The rise and persistence of a commercial model of healthcare and the potential shift towards the commodification of dental services, provided to consumers, should provoke thought about the nature and purpose of dentistry and whether this paradigm is cause for concern. Within this article, whether dentistry is a commodity and the legitimacy of dentistry as a business is explored and assessed. Dentistry is perceived to be a commodity, dependent upon the context of how services are to be provided and the (...) interpretation of the patient–professional relationship. Commercially-focused practices threaten the fiduciary nature of the interaction between consumer and provider. The solution to managing commercial elements within dentistry is not through rejection of the new paradigm of the consumer of dental services, but in the rejection of competitive practices, coercive advertising and the erosion of professional values and duty. Consumerism may bring empowerment to those accessing dental services. However, if the patient–practitioner relationship is reduced to a mere transaction in the name of enhanced consumer participation, this empowerment is but a myth. (shrink)

Cosmetic dentistry is a divisive discipline. Within discourses that raise questions of the purpose of the dental profession, cosmetic dentistry is frequently criticised on the basis of it being classified as a non‐therapeutic intervention. This article re‐evaluates this assertion through examination of ethics of care of the self, healthcare definitions and the social purpose of dentistry, finding the traditional position to be wanting in its conclusions. The slide of dentistry from a healthcare vocation towards being a predominantly business‐focused interaction between (...) clinician and consumer conflicts with traditional notions of dentistry as a profession. Whilst it is undeniable that cosmetic dental treatment particularly lends itself to the commercial paradigm, this is not exclusive to this area of professional practice. The cultural basis of dental appearance and the potential of the dental profession to exert coercive pressure upon the public to undergo treatment that is based upon social norms is discussed. This essay concludes that cosmetic dentistry is undeniably part of the professional purpose of 21st Century dentistry. However, the caveat that may be placed upon this, is that this status is conditional upon the professional conduct of dental practitioners remaining resilient to commercial practices not compatible with professional obligations. (shrink)

BackgroundWhat can the analysis of the evolution of a code of ethics tell us about the dental profession and the association that develops it? The establishment of codes of ethics are foundational events in the social history of a profession. Within these documents it is possible to find statements of values and culture that serve a variety of purposes. Codes of ethics in dentistry have not frequently presented as the subjects of analyses despite containing rich information about the priorities and (...) anxieties within the profession’s membership at the time that the code was written.Main textThis essay uses critical discourse analysis to explore the 2012 and 2018 versions of the Code of Ethics produced by the New South Wales Branch of the Australian Dental Association. This method of discourse analysis examines contradictions between the discourses within the codes and how these relate to broader social realties that surround the dental profession in New South Wales. By analysing the 2012 and 2018 codes together, it is possible to understand how the dental profession views its commitments to society as established through the social contract. Through this assessment, it will be demonstrated that both codes suffer due to their failure to consider the public as a key stakeholder in the creation and curation of the Code of Ethics and how this this relates intimately with the social contract between the profession and the public.ConclusionWithout the public being the central consideration, both codes amount to declarations of professional privilege and dominance. Although the more recent 2018 Code of Ethics demonstrates insight into the changes in public trust placed in the professions, this analysis shows that that the current code of ethics is still reluctant to recognise and engage with the public as an equal stakeholder in the planning and provision of oral health care and the development of the profession’s values and cultural trajectory. (shrink)

Communicative Understandings of Women's Leadership Development: From Ceilings of Glass to Labyrinth Paths, edited by Elesha L. Ruminski and Annette M. Holba, weaves the disciplines of communication studies, leadership studies, and women's studies to offer theoretical and practical reflection about women's leadership development in academic, organizational, and political contexts. This work claims a space for women's leadership studies and acknowledges the paradigmatic shift from discussing women's leadership using the glass ceiling to what Eagly and Carli identify as the labyrinth of (...) leadership. (shrink)

Commercialisation and consumerism have had lasting and profound effects upon the nature of oral health and how dental services are provided. The stigma of a spoiled dental appearance, along with the attraction of the smile as a symbol of status and prestige, places the mouth and teeth as an object and product to be bought and sold. How the dental profession interacts with this acquired status of the mouth has direct implications for the professional status of dentistry and the relationship (...) between the profession and society. This essay examines the mouth’s developing position as a symbol of status and prestige and how the dental profession’s interaction and response to this may have important effects on the nature of dentistry’s social contract with society. As rates of dental disease reduce in higher socioeconomic groups, dentistry is experiencing a reorientation from being positioned within a therapeutic context, to be increasingly viewed as body work. This is not in of itself problematic; as a discipline dentistry places a very high value upon the provision of enhanced or improved aesthetics. This position changes when the symbolic exchange value of an aesthetic smile becomes the main motivation for treatment, encouraging a shift towards a commercialised model of practice that attenuates professional altruism. The dental profession should not welcome the association of the mouth as a status and prestige symbol lightly; this article examines how this paradigm shift might impact upon the social contract and dentistry’s professional status. (shrink)

Bioethics, Volume 35, Issue 7, Page 646-651, September 2021.

This article examines recent developments in the regulation of the medical profession in England, with particular reference to doctors working in the National Health Service (NHS). It is argued that the Health Act 1999 and associated government policies are bringing about a shift from a «light touch», self-regulatory paradigm to a government-driven, interventionist approach. It is suggested that the reason for the change is not simply a governmental concern with the quality and nature of care provided by doctors, but more (...) significantly, a concern with the cost of that care. The article offers a critique of the new regime, drawing on the socio-legal literature on regulation. Some aspects of the reforms ignore the need to persuade doctors to comply, and may therefore result in cheating or «creative compliance»; other aspects of the reforms provide doctors with opportunities to «neutralize» their impact. It concludes with an examination of the wider significance of the change in regulatory paradigm, and of the agenda for future research in this field. (shrink)

© 2014 Taylor Francis. The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus testing of every client presenting for services in venues where HIV prevalence is high. Because older adults have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent and ever HIV testing in a probability sample of at-risk (...) adults seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months or ever. Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis. (shrink)

One dark and rainy night, Yuso sexually assaults and tortures Zelan. In escaping from the scene of his crime, he falls heavily and becomes an impotent paraplegic. Instead of treating his fate as divine retribution for his wicked acts, Yuso sees it as sheer bad luck. He shows no remorse for what he has done, and vainly hopes that he will recover his powers, which he now treats as involuntarily hoarded resources to be used on less rainy days. In the (...) presence of others, he pretends that he has turned over a new leaf. He asks for religious and educational books, hoping to make up for his poor education and deprived social background. But he immediately discards them when he is alone in favor of the pornographic magazines which he has bribed a nurse to smuggle in for him. His deception and various obscene acts committed in the hospital are exposed; by the time he comes up for trial, everyone knows that he is still a lustful, sadistic, and unrepentant man. Most retributivists have a sufficient justification for punishing Yuso independently of the social consequences of his punishment. Two features of the case might cause some difficulties. First, Yuso has already experienced considerable suffering and deprivation both before and after his crime, and retributivists might disagree about the relevance of the suffering to his punishment. Secondly, Yuso is unrepentant, and it is unlikely that punishment will change him. This might, as we shall see, create a problem for those who think that the justifying aim of punishment is the moral reform of the offender. (shrink)

BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for people with (...) intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level.ResultsAccording to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.ConclusionsConcretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences. (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a (...) tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

The legal requirements and justifications for collecting patient-identifiable data without patient consent were examined. The impetus for this arose from legal and ethical issues raised during the development of a population-based disease register. Numerous commentaries and case studies have been discussing the impact of the Data Protection Act 1998 and Caldicott principles of good practice on the uses of personal data. But uncertainty still remains about the legal requirements for processing patient-identifiable data without patient consent for research purposes. This is (...) largely owing to ignorance, or misunderstandings of the implications of the common law duty of confidentiality and section 60 of the Health and Social Care Act 2001. The common law duty of confidentiality states that patient-identifiable data should not be provided to third parties, regardless of compliance with the DPA1998. It is an obligation derived from case law, and is open to interpretation. Compliance with section 60 ensures that collection of patient-identifiable data without patient consent is lawful despite the duty of confidentiality. Fears regarding the duty of confidentiality have resulted in a common misconception that section 60 must be complied with. Although this is not the case, section 60 support does provide the most secure basis in law for collecting such data. Using our own experience in developing a disease register as a backdrop, this article will clarify the procedures, risks and potential costs of applying for section 60 support. (shrink)

Exposition of Abhidharma, Buddhist philosophy.

Recently a child’s right to a father was invoked to justify the prevention of single women from obtaining access to IVF. This article explores the conceptual and normative issues about the nature of the right and its conflict with a woman’s right to procreative autonomy. The discussion relates the conceptual issues to those raised in the context of ‘wrongful life’ tort cases. It concludes that the right to be born with a father, although conceptually sound, does not justify the restriction (...) on the procreative right of single women. (shrink)

The purpose of this essay is to study the problem of inherent obscurity of the criterion for maximal utility in utilitarianism. For the sake of convenience of analysis, situations of moral actions are classified into four categories. It is shown that morality is flexible, especially in the positive sense, in that a virtuous action can be taken in various ways and/or to various degrees. For some situations it is inherently unclear what the moral requirement is, and whether it is a (...) maximum or a minimum. It is concluded that the schism of the principle of utility between the principle of the good and the principle of the right seems to be inevitable, and the interpretation of the ultimate criterion for maximal utility should be relaxed or interpreted separately and differently according to the situation of action. (shrink)

If, as Saunders & van Brakel assert, hue, lightness, and saturation characterize artificial color spaces and not the colors of everyday life, one would expect those color spaces to have limited relevance to our understanding of color phenomena and to be of little practical application. This is not the case. Although people perceive these and equivalent color dimensions holistically rather than analytically, they are able to use such triples to categorize the colors of their environment.

Objectives To investigate empirically the motivations for not consenting to DNA biobanking in a Swedish population-based study and to discuss the implications. Design Structured questionnaires and semistructured interviews. Setting A longitudinal epidemiological project (PART) ongoing since 1998 in Stockholm, Sweden. The DNA-collection wave took place during 2006–7. Participants 903 individuals completed the questionnaire (participation rate 36%) and 23 were interviewed. All individuals had participated in both non-genetic waves of the project, but refused to contribute saliva samples during the DNA-collection wave. (...) Main outcome measures Motivations behind refusing to consent to DNA biobanking, with subsequent focus on participants' explanations regarding this unwillingness. Results Public refusal to consent to DNA biobanking, as revealed by the questionnaire, was mainly explained by a lack of personal relevance of DNA contribution and feelings of discomfort related to the DNA being used for purposes other than the respective study. Interviews of individuals representing the second motivation, revealed a significant mistrust of DNA biobank studies. The underlying beliefs and attitudes were associated with concerns about integrity, privacy, suspiciousness and insecurity. However, most interviewees were supportive of genetic research per se and interpreted their mistrust in the light of distressing environmental influences. Conclusion The results suggest a need for guidelines on benefit sharing, as well as trustworthy and stable measures to maintain privacy, as a means for increasing personal relevance and trust among potential participants in genetic research. Measures taken from biobanks seem insufficient in maintaining and increasing trust, suggesting that broader societal measures should be taken. (shrink)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

All students of the classical languages are aware that, in referring to intervals of time, the Greeks and Romans often employed a method of reckoning which was inclusive and consequently different from our own. The Greeks, for example, refer to the period between two celebrations of the Olympic games as a though we should call it a four-year interval. One instance of this kind of usage in Latin is the stereotyped formula employed in expressing a date: ante diem quintum Id. (...) Mai. is 11 May, though we should say that there was an interval of four days only between 11 and 15 May. Another instance is the use of tertiana and quartana as applied to fevers which recur on alternate days and on every third day respectively. The ramifications of this mode of expression are extensive, but I am only concerned here with one, namely the use of quisque with ordinals. (shrink)