Next SectionObjective The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. Methods This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Findings Most respondents (...) see a need for ethics support. This need is related to the complexity of contemporary healthcare, the contribution of ethics support to the core business of the organisation and to the surplus value of paying structural attention to ethical issues. The need for ethics support is, however, not unconditional. Reasons for a lacking need include: aversion of innovations, negative associations with the notion of ethics support service, and organisational factors like resources and setting. Conclusion There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice. (shrink)

In recent years, organisational theorists have been interested in the tensions faced by healthcare organisations. In this paper, these tensions are examined using the virtue approach to ethics of Alasdair MacIntyre. It is argued that although MacIntyre's framework shares many concerns with organisational studies, it supplements the analysis with a focus on moral content and evaluation. By providing moral evaluation of the stories told in organisations, an ethical analysis compels action on a basis that organisational studies does not. Nevertheless, (...) it is the analysis of stories in organisation studies that provides the tools for taking action. The analysis presented here provides an example of how ethics and organisational studies can be brought together to provide a stronger analysis of organisational phenomena. Indeed, it provides support for Nielsen's position that organisational theory and ethics are co‐dependent and suggests that greater attention should be paid to ethical concepts in the study of organisational phenomena. (shrink)

In their address of structural racism in healthcare, Sabatello and colleagues provide both a remarkable review of the empirical literature regarding the disproportionate impacts of the COVID...

Gilroy and Wade wrote 20 years ago that every policy presupposes an underlying moral argument that justifies it. This claim is now rarely contested: policy making is an inescapably moral enterprise...

Ethical foundations of patient safety -- Vigilance -- Mindfulness -- Compliance -- Humility -- Some theoretical aspects of vigilance and risk acceptability -- Fifty shades of error -- The standard care and medical malpractice law as an ethical achievement -- The present and the future.

Due to an editing error, this article was initially published with an incorrect title. The correct title is reflected above. The original article has been corrected.

ZusammenfassungPatientenmobilität und grenzüberschreitende Gesundheitsversorgung sind alltägliche Phänomene in der Europäischen Union. Im Jahr 2011 hat die EU eine Richtlinie erlassen, um in diesem Kontext Rechtssicherheit herzustellen. Bisher gibt es keine umfassenden systematischen Studien über ethische Aspekte grenzübergreifender Gesundheitsversorgung. In dieser Arbeit werden die rechtlichen Entwicklungen der grenzübergreifenden Gesundheitsversorgung dargestellt und die in der Literatur vereinzelt erwähnten ethisch relevanten Aspekte heuristisch und auf Patiententypologien aufbauend systematisch inventarisiert und diskutiert. Es zeigt sich, dass die Möglichkeit der Patientenmobilität und die damit vor allem (...) verbundenen Finanzierungsregelungen die Autonomie einiger Patienten sicherlich verbessern kann. Allerdings können wohl nicht alle Patienten Versorgungsverbesserungen erwarten. Im Gegenteil können sogar negative Konsequenzen für einige Patienten folgen, was vor allem aus gerechtigkeitstheoretischen Überlegungen kritisch zu sehen ist. (shrink)

Here we respond to Shaw et al., and show why the application of Conscientious Objection cannot be dismissed from cases of organ donation, where the donor is presumed to be dead.

My discussion is presented in three steps: The present position of the Catholic Church; why it is a relatively recent tradition; and the roots of the tradition.

:This article analyzes the criteria for the distribution of healthcare services through different justice theories such as utilitarianism and liberalism, pointing out the problems that arise when providing services to a culturally diverse population. The international epidemiological setting is a favorable one for discussing personal responsibility and luck egalitarianism; however, some provisions have to be made so that healthcare institutions do not treat ethnic, cultural, religious, and linguistic minorities unfairly. The article concludes by proposing that accommodations and culturally (...) sensible attention should be provided when possible, without affecting the equal opportunity of others to access these services. (shrink)

The following text is the de-identified and edited transcript of an invited presentation by Professor Clare Delany on the topic of ‘How clinical ethics discussions can be a model for accommodating and incorporating plural values in paediatric and adult healthcare settings.’ Professor Delany’s presentation formed part of the Conference on Accommodating Plural Values in Healthcare and Healthcare Policy, which was held in Melbourne, Australia, on Monday, October 30, 2023. This conference was a key output of the Australian (...) Research Council Discovery Project grant DP190101597, ‘Religion, pluralism, and healthcare practice: A philosophical assessment’. Professor Delany’s presentation was introduced by Doctor Lauren Notini, Research Fellow and Lecturer at Monash Bioethics Centre, Monash University. (shrink)

Gaining ethical clearance to conduct a study is an important aspect of all research involving humans but can be time-consuming and daunting for novice researchers. This article stems from a larger ethnographic study that examined research capacity building in Irish nursing and midwifery. Data were collected over a 28-month time frame from a purposive sample of 16 nurse or midwife research fellows who were funded to undertake full-time PhDs. Gaining ethical clearance for their studies was reported as an early ‘rite (...) of passage’ in the category of ‘labouring the doctorate’. This article penetrates the complexities in Irish clinical research ethics by describing the practices these nurse and midwife researchers encountered and the experiences they had. The key issue of representation that occurred in the context of ‘medicalized’ research ethics is further explored including its meaning for nursing or midwifery research. (shrink)

It is such a treat and a privilege to have been at the “Defining Health Law for the Future” symposium and to have met Charity’s family. She was dear to me.

In previous literature, ethicists mention several goals of Clinical Ethics Support (CES). It is unknown what key persons in healthcare institutions see as main–—and sub-goals of CES. This article presents the goals of CES as perceived by board members and members of ethics support staff. This is part of a Dutch national research using a mixed methods design with questionnaires, focus groups and interviews. Quantitative and qualitative data were analyzed and combined in an iterative process. Four main clusters of (...) goals were found: 1) encouraging an ethical climate, 2) fostering an accountable and transparent organization, 3) developing professionalism and a final goal, overarching the previous three, 4) good care. Most important sub-goals of CES were: attention for ethical issues, raising awareness of ethical issues, fostering ethical reflection and supporting employees. The article ends with a discussion on the desirability to further operationalize the general goal of good care, the context-boundedness of our findings and the need to relate goals of CES to the features of organizational cultures to further improve the integration of CES in healthcare institutions. (shrink)

Healthcare decisions evaluate treatment risks and benefits, using a shared decision-making process between patient and clinician. Healthcare workers (HCWs) offer treatments based on condition specific evidence and expert knowledge. The patient evaluates treatment choices from their individual perception of how helpful or harmful treatment might be. This is a “risk-taking” decision. Those in a disorder of consciousness (DOC) have unreliable or absent awareness. They cannot participate in the risk-taking decisional process outlined above. Instead, family members and HCWs evaluate (...) the options and determine how much risk is acceptable. We propose this is a distinctly different decisional process called “risk-making,” and that for those in a DOC it is influenced by multiple poorly understood factors. The different ways that decisions are made on their behalf may be negatively impacting their healthcare and creating a distributive justice need. A “risk-making” theory of DOC healthcare decision-making was developed via narrative literature review. It aims to explicate the realities of DOC decision-making practices, and surface rarely discussed assumptions and social factors possibly impacting DOC healthcare for discussion and future exploration. (shrink)

Healthcare workers carry a substantial risk of harm from infectious disease, particularly, but not exclusively, during outbreaks. More can be done by healthcare institutions to identify risks, quantify the current burden of preventable infectious disease amongst HCWs and identify opportunities for prevention. We suggest that institutional obligations should be clarified with respect to the mitigation of infectious disease risks to staff, and question the duty of HCWs to care while healthcare institutions persist with a reactive rather than (...) proactive attitude to infectious disease threats. (shrink)

Healthcare trends, stressors, and workplace violence -- Patient privacy and exploitation -- Abuse and assault -- Fraud and theft -- Suspicious death and homicide -- Investigations, sanctions, and discipline -- Prevention strategies and the future of healthcare crime.

Background: This article combines foundational and empirical aspects of healthcare education and develops a framework for teaching ethical theories inspired by pragmatist learning theory and recent work on the concept of moral resilience. It describes an exemplary implementation and presents data from student evaluation. Objectives: After a pilot implementation in a regular ethics module, the feasibility and acceptance of the novel framework by students were evaluated. Research design: In addition to the regular online module evaluation, specific questions referring to (...) the teaching of ethical theories were added using simple (yes/no) and Likert rating answer formats. Participants and research context: At the Bern University of Applied Sciences, a total of 93 students from 2 parallel sub-cohorts of the bachelor’s program in nursing science were sent the online survey link after having been exposed to the same modular contents. A total of 62% of all students participated in the survey. Ethical considerations: The survey was voluntary and anonymous. Students were free to write their name and additional comments. Findings: Students consider ethical theories—as taught within the proposed framework—as practically applicable, useful, and transferable into practice. Discussion: Teaching ethical theories within the proposed framework overcomes the shortcomings described by current research. Students do not consider the mutually exclusive character of ethical theories as an insurmountable problem. Conclusion: The proposed framework is likely to promote the effectiveness of healthcare ethics education. Inspired by pragmatist learning theory, it enables students to consider ethical theories as educative playgrounds that help them to “frame” and “name” the ethical issues they encounter in daily practice, which is seen as an expression of moral resilience. Since it does not advocate a single ethical theory, but is open to the diversity of traditions that shape ethical thinking, it promotes a culturally sensitive, ethically reflected healthcare practice. (shrink)

Background: In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions. Objectives: We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these (...) decisions ought to be made. Research design: This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made. Participants and research context: We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders. Ethical considerations: The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient. Findings: As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress. Discussion: We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care. Conclusions: One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients. (shrink)

This article discusses the notion of justice from a capabilities approach. We undertake an empirical analysis of the concepts of justice held by healthcare personnel, gleaned from a qualitative analysis of interviews on the subject of ethical dilemmas in everyday practice. The article states that Justice undoubtedly presents a work in progress, which implicates the link between justice as capability and human dignity.We empirically found a contrast between the views of justice based on the patient's own perceptions and those (...) based on the perceptions of healthcare personnel. We establish the kind of actions, communication skills and justice required to build a stronger relationship between patients and healthcare professionals, which would improve prognosis, treatment efficiency and therapeutic adhesion. (shrink)