requirements for sharing sovereignty and sharing resources are largely upheld by Future Health Systems. Facilitating factors included having a decentralised governance model, LMIC partners with good research capacity, and firm budgets. Higher labour costs in the US and UK and the funder's policy of allocating funds to consortia on a reimbursement basis prevented full alignment with guidance on sharing resources. The lessons described in this paper can assist other consortia to more systematically link their governance policy and practice to the promotion of health equity. [ABSTRACT FROM AUTHOR]

When should we use care robots? In this paper we endorse the shift from a simple normative approach to care robots ethics to a complex one: we think that one main task of a care robot ethics is that of analysing the different ways in which different care robots may affect the different values at stake in different care practices. We start filling a gap in the literature by showing how the philosophical analysis of the nature of healthcare activities can contribute to (care) robot ethics. We rely on the nature-of-activities approach recently proposed in the debate on human enhancement, and we apply it to the ethics of care robots. The nature-of-activities approach will help us to understand why certain practice-oriented activities in healthcare should arguably be left to humans, but certain (predominantly) goal-directed activities in healthcare can be fulfilled (sometimes even more ethically) with the assistance of a robot. In relation to the latter, we aim to show that even though all healthcare activities can be considered as practice-oriented, when we understand the activity in terms of different legitimate 'fine-grained' descriptions, the same activities or at least certain components of them can be seen as clearly goal-directed. Insofar as it allows us to ethically assess specific functionalities of specific robots to be deployed in well-defined circumstances, we hold the nature-of-activities approach to be particularly helpful also from a design perspective, i.e. to realize the Value Sensitive Design approach. [ABSTRACT FROM AUTHOR]

In an attempt to gain some control over ever escalating health care cost, many organizations have moved to a managed care concept of health benefits. Managed care health benefit strategies account for well over 90 percent of all employer sponsored health benefit programs. In essence, managed care coverage usually demands, at a minimum, some form of utilization review in regard to provider services. Thus the privacy of the traditional doctor patient relationship must inevitably be modified when managed care enters the picture. This paper provides a framework for analyzing the managed care phenomenon as well as surfacing ethical questions and issues that will continue to arise as managed care grows. [ABSTRACT FROM AUTHOR]

Accountable Care Organizations (ACOs) are a key mechanism of the Patient Protection and Affordable Care Act (PPACA). ACOs will influence incentives for providers, who must understand these changes to make well-considered treatment decisions. Our paper defines an ethical framework for physician decisions and action within ACOs. Emerging ethical pressures providers will face as members of an ACO were classified under major headings representing three of the four principles of bioethics: autonomy, beneficence, and justice (no novel conflicts with non-maleficence were identified). Conflicts include a bias against transient populations, a motive to undertreat conditions lacking performance measures, and the mandate to improve population health incentivizing life intrusions. After introducing and explaining each conflict, recommendations are offered for how providers ought to precede in the face of novel ethical choices. Our description of novel ethical choices will help providers know what to expect and our recommendations can guide providers in choosing well. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various articles in the issue on topics including socio-political, cultural and healthcare context of patient-physician mistrust; and implications of patient–physician trust and mistrust in the Chinese context.

A response by Douglas S. Diekema and Norman Fost about their article "Ashley Revisited: A Response to the Critics," is presented. They emphasize that their goal for writing the paper was to encourage people to examine ethical issues raised by Ashley's case. They respond to issues including growth attenuation and medial uncertainty.

In this paper, I will explore ideas advanced by Bradshaw, Pence and others who have written on compassion in healthcare. I will attempt to see how and whether their assumptions about compassion can be justified, and explore the role compassion should play in a modern healthcare system. I will justify scepticism at the idea of attempting to incentivise compassion through metrics. The Francis Report raises important questions concerning the nature of a healthcare system that harms rather than helps patients. If something is failing in modern healthcare, those in charge should naturally seek to remedy it. I will investigate whether this is due to the disappearance of compassion, and if so, what is it that is emerging to fill its place. I will consider whether we need to rehabilitate or enforce compassion in the system, or to acknowledge that our modern healthcare systems are incompatible with compassion and how we can make the best of what remains. [ABSTRACT FROM AUTHOR]

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system 'in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.' We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. [ABSTRACT FROM AUTHOR]

The rise of quality improvement research and comparative effectiveness research in health care settings constitutes progress toward the goal of what the Institute of Medicine has called a 'learning healthcare system,' in which we are 'drawing research closer to clinical practice by building knowledge development and application into each stage of the healthcare delivery process.' As clinical research and clinical practice move closer to a deliberately integrated system, the distinction between the two is increasingly blurred, although the sharp distinction in U.S. regulations and research ethics literature remains in place. In the 1970s and for two decades thereafter, this distinction was helpful: for some forms of research, it sheds light on which activities require ethical oversight. Research that is closely integrated with health care-notably, health delivery research-was then uncommon, however. That is no longer the case, and regulations and research ethics need to change to accommodate the new landscape. In this paper, we argue that conceptual, moral, and empirical problems surround the received view that we can and should draw sharp distinctions between clinical research and clinical practice. We start with the history of the research-practice distinction in the reports of a U.S. national commission and in U.S. federal regulations, and then offer a critical assessment of five characterizations of research that have been used in policy documents and the scholarly literature to try to make a sharp distinction between research and practice. We challenge the clarity and the tenability of these characterizations as a way of distinguishing research from practice. We argue that the received view of the research-practice distinction leads to overprotection of the rights and interests of patients in some cases and to underprotection in others. We contend that a new ethical foundation needs to be developed that facilitates both care and research likely to benefit patients, and that provides oversight that, rather than being based on a distinction between research and practice, is commensurate with risk and burden in both realms. [ABSTRACT FROM AUTHOR]

Research into the effects of medical interventions is one of the oldest traditions of any medicine, as is the study of its ethical dimension. In this paper, we briefly describe and recount the history of both quantitative and qualitative methods in clinical research. We discuss key theoretical, methodological and practical features of both methodological perspectives and consider some of the central ideas of medical ethics. We sketch a theory of the relationship between the quantitative and qualitative as essentially complementary and interdependent. The theory is illustrated by reference to the placebo effect and a research 'case study' from within the Chinese medicine community. We conclude that despite the challenges, combined research methodologies in Chinese medicine offer both scientific and ethical benefits. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Oncology / Türk Onkoloji Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Many countries encourage immigration, yet almost without exception they impose medical conditions on the admissibility of prospective immigrants. This paper examines the ethical defensibility of this practice. It argues that the neighbourhood principle, which states that we owe a greater duty to neighbours than to strangers, when properly understood, extends to all human beings, that economic and safety considerations play only a limited role in ethically underwriting an exclusionary policy, and that medical immigration criteria should be harmonized with treatment eligibility criteria for citizens of the relevant countries themselves. [ABSTRACT FROM AUTHOR]

Clinical ethics committees have recently been established in nearly all Norwegian hospital trusts. One important task for these committees is clinical ethics consultations. This qualitative study explores significant barriers confronting the ethics committees in providing such consultation services. The interviews with the committees indicate that there is a substantial need for clinical ethics support services and, in general, the committee members expressed a great deal of enthusiasm for the committee work. They also reported, however, that tendencies to evade moral disagreement, conflict, and ‘outsiders’ are common in the hospitals. Sometimes even the committees comply with some of these tendencies. The committees agree that there is a need to improve their routines and procedures, clarify the committees' profile and field of responsibility, to make the committees well-known, to secure adequate operating conditions, and to develop organizational integration and support. Various strategies to meet these challenges on a local, regional or national level are also explored in this paper. [ABSTRACT FROM AUTHOR]

This paper reports on a multidisciplinary meeting held to discuss ethical issues in medical research in the developing world. Many studies, including clinical trials, are conducted in developing countries with a high burden of disease. Conditions under which this research is conducted vary because of differences in culture, public health, political, legal and social contexts specific to these countries. Research practices, including standards of care for participants, may vary as a result. It is therefore not surprising that ethical issues emerge. This meeting sought to identify and discuss these issues from the perspectives of the many actors in such research, including community representatives, with a view to finding ethical and pragmatic solutions to these issues. Dialogue between these actors was also promoted, with a view to identifying the need to develop such dialogue in future. Drawing from the experiences of the speakers, the colloquium attempted to outline some answers to several key questions characterising the field today. Experiences related to epidemiologic research, vaccine trials, drug trials, diagnostic tests and to some fundamental ethical issues in health research. Speakers were from different countries, disciplines and professions. The meeting provided a forum for consultation and debate between different ethics actors. Both encouraging findings and challenges emerged. [ABSTRACT FROM AUTHOR]

The paper proposes an optimal response-adaptive procedure for a general class of responses using a combination of two clinically relevant optimality criteria. We provide a thorough development for trials involving two treatments and sketch the possible extension for multiple treatments. Some related asymptotic results are worked out. We provide simulation studies to compare the performance of the proposed procedure with some of the existing competitors. We illustrate our methodology on data from a real clinical trial. [ABSTRACT FROM AUTHOR]

The ethics review system of research is now well-established, at least in the developed world, although there are many differences in how countries view it and go about managing it. The UK specifically is now seeking to revise its system by speeding up the process of ethics approval but only for some studies. It is proposed that only those studies which pose "no material ethical issues" should be "fast-tracked". However, it is unclear what this means, who should decide and what should be included in this category. In this paper, we go some way towards answering these questions. While we are certain that the debate is only just beginning, we are equally certain that it will continue to run long after the system has been reformed. To stimulate this conversation and to inform a pilot project of the new system directly, we review two candidates to help give some substance to the notion of "material" ethical issues. Firstly, material could mean a certain type or degree of risk. Second, material could mean how physically invasive the research is. We conclude that there is still much work to be done on making the system of governing health and social care consistent and practicable. [ABSTRACT FROM AUTHOR]

The essays in this Special Section are about the ethics of Commercialism in Medicine. They are written, for the most part, by bioethicists, with the support of several prominent physicians and a health policy lawyer. This journal is, of course, devoted to ethics. Thus, our intent is to subject the question of commercialism in medicine to ethical scrutiny. Much has been written about commercialism in healthcare but very little about the ethics of commercialism in healthcare. One of our authors, Dr. Jerome Kassirer, has encouraged a national dialogue about these issues. We hope to start that dialogue in the bioethical community and, through that community, into the nation.Special thanks to J. Westly McGaughey for his editorial assistance in preparing this collection of papers. [ABSTRACT FROM AUTHOR]

Copyright of Revista Eletronica de Enfermagem is the property of Revista Eletronica de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Through a case study, this paper addresses ethical issues and dilemmas faced by a Family Therapist working in a Child and Adolescent Mental Health Service (CAMHS) in the National Health Service. When there are legal and societal obligations on parents/carers to ensure that the needs of children and young people are met within a family context, working with a young person in a health care setting oriented to the individual raises ethical dilemmas around consent. When the values of young people and their parents conflict, legal, ethical and political issues can be raised. These have implications for the duties of health care professionals and the rights, interests and autonomy of the individual young people and their parents. The importance of justice to CAMHS practitioners' ethical decision-making about when to prioritize the individual over the family, or vice versa, is emphasized. [ABSTRACT FROM AUTHOR]