BackgroundObtaining consent has become a standard way of respecting the patient’s rights and autonomy in clinical research. Ethical guidelines recommend that the child’s parent/s or authorised legal guardian provides informed consent for their child’s participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child’s illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy will (...) assist in developing appropriate consent guidelines.MethodsWe conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants’ views about informed consent processes. Data analysis was facilitated by NVIVO 11 software.ResultsAll participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting.ConclusionThe health care context, culture and research process influenced participants’ understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent.Trial registration Not applicable. (shrink)

As Steve Kaminshine said in his comments at the symposium honoring Charity Scott, I was recruited to come to Georgia State University as a “Law and Bioethics” scholar who had spent more than sixteen years shuttling between an office in a hospital and another in a law school. But when I first visited Georgia State Law, I did not know that more than ten years earlier Charity Scott had spent the better part of an academic year living and breathing clinical (...) ethics at Grady Memorial Hospital.1 Because of her usual habit of immersion in all learning experiences, in that year Charity gained more insight into how hospitals work and how physicians behave when they are knee deep in their professional milieu of life and death decision-making than many full-time bioethics academics do in a career. For the rest of her career Charity kept one foot well planted in the medical context, as an advisor in problems of research ethics, as a teacher in her own medical-legal partnership structured around real-life clinical problems, and as an ethical analyst who could never be accused of mouthing a mantra of phrases, the “vacuous incantation of abstract principles”2 that might pass for bioethics discourse in some circles. (shrink)

Christian health care professionals in our secular and pluralistic society often face uncertainty about the place religious faith holds in today's medical practice. Through an examination of a virtue-based ethics, this book proposes a theological view of medical ethics that helps the Christian physician reconcile faith, reason, and professional duty. Edmund D. Pellegrino and David C. Thomasma trace the history of virtue in moral thought, and they examine current debate about a virtue ethic's place in contemporary bioethics. Their (...) proposal balances theological ethics, based on the virtues of faith, hope, and charity, with contemporary medical ethics, based on the principles of beneficence, justice, and autonomy. The result is a theory of clinical ethics that centers on the virtue of charity and is manifest in practical moral decisions. Using Christian bioethical principles, the authors address today's divisive issues in medicine. For health care providers and all those involved in the fields of ethics and religion, this volume shows how faith and reason can combine to create the best possible healing relationship between health care professional and patient. (shrink)

Background: Empirical studies in Muslim communities on organ donation and blood transfusion show that Muslim counsellors play an important role in the decision process. Despite the emerging importance of online English Sunni fatwas, these fatwas on organ donation and blood transfusion have hardly been studied, thus creating a gap in our knowledge of contemporary Islamic views on the subject.Method: We analysed 70 English Sunni e-fatwas and subjected them to an in-depth text analysis in order to reveal the key concepts in (...) the Islamic ethical framework regarding organ donation and blood transfusion.Results: All 70 fatwas allow for organ donation and blood transfusion. Autotransplantation is no problem at all if done for medical reasons. Allotransplantation, both from a living and a dead donor, appears to be possible though only in quite restricted ways. Xenotransplantation is less often mentioned but can be allowed in case of necessity. Transplantation in general is seen as an ongoing form of charity. Nearly half of the fatwas allowing blood transfusion do so without mentioning any restriction or problem whatsoever. The other half of the fatwas on transfusion contain the same conditional approval as found in the arguments pro organ transplantation.Conclusion: Our findings are very much in line with the international literature on the subject. We found two new elements: debates on the definition of the moment of death are hardly mentioned in the English Sunni fatwas and organ donation and blood transfusion are presented as an ongoing form of charity. (shrink)

Mark J. Cherry; The Body for Charity, Profit and Holiness: Commerce in Human Body Parts, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume.

Charity Scott brought health law to Georgia State College of Law in the fall of 1987. Through her faculty appointment, along with her boundless energy and intellectual curiosity, she set herself on an odyssey. She began by teaching a single general health law class. This beginning led to the development of a full curriculum in the field, complete with experiential learning opportunities and a certificate in health law program. In addition to creating learning and career opportunities in health law for (...) law students, her development of the Center for Health, Law and Society created academic opportunities for leading health law faculty. (shrink)

As I sit down to begin this essay, the strains of “Tristan und Isolde” are still ringing in my ears; meanwhile, another dozen or so Pakistanian refugees have died for lack of sufficient food, shelter, or medical attention, probably, during the time it will have taken to compose this paragraph. The Isolde in that performance commanded, probably, a fee of four or five thousand dollars; each member of the audience paid, on the average, perhaps ten dollars to see the (...) performance. This works out, probably, to an average of one year’s worth of refugees kept alive and in some sort of health for every two members of the audience, or about two hundred for the wages of the leading soprano for one evening. The arithmetic is doubtless inaccurate: possibly it would require as much as three opera tickets to keep our refugee going, and Isolde could manage but fifty. But the orders of magnitude are about right. (shrink)

Few people in my memory have a name that more appropriately defines the life they have lived. “Charitable purpose” as defined in O.C.G.A. § 43-17-2 includes any charitable or benevolent purpose including health, education, or social welfare. Anyone who knew Charity Scott knows that she lived a life devoted to providing and improving the health of her community, the education of law students about health law and its use to improve the health of her community, and social welfare by addressing (...) the socio-economic determinants of health. If she had not been assigned that name at birth, those of us who knew her could have easily assigned Charity as a nickname. (shrink)

These comments seek to take issue with the contention that society has a responsibility to provide its members with any needed health care. In order to deal with this claim, we must first make clear exactly what it meant by the proposition. I take it that those who embrace this view mean considerably more than that each of us has a moral obligation to contribute to those in need of medical attention who are unable, for one reason or another, (...) to afford the necessary care. This is a moral proposition and is traditionally dealt with under the heading of charity. But the contention, as here used, means considerably more since its main implications are not moral but primarily political. (shrink)

Background: Empirical studies in Muslim communities on organ donation and blood transfusion show that Muslim counsellors play an important role in the decision process. Despite the emerging importance of online English Sunni fatwas, these fatwas on organ donation and blood transfusion have hardly been studied, thus creating a gap in our knowledge of contemporary Islamic views on the subject. Method: We analysed 70 English Sunni e-fatwas and subjected them to an in-depth text analysis in order to reveal the key concepts (...) in the Islamic ethical framework regarding organ donation and blood transfusion. Results: All 70 fatwas allow for organ donation and blood transfusion. Autotransplantation is no problem at all if done for medical reasons. Allotransplantation, both from a living and a dead donor, appears to be possible though only in quite restricted ways. Xenotransplantation is less often mentioned but can be allowed in case of necessity. Transplantation in general is seen as an ongoing form of charity. Nearly half of the fatwas allowing blood transfusion do so without mentioning any restriction or problem whatsoever. The other half of the fatwas on transfusion contain the same conditional approval as found in the arguments pro organ transplantation. Conclusion: Our findings are very much in line with the international literature on the subject. We found two new elements: debates on the definition of the moment of death are hardly mentioned in the English Sunni fatwas and organ donation and blood transfusion are presented as an ongoing form of charity. (shrink)

Larry Temkin draws on the work of Angus Deaton to argue that countries with poor governance sometimes rely on charitable giving and foreign aid in ways that enable them to avoid relying on their own citizens; this can cause them to be unresponsive to their citizens’ needs and thus prevent the long-term alleviation of poverty and other social problems. I argue that the implications of this “lack of government responsiveness argument” (or LOGRA) are both broader and narrower than they might (...) first appear. I explore how LOGRA applies more broadly to certain types of charitable giving in developed countries, with a focus on medical crowdfunding. I then highlight how LOGRA does not apply to charitable giving aimed at alleviating the suffering of the absolutely politically marginalized, or those especially vulnerable people to whom governments are never responsive. (shrink)

Hospital ethics committees (HECs) traditionally focus on clinical ethics but are increasingly recognized for their potential role in addressing organizational ethics, particularly in the allocation of charity care resources. This commentary explores the expanded role of HECs in charity care allocation, emphasizing the core ethical principles of justice, transparency, and accountability. We discuss the need for HECs to develop expertise in organizational ethics, differentiate between emergency and chronic resource allocation, and apply value-based insurance design principles to set service boundaries. By (...) adopting an egalitarian approach to justice, HECs can help reduce health disparities and ensure equitable access to charity care. Enhanced transparency and accountability through clear criteria, regular audits, and public reporting are also vital. This paper underscores the importance of integrating these ethical principles into healthcare resource allocation to promote health equity and maintain the financial sustainability of healthcare institutions. (shrink)

I applied to law school as a means to an end. To “fix the system,” to make a difference, to advocate for meaningful change that improves health and well-being of others. Charity Scott accomplished, in her academic career, what I have not. At least thus far, I have chosen to follow a different path, dipping in and out of my original mission. Charity, by contrast, was focused and centered, never deviating from her integrity, purpose, kindness, advocacy, and brilliance. She gracefully (...) married the intellectual enterprise of legal education with an unwavering mission to improve individual lives — of students, colleagues, clients, practitioners, and public servants. She was among pioneers in the health law field. She pioneered the medical-legal partnership model. She made a difference. (shrink)

Balancing on a tightrope twenty feet above the ground is outside the comfort zones of many health law professors. Being there forces you to consider in new ways yourself, your skills, and your surroundings. Fears arise, and yet you must still act. And you must trust that the person who offered you this opportunity cared about you and your well-being, and that they would ensure there was a way to get from where you began to the other side.

Media appeals encouraging people to sign organ donor cards suggest that donating one's own organs after death or donating the organs of a deceased family member is an act of charity, i.e., something which it would be meritorious for people to do but not wrong to avoid. This paper argues to the contrary that posthumous organ donation is a moral duty, a duty of the type that rests at the base of recently enacted state “Good Samaritan” laws which require a (...) witness to an emergency situation to render aid to the victim when this can be done at minimal cost/risk to the potential rescuer. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Striving To Do Good:Well-Springs, Realities, and Paradoxes of Medical Humanitarian WorkRenée C. FoxThe voices that speak from the pages of these testimonial narratives are those of physicians who are engaged in medical humanitarian work. The preponderance of them are based in U.S. academic medical centers where they have clinical, teaching, and research responsibilities from which they regularly "commute" to care for patients in what the euphemistic (...) language of "global health" terms "resource-limited," rather than "poor" countries." This "hybrid life," as one of the physicians (Robert Riviello) refers to it, has transported them periodically to numerous African societies (to Algeria, Ethiopia, Gabon, Morocco, Rwanda, Sudan, Tanzania, and Uganda), to Haiti, to India and Nepal, and to Guatemala and Mexico. Three of the "stories" are written by physicians at work in the countries where they were born (Prasanta Tripathy in Eastern India, Sridevi Seetharam and colleagues in Southern India, and Paul Pierre, in Haiti).Only one group of physician-coauthors (Maricruz Merino, Jonathan Iralu, and Sonya Shin) write about their experiences in practicing medicine among poor and socially disadvantaged patients on the American mainland—in the setting of the Navajo Indian reservation in Gallup, New Mexico.All these physicians describe their involvement in humanitarian medicine as emanating from their commitment to "social justice," to "saving lives," and to "caring for the poor"; to their universalistic convictions about "human solidarity," and the non- otherness of others; to their indignation about the inequities and injustices of the world, particularly with regard to access to health care (in the words of Jeffrey Deal, "[They] deserve better. They all do"); and to their "passionate" desire, not just their "sense of duty," to help rectify these wrongs (Richard Keiden). I was struck by the fact that none of them uses the word "suffering" to describe the plight of the persons whom they feel they have been called to medically assist.Three of the physicians express the wellsprings of their motivation in religious terms. Richard Keiden refers to a "guiding principle of Judaism" on which his medical humanitarian work has been founded—"tzedakah"—which "translates as charity but actually means righteousness," is based on a "concept of social justice," and is "an obligation, not a choice." Robert Riveillo says that at the time of his graduation from high school he envisioned his "life's work as a long-term missionary surgeon"; he invokes "loving mercy," as well as justice, "in this work of solidarity" that he has undertaken; and he poignantly admits that "most days I still long to pack my things, my family, and our efforts and move to Africa for a life of direct service." What Jeffrey Deal writes is the most explicitly and ardently religious of all. He identifies his work as a physician in Sudan with Jesus's "desire for us to care [End Page 115] for the poor and downtrodden in His stead." He is haunted by his "failure" to deliver alive a "partially born" baby girl who for him incarnated "the least of the least" of whom Jesus "spoke passionately." And in touching "ever so briefly... [that] one, tiny being [he] encountered... [on ] that hot morning in Sudan," he attests, he "touched Jesus."Jeffrey Deal is not the only one who was so stricken by the death of a baby or a child. For a number of these physicians (Sadath Sayeed, Maneesh Batra, and for Sridevi Seetharam, Lisa Adams and their colleagues), it was a tragedy that they found hard to bear with "detached enlightenment" (Sayeed), or to accept. The most demonstrably heartbroken and morally outraged among them is Sadath Sayeed, who "wept uncontrollably" over the death of a baby boy, born "at home" in Haiti, "probably in one of the hundreds of make-shift tent cities." The baby was not breathing continuously, and was "handed" to him to care for. At the close of the "story " about this experience that he recounts, Sayeed lashes out with fury and angst at those who were likely to ask him, "How was it in Haiti?" Do you want to hear "my real answer?" he replies:... [L]et me summarize my last patient for you: Good luck Dad... (shrink)

Debate continues over the acts/omissions doctrine, and over the concepts of duty and charity. Such issues inform the debate over the moral permissibility of euthanasia. Recent papers have emphasised moral sensitivity, medical intuitions, and sub-standard palliative care as some of the factors which should persuade us to regard euthanasia as morally unacceptable. I argue that these lines of argument are conceptually misdirected and have no bearing on the bare permissibility of voluntary euthanasia. Further, some of the familiar slippery slope (...) arguments against voluntary euthanasia compromise the principle of autonomy to which both supporters and opponents of euthanasia adhere. I discuss a model for doctor/patient relationships which can be applied to cases which would be seen by all disputants as strong prima facie cases for euthanasia. I argue that in certain cases it will be ordinary medical practitioners who are duty-bound to assist death. (shrink)

Five proposals for admitting better applicants into medical school are discussed in this article: An A level in a humanity or social science would be required, to supplement—not replace—the stringent science requirement. This would ensure that successful candidates would be better “primed” for the medical curriculum. Extra points in the applicant’s initial screening would be awarded for an A level in English literature. There would be a minimum age of 23 for applicants, although a prior degree would not (...) be required. This is to ensure that the applicants are mature enough to know themselves and the world better, to make a more informed and motivated choice of career, and to get more out of the humanities components of the curriculum. A year’s full-time experience in a healthcare or charity environment would be desirable. Applicants would be given two lists of interview discussion topics to prepare: works of literature and topics in healthcare politics. (shrink)

This introduction to Christian Bioethics 15/2 focuses on the challenges which secular moral reconstruction and secular political implementation presents for Christian diakonia. It summarises the various Roman Catholic, Protestant, and Orthodox ways in which Christians’ loving service to the world have been integrated either into the secular state's provision of social welfare or into the Church's liturgical life by the authors of this issue. This summary centres on questions concerning the political nature of Christian charity, its role within the church, (...) the implication of public funding for the integrity of the Christian service, the relationship between love and justice, and the impact of different kinds of feminism on Christian diaconic work. (shrink)

The United Nations Convention on the Rights of Persons with Disabilities, adopted on December 13, 2006, and entered into force on May 3, 2008, constitutes a key landmark in the emerging field of global health law and a critical milestone in the development of international law on the rights of persons with disabilities. At the time of its adoption, the U.N. High Commissioner for Human Rights heralded the CRPD as a rejection of the understanding of persons with disabilities “as objects (...) of charity, medical treatment and social protection” and an embrace of disabled people as “subjects of rights.”The text of the Convention itself, and the highly participatory process by which it was negotiated, signal a definitive break from previous international approaches that focused on disability within a medical model framework. In contrast to traditional approaches, the CRPD embraces a social model of disability, concentrating the disability experience not in individual deficiency, but in the socially constructed environment and the barriers that impede the participation of persons with disabilities in society. (shrink)

This paper looks at conflicts of interest in the not-for-profit sector. It examines the nature of conflicts of interest and why they are of ethical concern, and then focuses on the way not-for-profit organisations are especially prone to and vulnerable to conflict-of-interest scandals. Conflicts of interest corrode trust; and stakeholder trust (particularly from donors) is the lifeblood of most charities. We focus on some specific challenges faced by charitable organisations providing funding for scientific (usually medical) research, and examine a (...) case study involving such an organisation. One of the principal problems for charities of this kind is that they often distribute their funds within a relatively small research community (defined by the boundaries of a small region, like an American state or Spanish Autonomous region, or a small country), and it often proves difficult to find high-level researchers within the jurisdiction to adjudicate impartially the research grants. We suggest and recommend options appropriate for our case study and for many other organisations in similar situations. (shrink)

The formerly established medically-based idea of disability, with its charity-based approach to treatment and services, is being replaced by a human rights-based approach in which people with impairments are no longer considered medical problems, totally dependent on the beneficence of non-impaired people in society, but have fundamental rights to support, inclusion, and participation. This interdisciplinary book examines the diverse concerns that people with impairments face in the context of human rights, provides insights into new developments on important issues relating (...) human rights to disability, and features new approaches and solutions to vital problems in the current debate. (shrink)

This paper analyses the immunological response of breast cancer patients through the lens of medical semiotics. From this perspective both psychological and physiological symptoms are treated as a set of transitive signs. The symptomatic journey of breast cancer patients was documented through an ethnographic engagement with a breast cancer charity. This journey consists of diagnosis, treatment and remission, where both the physical and psychological trauma maybe irreversible. Equally the genetic disposition of each patient and the variability of the treatment (...) give rise to a plethora of possible immunological responses. The case study organization provided both therapeutic treatment but also sold oncology products to its patients, matching the products’ composition to the specific immunological responses caused by breast cancer treatment, e.g., brittle skins or hair loss, etc. This paper explores how the varied and transient nature of immunological semiosis is identified and commoditized into an economic process. This challenging social context is of interest from a semiotic stand point because it offers a singular paradigm to explain the evolution of signs and symptoms into sales. (shrink)

Medical experimentation on humans with “classic” sexually transmitted diseases (e.g., syphilis, gonorrhea) is not generally well known, but experimentation with others such as Granuloma inguinale, or Donovanosis, is even less so. Endemic to non-existent here, hyper-epidemic there, between 1880 and 1950 Donovanosis was linguistically and morally “constructed” as a disease of poor, sexually profligate, tropical, darkly-skinned persons. It was also experimentally produced on and in African-American patients in many charity hospitals in the American South. This essay analyzes Donovanosis literature (...) of the period that heavily featured skin color, climate and tropicality, venereal sin, and racial susceptibility. It then recounts the history of human experimentation with it, and explains both its linguistic construction and its biomedical experimental history in terms of “disease narratives” produced not only by but for venereologists. (shrink)

In the author's dual identities of Disney fanatic and philosopher of disability, he was as delighted as a five‐year‐old on their first trip to the Magic Kingdom to see the progress that Disney had made in Finding Dory by depicting what philosophers call the social model of disability. In contrast to the social model of disability, people often see the medical model, in which disability is understood as an individual problem to be remedied through medical treatment or charity. (...) Not to get too far ahead of themselves, but Dopey from Snow White is a perfect illustration of a character with a disability portrayed in terms of the medical model. Keep pondering that while people consider a darker side to the Finding Dory disability paradise, one that reveals it is only a wonderful world for those who can speak. (shrink)

By their very nature, overseas medical missions (and even domestic medical charities such as free clinics ) are designed to serve vulnerable populations. If these groups were capable of protecting their own interests, they would not need the help of medical volunteers: their medical needs would be met through existing government health programs or by utilizing their own resources. Medical volunteerism thus seems like an unfettered good: a charitable activity provided by well-meaning doctors and nurses (...) who want to give of their time, skills, and resources to help those who would not otherwise be able to take care of their medical needs. In this article, I argue that if medical volunteerism is to be good, however, it must always meet certain basic ethical requirements. These requirements may be (and perhaps often are) overlooked in the rush to organize and carry out short-term medical missions. I illustrate my point with special reference to short-term medical missions designed to provide surgical repair of obstetric vesico-vaginal fistula, a condition in which the tissues that normally separate the bladder from the vagina are destroyed by obstetric trauma, leading to continuous and unremitting incontinence in the affected woman. (shrink)

New York Post Best Book of 2016 We often think of our capacity to experience the suffering of others as the ultimate source of goodness. Many of our wisest policy-makers, activists, scientists, and philosophers agree that the only problem with empathy is that we don’t have enough of it. Nothing could be farther from the truth, argues Yale researcher Paul Bloom. In AGAINST EMPATHY, Bloom reveals empathy to be one of the leading motivators of inequality and immorality in society. Far (...) from helping us to improve the lives of others, empathy is a capricious and irrational emotion that appeals to our narrow prejudices. It muddles our judgment and, ironically, often leads to cruelty. We are at our best when we are smart enough not to rely on it, but to draw instead upon a more distanced compassion. Basing his argument on groundbreaking scientific findings, Bloom makes the case that some of the worst decisions made by individuals and nations—who to give money to, when to go to war, how to respond to climate change, and who to imprison—are too often motivated by honest, yet misplaced, emotions. With precision and wit, he demonstrates how empathy distorts our judgment in every aspect of our lives, from philanthropy and charity to the justice system; from medical care and education to parenting and marriage. Without empathy, Bloom insists, our decisions would be clearer, fairer, and—yes—ultimately more moral. Brilliantly argued, urgent and humane, AGAINST EMPATHY shows us that, when it comes to both major policy decisions and the choices we make in our everyday lives, limiting our impulse toward empathy is often the most compassionate choice we can make. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How was Haiti?Sadath Sayeed"She smelled of milk and urine. Chacko marveled at how someone so small and undefined, so vague in her resemblances, could so completely command the attention, the love, the sanity of a grown man."—Arundhati Roy from The God of Small ThingsFather and SonTwenty minutes before I was to be taxied to the airport in Port-au-Prince, the baby boy handed to me did not breathe continuously. He (...) didn't breathe at all. Born a few hours earlier at home—probably in one of the hundreds of make-shift tent cities. I did ask if the baby cried after he came out of mom. Yes. He didn't suckle well and stopped crying. Dad decided to get help. Climbed onto a moped with his baby wrapped in a blanket. Must have tucked him under one arm and rode between piles of rubble to the closest health care facility.People at this other place tried to help his baby boy breathe. They pushed air into his mouth like you are doing. After a few minutes, they said that they couldn't help anymore."Go to the University hospital."From a shirt sleeve pocket, he pulled a crumpled white piece of paper with some writing scribbled on it. I gathered it documented this last visit. They took the time to hand him a note before they sent him on his way.What did Dad think? Thanks for the note. Okay, now what? Swaddle my baby. Tuck him under one arm. Hop on my moped.Strained ResourcesL'Université d'État d'Haïti has been the main teaching hospital for all of the country for decades. Many, if not most, formally trained Haitian health care providers have spent some time in Port-au-Prince at this institution. As important as it is, it has suffered from neglect over many, many years. The earthquake made matters exponentially worse. [End Page 98]Dad must have been directed to the pediatric service when he arrived. There, a few Haitian pediatric residents and nurses were doing what they did every morning. Tending to an overcrowded patient population of babies, children, and parents. The pediatrics building was left uninhabitable. All inpatient and outpatient care took place on a street where the tents had been erected.In the ICU, tent twenty beds filled a space probably meant for ten military style cots. Metal cribs and full adult hospital beds were jammed next to one another to fill every possible nook. Parents slept on the adult beds with their sick children or underneath the cribs. Siblings too. Outside, hundreds of parents would line up starting at six a.m. and stand in line for hours so that they could get their children seen in a couple of smaller tents that were used to run the outpatient clinics. Moms would fan their kids under the shade of trees on the side of the road. Feed them some milk or juice while they waited. Smile at us passers-by. They seemed to possess a bottomless well of patience.Power cords with extension wires littered the street-hospital floor under the canopy.When it rained, we were only modestly concerned about electrocution. A single 1950's style metal desk with two worn out chairs greeted visitors to the entry way and was usually occupied by some of the medical staff. A single, large metal fan that had collected enough dust and soot in its circular cage to look bearded hummed a breeze toward the desk.A bottomless well of patience and resiliency. In the popular media, this last word has been thrown around a lot to describe the character of the Haitian people. It is insufficient. Their adversity is truly absurd. Sense cannot be made of the scene in the pediatrics tents months after the earthquake struck, nor elsewhere on that campus, let alone outside its walls.The local medical staff hadn't been paid a dime in many months even prior to the earthquake. They suffered unimaginable losses during the earthquake. They still came to work."We love our children. They love us too."What so many of us think of as charity... (shrink)

Background: Hospital nurses are frequently the first care givers to receive a patient’s request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses’ opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. Methods: A phone survey conducted among a random national sample of (...) 1502 French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. Results: Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. Conclusions: Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call “good” euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia. (shrink)

The purpose of this paper is to review the rising influence of commercialism in American medicine and to examine some of the consequences of this trend. Increased competition subverts physician collegiality, draws hospitals into for-profit ownership and behavior, and leads clinical investigators into secrecy and possibly into bias and abuse. Medicine faces a deprofessionalization evidenced in loss of control over the clinical setting and over self-regulation. Health care becomes a commodity relying on cultivation of desires instead of satisfaction of needs, (...) even as many basic needs go unmet. Patients become consumers empowered with lawsuits and the connection of medicine to the relief of suffering is attenuated. Medical encounters are increasingly impersonal, dominated by specialization, technology, and bureaucracy. Patients are losing their physician-advocates to new conflicts of interests, physicians are losing their impulse to charity, and trust in the doctor-patient relationship and in medicine generally is eroding. (shrink)

Congress recently decided that undocumented aliens are ineligible for medical benefits under the 1966 Medicaid Act, overruling a judicial decision that would have required the federal government to reimburse states partially for the costs of providing free care. Is providing such care simply a matter of prudence and charity? Or do illegal aliens have strong moral claims to medical care that generate duties for hospitals and government agencies?

In this study, we investigated whether background information of a visual charity appeal can influence people’s motivation to donate and the hypothetical amount donated. Specifically, participants were presented with a charity appeal to help a local hospital respond to the Coronavirus Disease-19 emergency depicting a man sitting on a bed in a hospital room. The number of visual details depicted in the background was manipulated according to three conditions: “High information” condition, “low information” condition, and “no information” condition. We investigated (...) whether the number of visual background details would have increased the tangibility of the cause measured as the hospital’s adequate preparedness to deal with the COVID-19 emergency and severity of the patient’s medical conditions. We also investigated whether increased tangibility, elicited by a higher amount of background information, would heighten participants’ perceived impact of their donation and warm glow, which in turn would have led to increased motivation to donate and the amount donated. We found no significant direct effect of condition on the donated amount. However, path models revealed that more background information positively influenced participants’ motivation to donate and the amount donated indirectly through increased tangibility, impact, and warm glow. Finally, we showed that a higher risk perception of COVID-19 was associated with higher donations. Results are discussed in line with relevant literature. (shrink)

Dying patients have more than medical needs. In fact, what they feel most sharply, whether or not they are religious, are spiritual concerns. The Christian theological virtues of faith, hope, and charity, properly interpreted and translated to reflect the universal concerns with which they are connected, provide a starting point.

The tobacco industry first began to promote the idea that a minority of smokers are 'genetically predisposed' to lung cancer in the 1950s. We used tobacco industry documents available as a result of litigation to investigate the role of the tobacco industry in funding the 'scientific bandwagon' described by Fujimura, in which genetics has come to dominate the cancer research agenda. From 1990-1995 inclusive, 52% of the project funding allocated by British American Tobacco's Scientific Research Group went to genetic research, (...) mainly based in universities and at one cancer charity. The largest project involved a pharmacogenetic research unit, based in a UK medical school, which was established with the help of tobacco industry PR consultants in 1988. The unit received half its project funding from the industry in 1992. Its main aim was to identify a minority of smokers who are supposedly 'genetically susceptible' to lung cancer, so that smoking cessation measures could be targeted at them. This aim was adopted and promoted by influential scientists at the US National Institutes of Health and the UK Medical Research Council in the late 1980s, in the run up to the Human Genome Project.BAT's research funds were also used to counter claims by others to have identified a unique 'genetic fingerprint' for tobacco smoke in lung cancer cells. We conclude that the tobacco industry has played a significant role in shaping research agendas, in particular, by promoting the idea that individual genome screening would be of benefit to public health. (shrink)

Over the past few years, the number of Christian projects and charities working in the mental health sector in the United Kingdom has increased dramatically. At the same time, scientific and medical understandings of mental health have been advancing rapidly. These parallel trends beg a serious question: is the Christian Church's response to mental health authentically engaging with a changing scientific picture? Are theological questions like responsibility, sin, redemption, and reconciliation taking account of a changing landscape? This is not (...) a theoretical question, but has major practical consequences for developing practical pastoral responses. (shrink)

The burden of social responsibility is on the pharmaceutical industry. It is producing drugs and medical equipment which have to fulfill high quality standards, because they are very important from society point of view. The main business activity of pharmaceutical companies can be assessed as doing something good. However, a lot of drug producers are also involved in other ways of working for public wellness. There are using a great range of the instruments and programs to manage the corporate (...) social responsibility. The article describes the results of 31 in-depth interviews with the pharmaceutical sales representatives conducted between the June – November 2007. It shows what problems can be created during organizing: charity action, white Sundays, conferences for physicians and other pro bono events. It explains how such actions can meet with public opinion accusations. The main aim of this paper is to answer the questions: What are the advantages of realizing CSR for pharmaceutical companies? Is it true that this conception is used as a marketing tool by drug producers? What the pharmaceutical sales representatives think about charity actions that are conducted in their companies? (shrink)

The aim of this paper is to illustrate some difficulties connected with the global ethic. The author shows mutual relations between socio-economic domain and the public health. Beginning with Peter Singer’s argumentation, the author points that the inequality is the main factor hampering moral action. The inequality generated by contemporary capitalism has an immediate influence on the health of people. Individual charity is not sufficient to solve such problems like life expectancy, health care, starvation or global warming. According to the (...) author, liberation of medical practices from the power of capital is a condition of the possibility of the public health. (shrink)

Christianity changed the world for the better through the development of education, charity organisations, art, music, law and medical care among others. However, not all changes initiated by Christianity were positive. The Christian religion was also responsible for division, death, destruction and war. Focusing on the positive changes, nearly 500 years after the reformation though, it seems as if Christianity has lost its renewing and transformative powers. It seems as if society, politics and the economy are pressurising Christianity to (...) conform to the world and not the other way round. Therefore, the research focuses on the question whether Christians can bring about positive change and transformation to the current problems in society. What can Christians do to provide a religious response to current persistent societal problems? Change agents - people who drive positive change - are capable and competent, make use of networks, are visible and contactable and are often also outsiders in the communities they serve. Examples of the work done by change agents - Christians within their local communities - through small-scale community projects are showcased here to suggest possible ways forward for dealing with persistent problems from a Christian point of view. (shrink)

In this book, an international group of philosophers, economists and theologians focus on the relationship between justice, luck and responsibility in health care. Together, they offer a thorough reflection on questions such as: How should we understand justice in health care? Why are health care interests so important that they deserve special protection? How should we value health? What are its functions and do these make it different from other goods? Furthermore, how much equality should there be? Which inequalities in (...) health and health care are unfair and which are simply unfortunate? Which matters of health care belong to the domain of justice, and which to the domain of charity? And to what extent should we allow personal responsibility to play a role in allocating health care services and resources, or in distributing the costs? With this book, the editors meet a double objective. First, they provide a comprehensive philosophical framework for understanding the concepts of justice, luck and responsibility in contemporary health care; and secondly, they explore whether these concepts have practical force to guide normative discussions in specific contexts of health care such as prevention of infectious diseases or in matters of reproductive technology. Particular and extensive attention is paid to issues regarding end-of-life care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Building a FoundationRichard KeidanA guiding principle of Judaism is "tzedakah," which translates as charity but actually means righteousness, reflecting that tzedakah is an obligation, not a choice. This concept of social justice was taught to me at home, at school and at synagogue. I gave to charities and did occasional charitable work. As my parents had taught me, I taught my own children the spirit of giving, but it (...) did come from a place of obligation, not passion. I have since come to learn that there is a world of difference between just fulfilling our obligations to each other and letting them guide the kind of person we become.It is ironic how the process of becoming a doctor—a person society expects to be selfless— requires total self-absorption. Think about it. I was trained to compete with my classmates in order to be accepted to the best university, medical school, residency, and then fellowship. I spent more than one hundred hours each week in the hospital during surgical residency. If I had free time, I wanted to do what I wanted to do. I was so focused on the end result that I had little time to think of others, let alone to ponder the inequities of the world.Several events led to the awakening of my conscience. One was an opportunity to go to Ethiopia and perform a couple weeks' worth of cancer surgery through Mother Teresa's Clinic. Quite frankly, I went because it seemed like an exciting adventure. However, I was completely overwhelmed by the experience. The conditions were abominable. The stories of each of my patients were heart-wrenching. I encountered a 14-year-old boy, the same age as my son, who had a tumor 15 cm in thickness wrapped around his neck. In order to hide the tumor he wore a scarf, but this still did not prevent him from being shunned. He traveled by himself for several days on a bus to reach the clinic. He had no one to advocate on his behalf, was unable to speak the local language, had never been outside his village (let alone in a motor vehicle), and he fearlessly underwent major surgery all by himself.The inequalities in health care compared to my suburban hospital were unfathomable. I cried every night in my hotel room. There seemed to be no solution to this situation. Soon after I returned home, Ethiopia became a distant memory. The experience cut me to the bone, but for whatever reason, I did not rally. I did not see myself as part of the solution. It took an entirely different international experience to open my eyes.There is a saying, "One goes to the Himalayas to see the mountains, but returns for the culture." In 1982, on a sabbatical from my surgical training, I went to Nepal to see the Himalayas, but fell in love with the people. Living in the most basic shelters, eating the most basic diets, with no access to clean water or toilets and little access to health care or education, the people seemed happy. I was invited into their homes and lives, slept on their straw mats, ate their rice and drank their tea. Their spirit and sense of contentment drew me back over the years 15 times. Nepal became a sanctuary for me, a place that gave me time to reflect upon what is truly important, a place that provided energy and inspiration for me. Its public health and education needs were apparent to me, but again, I felt sympathy for my Nepali friends; I did not see that I could—and must—help.It took a chance meeting to change that. Two years ago, I was on an exploratory trek on the Great Himalayan Trail in the Kanchenjunga region of Nepal. Namgyal was our sirdar (head sherpa guide), short in stature, but a giant of a man. Lacking a formal education, but very bright and [End Page 84] motivated, he rose through the ranks from porter all the way to lead sherpa of Everest Expeditions. He had reached the summit of Everest ten times by the age of thirty. He led... (shrink)

Discourses of recovery and resilience have risen to positions of dominance in the mental health field. Models of recovery and resilience enjoy purchase, in both policy and practice, across a range of settings from self-described psychiatric survivors through to mental health charities through to statutory mental health service providers. Despite this ubiquity, there is confusion about what recovery means. In this article we problematize notions of recovery and resilience, and consider what, if anything, should be recovered from these concepts. We (...) focus on three key issues, i) individualization, ii) the persistence of a deficit model, and iii) collective approaches to recovery. Through documentary analysis we consider these issues across third sector organizations, and public and mental health policy. Firstly, definitional debates about recovery reflect wider ideological debates about the nature of mental health. The vagueness of these concepts and implicit assumptions inherent in dominant recovery and resilience discourses render them problematic because they individualize what are social problems. Secondly, these discourses, despite being seen as inherently liberatory are conceptually dependent on a notion of deficit in that talk of “positives” and “strengths” requires the existence of “negatives” and “weaknesses” for these concepts to make sense. We argue that this does little to substantially transform dominant understandings of psychological distress. Thirdly, these issues combine to impact upon the progressive potential of recovery. It comes to be seen as an individualistic experiential narrative accompaniment to medical understandings where the structural causes of distress are obscured. This in turn impacts upon the potential for recovery to be used to explore more collective, political aspects of emotional distress. Drawing on the work of Fraser, we use this critique to characterize “recovery” as a “struggle for recognition,” founded on a model of identity politics which displaces and marginalizes the need for social, political and economic redistribution to address many of the underlying causes of emotional distress. We conclude by stating that it is only when the collective, structural experiences of inequality and injustice are explicitly linked to processes of emotional distress that recovery will be possible. (shrink)

Prolonging neonatal lifeThe paradox that medicine’s success breeds medicine’s problems is well known to readers of the Journal of Medical Ethics. Advances in neonatal medicine have worked wonders. Not long ago, extremely premature birth babies, or those born with very serious health problems, would inevitably have died. Today, neonatologists can resuscitate babies born at ever-earlier stages of gestation. And very ill babies also benefit from advances in neonatal intensive care. Infant lives can be prolonged. Unfortunately, several such babies will (...) not survive for long whatever is done for them. Others will live to leave hospital, but face severe health problems. Doctors have gained the ability to prolong neonatal life. But should they always do so? This question is central to the recent report of the Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine.1 In many quarters, the report received a very positive response, commended in The Lancet as “thoughtful, sensitive and sensible” and welcomed by the premature baby charity BLISS. Critics attacked on both flanks. The report goes too far—ushering in a culture of “throw away babies”. Or it does not go far enough—failing to endorse the Dutch precedent to sanction active neonatal euthanasia.TOO FAR?One of the key recommendations of the report is that guidelines be developed in relation to the institution of intensive neonatal care. It is these guidelines, which have been savaged by some parts of the media. The BMA called them “blanket rules” smothering clinical discretion. The guidelines on resuscitation at birth apply to babies born at the borderline of viability, that is, at or before a gestational age of 25 weeks 6 days. The earlier the baby is born, the lower are the chances that he/she will survive to leave hospital. Before 21 weeks 6 days, none of …. (shrink)

This paper suggests that late nineteenth-century definitions of self-mutilation, a new category of psychiatric symptomatology, were heavily influenced by the use of self-injury as a rhetorical device in the novel, for the literary text held a high status in Victorian psychology. In exploring Dimmesdale’s “self-mutilation” in The Scarlet Letter in conjunction with psychiatric case histories, the paper indicates a number of common techniques and themes in literary and psychiatric texts. As well as illuminating key elements of nineteenth-century conceptions of the (...) self, and the relation of mind and body through ideas of madness, this exploration also serves to highlight the social commentary implicit in many Victorian medical texts. Late nineteenth-century England, like mid-century New England, required the individual to help himself and, simultaneously, others; personal charity and individual philanthropy were encouraged, while state intervention was often presented as dubious. In both novel and psychiatric text, self-mutilation is thus presented as the ultimate act of selfish preoccupation, particularly in cases on the “borderlands” of insanity. (shrink)

When physicians today appeal to “conscience,” it has been alleged such exercises pejoratively reflect “conscience without consequence” as contemporary practitioners are said to be insulated from the consequences of such decisions. It has also been implied these physicians avoid traditional professional responsibilities—including providing charity care and making house or night calls. The assertions demand clarification. Fundamentally, what traits constitute an integrated professionalism specific to Christian physicians? Historical evidence verifies sanctity-of-life affirmations by Christian physicians throughout Church history. However, surveying Christian (...) class='Hi'>medical practices in the initial centuries of the Common Era, and more recently in the United States, supports integration of conscience with philanthropy and a rigorous definition of a medical vocation. These suggest there may be deterioration in a holistic commitment to medicine in the United States. Reclaiming an integrated professional paradigm—wherein conscience, philanthropia, and vocation are combined—is essential to an authentic contemporary witness. (shrink)

Christianity changed the world for the better through the development of education, charity organisations, art, music, law and medical care among others. However, not all changes initiated by Christianity were positive. The Christian religion was also responsible for division, death, destruction and war. Focusing on the positive changes, nearly 500 years after the reformation though, it seems as if Christianity has lost its renewing and transformative powers. It seems as if society, politics and the economy are pressurising Christianity to (...) conform to the world and not the other way round. Therefore, the research focuses on the question whether Christians can bring about positive change and transformation to the current problems in society. What can Christians do to provide a religious response to current persistent societal problems? Change agents – people who drive positive change – are capable and competent, make use of networks, are visible and contactable and are often also outsiders in the communities they serve. Examples of the work done by change agents – Christians within their local communities – through small-scale community projects are showcased here to suggest possible ways forward for dealing with persistent problems from a Christian point of view. (shrink)

Belgian physicians recently reported on organ donation after euthanasia. In patients suffering mainly from a neurodegenerative disorder, the organ donation procedure starts after cardiac death due to euthanasia. The Church condemns the act of euthanasia. The act of procuring organs after euthanasia cannot be approved either, since those who procure the organs must cooperate closely with those who perform the euthanasia. Although the act of organ donation itself can be an act of charity, participation in organ donation after euthanasia suggests (...) approval of euthanasia. A patient may, because of a difficult medical situation, choose to accept an organ obtained after euthanasia but should dissociate himself explicitly from the act of euthanasia itself. National Catholic Bioethics Quarterly 12.3 (Autumn 2012): 431–437. (shrink)