Public health is often distinguished from heaslth care in that it is said to serve more 'collective' goals, such as 'the common good' rather than the good of individual people. However, it is not clear what this good is supposed to be (although it is supposed to be 'common'). In regular health care we see in the West a gradual expansion of traditional goals exclusively in terms of length and quality of life to goals having to do more (...) with autonomy - the ability of people to control and direct their own lives. This has lead to a number of questions regarding how such an ethical ideal of promotion of autonomy may be construed, whether or not it really is an ideal, what practical consequences it has etc. (shrink)

The idea that there is such a thing as a human right to health has become pervasive. It has not only been acknowledged by a variety of international law documents and thus entered the political realm but is also defended in academic circles. Yet, despite its prominence the human right to health remains something of a mystery - especially with respect to its philosophical underpinnings. Addressing this unfortunate and intellectually dangerous insufficiency, this book critically assesses the stipulation that (...) health is a human right which - as international law holds - derives from the inherent dignity of the human person. Scrutinising the concepts underlying this stipulation, it shall conclude that such right cannot be upheld from a philosophical perspective. (shrink)

We consider the implications for the ethical evaluation of research programs of two fundamental changes in the revised research ethical guideline of the Council for International Organizations of Medical Sciences. The first is the extension of scope that follows from exchanging “biomedical” for “health‐related” research, and the second is the new evaluative basis of “social value,” which implies new ethical requirements of research. We use the example of antibiotic resistance interventions to explore the need to consider the instances of (...) what we term the pragmatic risks of such interventions to evaluate the social value of certain kinds of health‐related research. These (pragmatic) risks severely threaten the social value of interventions in every area where human and social responses significantly impact on their effectiveness. Thus, the social value of health‐related research needed to demonstrate its effectiveness depends on the extent and successful management of such risks. Research designed to take into account the management of pragmatic risks also gives rise to similar types of risks, and the potential for social value in light of those risks needs to be considered in ethical reviews based on the new guidelines. We argue that, to handle this new expanded task, the international system of research ethical review addressed by the guidelines needs institutional development. (shrink)

Antibiotic resistance, arising when bacteria develop defences against antibiotics, is creating a public health threat of massive proportions. This raises challenging questions for standard notions in bioethics when suitable policy is to be characterized and justified. We examine the particular proposal of expediting innovation of new antibiotics by cutting various forms of regulatory ‘red tape’ in the standard system for the clinical introduction of new drugs. We find strong principled reasons in favour of such a lowering of the ethical (...) standards of research and the clinical introduction of new antibiotic formulas. However, this support is undermined by pragmatic challenges owing to expected responses from stakeholders, creating uncertainty about which policies could actually be effectively implemented. We describe an underlying dilemma on how to rationally justify compromises between ideal ethical justification and pragmatic risks that needs to be further addressed in this light. We suggest a solution to this dilemma related to proposals of expediting antibiotic drug innovation. (shrink)

A new landscape of prenatal testing is presently developing, including new techniques for risk-reducing, non-invasive sampling of foetal DNA and drastically enhanced possibilities of what may be rapidly and precisely analysed, surrounded by a growing commercial genetic testing industry and a general trend of individualization in healthcare policies. This article applies a set of established ethical notions from past debates on PNT for analysing PNT screening-programmes in this new situation. While some basic challenges of PNT stay untouched, the new development (...) supports a radical individualization of how PNT screening is organized. This reformation is, at the same time, difficult to reconcile with responsible spending of resources in a publicly funded healthcare context. Thus, while the ethical imperative of individualization holds and applies to PNT, the new landscape of PNT provides reasons to start rolling back the type of mass-screening programmes currently established in many countries. Instead, more limited offers are suggested, based on considerations of severity of conditions and optimized to simultaneously serve reproductive autonomy and public health within an acceptable frame of priorities. The new landscape of PNT furthermore underscores the ethical importance of supporting and including people with disabilities. For the very same reason, no ban on what may be analysed using PNT in the new landscape should be applied, although private offers must, of course, conform to strict requirements of respecting reproductive autonomy and what that means in terms of counselling. (shrink)

This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs.

This article examines the responsibilities of researchers who conduct exploratory research to provide a service to vulnerable respondents. The term “service” is used to denote the provision of a tangible benefit in relation to the research question that is apart from the altruistic research benefits. This article explores what this “service” could look like, who might be responsible for providing it, and the challenges associated with such a service. The article argues that not providing a tangible benefit to vulnerable research (...) participants is inconsistent with the principle of social justice that undergirds much of the rationale for conducting health disparities research. (shrink)

In this paper it is argued that courts must, where appropriate, take into account the fact that National Health Service hospitals are under‐funded when they determine the standard of care owed by such hospitals and their professional staff to patients. Although this suggestion is inconsistent with the traditional view of the courts, its adoption would bring negligence cases into harmony with judicial review decisions. It would also cohere with a new understanding of accident causation within complex organisations, which suggests (...) that many of the injuries suffered by patients in under‐funded hospitals are the result of systemic failures that cannot necessarily be attributed to those who are the last actors in the causal chain leading to damage. (shrink)

While health care goals are usually formulated in terms of the securing of good health for the population, the goal of public health is to an increasing extent, at least in Western countries, being formulated in terms of the provision of societal preconditions for securing of good health. This goal may be attained although no one enjoys good health as a result, namely if people choose not to make use of the preconditions provided. However, reaching (...) this goal may still seem desirable in that it promotes the autonomy of people with regard to health-related choices. In this presentation, I address the questions: 1) whether or not the promotion of autonomy may be supported as goal of public health on the basis of ethical theories dealing with autonomy, 2) whether this support is equally strong regardless of the economic, social and cultural conditions of different countries. I will argue that the first question may be answered affirmatively only if certain important revisions are made in the ethical theories in questions but that these revisions at the same time raise a number of very complicated issues in theory as well as in practice. Regarding the second question, I will claim that in so far as the goal of promoting autonomy may be morally justified, there are a number of reasons supporting the suggestion that this justification is much stronger in societal settings where reasonably high health and welfare levels are allready secured. (shrink)

‘Researcher identity’ affects global health research in profound and complex ways. Anthropologists in particular have led the way in portraying the multiple, and sometimes tension-generating, identities that researchers ascribe to themselves, or have ascribed to them, in their places of research. However, the central importance of researcher identity in the ethical conduct of global health research has yet to be fully appreciated. The capacity of researchers to respond effectively to the ethical tensions surrounding their identities is hampered by (...) lack of conceptual clarity, as to the nature and scope of the issues involved. This paper strives to provide some clarification of these ethical tensions by considering researcher identity from the perspective of (1) Guillemin and Heggen's (2009) key distinction between procedural ethics and ethics in practice, and (2) our own distinction between perceptions of identity that are either symmetrical or asymmetrical, with the potential to shift research relationships toward greater or lesser ethical harmony. Discussion of these concepts is supported with ethnographic examples from relevant literature and from our own (United States (US) Government-funded) research in South Africa. A preliminary set of recommendations is provided in an effort to equip researchers with a greater sense of organization and control over the ethics of researcher identity. The paper concludes that the complex construction of researcher identity needs to be central among the ethical concerns of global health researchers, and that the conceptual tools discussed in the paper are a useful starting point for better organizing and acting on these ethical concerns. (shrink)

While promoting population health has been the classic goal of public health practice and policy, in recent decades, new objectives in terms of autonomy and equality have been introduced. These different goals are analysed, and it is demonstrated how they may conflict severly in several ways, leaving serious unclarities both regarding the normative issue of what goal should be pursued by public health, what that implies in practical terms, and the descriptive issue of what goal that actually (...) is pursued in different contexts. A basic conflict of perspective is handled by integrating the ideas of public health striving for health-related autonomy and equality, resulting in a prioritarian oriented population approach to health-related autonomy. This integrated goal is demonstrated to constrain itself in several ways attractive from the point of view of the classic goal, but several serious problems remain. For this reason, a model where all of the three goals are integrated into one coherent structure where they can be assigned varying degrees of importance relative to the level of population health is described. It is argued that this model avoids the problems set out earlier, and is actually normatively preferable to the classic goal alone. It is furthermore argued that the model may be employed as a useful tool for descriptive ethics, as well as a vehicle for international harmonisation of public health policies. A number of practical implications regarding, e.g., the importance of respecting autonomy and the allocation of public health resources are noted, as are a battery of questions for further research. (shrink)

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in (...) view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective. (shrink)

Purpose: We investigated the role of gender in abusive leadership practices, along with the effects of abusive leadership on employee health. We tested two hypotheses regarding the relationship between abusive leadership practices and subordinates’ health outcomes. Design: At two points of measurement, 663 participants in Germany rated their 158 direct team leaders on abusive supervision and stated their own levels of emotional exhaustion and somatic stress. To test our hypotheses, we used a mixed model approach. Findings: The results (...) show no gender differences between the ratings for female and male leaders regarding abusive supervision, but do confirm that the leaders’ gender did play a role in employees’ perceptions of abuse; perceived abusive supervision is more strongly related to increased emotional exhaustion and somatic stress when the leader is male. Limitations: The generalizability of the study is limited due to a majority of females in the sample. Practical implications: Organisations should review their policies and procedures to first identify abusive supervision, then to offer adequate support programs for both leaders and subordinates. Originality/value: The study integrates gender into research on leadership and health, shifting the focus from previous studies that investigated constructive to destructive leadership. A further strength of the study is the application of a multilevel design and two separate points of measurement. (shrink)

Definition of the problemMedical and nursing care often takes place within complex organizational structures that comprise numerous facilities at numerous locations. We introduce an interactive ethical concept, designed in cooperation with the diaconal foundation BruderhausDiakonie Reutlingen and the International Centre for Ethics in Science, University of Tübingen, to address the particular needs of such organizations.ArgumentsTherefore we portray the interactive Nijmegen Model which combines an ethics committee located at the management level and situational ethical case deliberations on the ward in order (...) to bring together two indispensable ways of ethical reflection in organizations: “top-down”/“bottom-up”. We illustrate the challenges of implementing the said model into the organizational construction of the BruderhausDiakonie and how to address these by means of conception and implementation.ConclusionConsidering the implementational challenges that we encountered, the Nijmegen Model needs to be enhanced by introducing a link between the committee and the case deliberations. We delineate the basic elements and the requirements for such a position while reporting our initial practical experience with this model. (shrink)

Many cultural competency efforts in healthcare stress the importance of cultural diversity and difference. This emphasis is necessary and well justified. It has helped sensitize healthcare systems to the differences among people and their health-related attitudes, preferences, and behaviors. However, the emphasis on diversity and difference has, unfortunately, also detracted from serious consideration of the things that cultures have in common and the possibility that socioeconomic differences are today far more important than cultural ones in determining healthcare outcomes.

Reducing disparities in health for racial and ethnic minorities has been a focus for US public health since the Heckler Report. Yet, a majority of racial and ethnic minorities in the US continue to have lower life expectancies and are more susceptible to poorer health outcomes compared to their white counterparts. Improvements in public health have been thwarted by ideological differences and structural restraints that necessitate an alternative method aimed at reorienting ethical discourse and guiding the (...) public health as an institution. Informed by a neo-Aristotelian concept of justice and the good life explicated through the Catholic social tradition, a new framework will enable public health to more wholly achieve its aim in the service of the populations that continue to be marginalized. (shrink)

Why does equality matter, as a social and political value, and what does it require? Relational egalitarians argue that it does not require that people receive equal distributive shares of some good, but that they relate as equals. Christian Schemmel here provides the first comprehensive development of a liberal conception of relational equality, one which understands relations of non-domination and egalitarian norms of social status as stringent demands of social justice. He first argues that expressing respect for the freedom and (...) equality of individuals in social cooperation requires stringent protections against domination. Taking this as a starting point, he then develops a substantive, liberal conception of non-domination and argues that non-domination is a particularly important, but not the only, concern of social justice. From there, Schemmel develops an account of the wrongness of inegalitarian norms of social status which shows how status-induced foreclosure of important social opportunities is a social injustice in its own right, over and above the role of status inequality in enabling domination, and the threats it poses to individuals' self-respect. Finally, Schemmel articulates the core requirements of liberal relational egalitarianism for political, economic, and health justice: these amount to demands for far-reaching forms of equality in all three domains, which can rarely, if ever, be overridden by competing concerns. With expert rigor and creativity, Justice and Egalitarian Relations brings together scholarship in a variety of related topics, from social justice and liberalism to distributive and relational equality, social equality, neo-republicanism, and non-denomination. (shrink)

Die Zeitgeschichte der Prävention hat Konjunktur. An ihr lässt sich nämlich exemplarisch der Wandel von Konzepten, Organisation und Praxis des biopolitischen Regierens von Bevölkerung anhand des vorbeugenden gesellschaftlichen Umgangs mit Gesundheit und Krankheit beleuchten. Eine entscheidende Technologie ist hierbei die Gesundheitsaufklärung. Diese ist jedoch nach wie vor gerade im Hinblick auf ihre methodologischen Wandlungsprozesse sowie auf die Relationen zwischen internationalen Entwicklungen und nationalen Implementationen wenig erforscht. Auf Grundlage einer quantitativen sowie qualitativen Analyse dreier englischsprachiger Zeitschriften wird diese Lücke im Folgenden (...) ein Stück weit geschlossen. Es wird gezeigt, wie sich in den 1950er Jahren ein internationaler Fachdiskurs der Gesundheitserziehung etablierte und in diesem sich ein verwissenschaftlichendes Berufsfeld konstituierte. Darin wurde die Forderung deutlich, vom deutschen Modell einer anschaulichen Vermittlung medizinischen Wissens vor allem durch Ausstellungen abzukommen und sich auf die Integration sozialwissenschaftlicher Erkenntnisse und Methoden zu fokussieren. Aus der Perspektive der behavioural sciences wurden das Handeln und die Möglichkeit seiner Beeinflussung in Netze wechselseitiger Einflussfaktoren eingefügt: Nur Umfrageforschung zu Gesundheitseinstellungen und -motivationen sowie zur Wirkung der eigenen Aktivitäten schien es zu ermöglichen, den in der Gesundheitserziehung priorisierten Zweck zu erfüllen, Verhalten zu ändern. Über solch eine Zweck‑, Mittel- und Wissensbestimmung, die – gleichwohl unterschiedlich – sowohl in der Bundesrepublik als auch in der DDR rezipiert und institutionalisiert wurde, vergewisserten sich die Akteure im Diskurs, einer internationalen Profession der healtheducators anzugehören. Doch die Hoffnungen, „Rezepte für die Lenkung der Menschen“ zu finden, erfüllten sich auch mit mehr Forschung und der Implementation ihrer Ergebnisse nicht. (shrink)

The Swedish solution to the legal handling of professional conscientious refusal in healthcare is described. No legal right to conscientious refusal for any profession or class of professional tasks exists in Sweden, regardless of the religious or moral background of the objection. The background of this can be found in strong convictions about the importance of public service provision and related civic duties, and ideals about rule of law, equality and non-discrimination. Employee's requests to change work tasks are handled on (...) a case-by-case basis within the frames of labour law, ensuring full voluntariness, and also employer's privilege regarding the organisation and direction of work, and duties of public institutions to provide services. Two complicating aspects of this solution related to the inclusion of ‘alternative medical’ service providers in a national health service, and professional insistence on conscientious refusal rights to accept legalised assisted dying are discussed. The latter is found to undermine the pragmatic reasons behind recent attempts by prolife groups to challenge the Swedish solution related to legal abortion in courts. (shrink)

Few studies have considered in detail the ethical issues surrounding research in which investigators ask community members to engage in research subject recruitment within their own communities. Peer-driven recruitment and its variants are useful for accessing and including certain populations in research, but also have the potential to undermine the ethical and scientific integrity of community-based research. This paper examines the ethical implications of utilizing community members as recruiters of human subjects in the context of PDR, as well as the (...) authors' experience with a variant of PDR in a research project in South Africa. The importance of situating PDR in a comprehensive community engagement process that is responsive to the constraints of science and local needs and interests is emphasized. The paper will have relevance to bioethicists, health researchers, and research regulators concerned about the appropriate use of peer-driven recruitment strategies in health research. (shrink)

This paper analyses ethical issues in forensic psychiatric research on mentally disordered offenders, especially those detained in the psychiatric treatment system. The idea of a 'dual role' dilemma afflicting forensic psychiatry is more complicated than acknowledged. Our suggestion acknowledges the good of criminal law and crime prevention as a part that should be balanced against familiar research ethical considerations. Research aiming at improvements of criminal justice and treatment is a societal priority, and the total benefit of studies has to be (...) balanced against the risks for research subjects inferred by almost all systematic studies. Direct substantial risks must be balanced by health benefits, and normal informed consent requirements apply. When direct risks are slight, as in register-based epidemiology, lack of consent may be counter-balanced by special measures to protect integrity and the general benefit of better understanding of susceptibility, treatment and prevention. Special requirements on consent procedures in the forensic psychiatric context are suggested, and the issue of the relation between decision competence and legal accountability is found to be in need of further study. The major ethical hazard in forensic psychiatric research connects to the role of researchers as assessors and consultants in a society entertaining strong prejudices against mentally disordered offenders. (shrink)

The IOC and WADA have announced their ambition to develop control program in order to detect athletes' illegitimate use of genetic technology for enhancing performance. Although it is far from clear what such uses should be counted as illegitimate, as well as to what extent the idea of control programs for such things is a feasible idea, I will assume that such programs will concern so-called somatic genetic modifications that aims at altering the athlete's initial bodily biochemistry in a way (...) that may enhance performance without the presence of any medical reason for undertaking such modifications. This means that the envisioned control-program will have to make use of the method of genetic testing in order to detect the possible presence (or non-presence) of various genetic variants within the athlete. As a consequence of this, several ethical issues familiar within the field of genetic testing for health purposes are suddenly actualised within the area of doping control. These issues concern primarily how to handle and communicate the information about the athlete that is uncovered by such testing. However, due to the ways in which gene doping may be performed, in the case of atheletic control programs, issues of medical safety and the question of what hardships it is reasonable to require of athletes to endure also become paramount. As a consequence, one may ask whether or not sporting ethics will have to consider applying the rule of informed consent in connection to testing programs of the kind here discussed. (shrink)

ZusammenfassungTrotz seiner großen Verbreitung in den Lebenswissenschaften wurde dem Aquarium bisher wenig wissenschafts- und technikhistorische Aufmerksamkeit zuteil. Dies ist nicht zuletzt durch den Umstand begründet, dass das Aquarium und seine Geschichte bisher größtenteils als außerwissenschaftlich aufgefasst wurden. Dabei spielen so unterschiedliche Kontexte wie Akklimatisierung, Amateurnaturkunde und bürgerliche Populärkultur eine wichtige Rolle. Gleichzeitig ist die Entwicklung des Aquariums aber auch eng mit der Geschichte der Lebenswissenschaften verbunden. Mit Blick auf die zweite Hälfte des 19. Jahrhunderts verstehe ich das Aquarium als techno-natural (...) assemblage, in der Technologie, Kultur und Natur zu einem künstlichen Naturraum verbunden sind. Seine Geschichte beginnt in der britischen Amateurnaturkunde und der französischen Akklimatisierungsbewegung. Im Deutschland des späten 19. Jahrhunderts entwickelte sich das Aquarium zu einem Massenphänomen. Gleichzeitig hielt es Einzug in die Lebenswissenschaften, wo es als Einfallstor, Instrument und Umwelt Verwendung fand. Wie sich zeigt, ist das Aquarium eine hochgradig konstruierte Technologie, die sich aus einer Verbindung unterschiedlicher Traditionen herausgebildet und das Leben in die Lebenswissenschaften gebracht hat. (shrink)

Predictive interventions and practices are becoming a defining feature of medicine. The author points out that according to the inner logic and external supporters of modern medicine, participating in healthcare increasingly means participating in knowing, sharing, and using of predictive information. At the same time, the author addresses the issue that predictive information may also have problematic side effects like overdiagnosis, health-related anxiety, and worry as well as impacts on personal life plans. The question is raised: Should we resort (...) to stigmatization if doing so would increase participation in predictive interventions, and thereby save healthcare costs and reduce morbidity and premature death? The paper concludes that even if such a strategy cannot be ruled out in some forms and contexts, we ought to be very cautious about the dangers of shame and stigmatization. (shrink)

J’explore de façon critique la supposition du DSM[1] et de théoriciens tels que Wakefield et Gert selon laquelle les troubles mentaux doivent être attribués à un individu plutôt qu’à un groupe de personnes. Cette supposition est particulièrement problématique en pédopsychiatrie où le système familial est très souvent au centre de l’attention clinique. Il y a bien sûr des éléments de preuve substantiels indiquant que certains troubles mentaux des individus sont causés par leurs relations avec les autres et que leur guérison (...) est grandement facilitée en traitant le groupe, tel que la famille, comme un tout. Malgré cela, il y a eu beaucoup moins de travail conceptuel visant à définir ce que cela pourrait être pour un couple, une famille ou un autre groupe que de se voir attribuer un trouble mental. Pour traiter de cette question, j’utilise un débat entre Wakefield et Murphy et Woolfolk sur la question de savoir s’il fait partie du concept de trouble mental que celui-ci soit causé par une dysfonction interne de la personne. Je discute aussi de la proposition faite par Bolton d’abandonner complètement le concept de trouble mental et d’utiliser plutôt le concept, plus large, de problème de santé mentale. Je soutiens qu’en fin de compte le caractère individuel des troubles mentaux ne constitue pas une vérité conceptuelle a priori, et qu’il faut faire intervenir des considérations pragmatiques pour décider s’il est utile de nous limiter à une telle définition ou si nous pourrions être mieux servis par une définition plus extensive. Je fais le lien avec le pragmatisme et je soutiens qu’une approche pluraliste non réductive est particulièrement appropriée en pédopsychiatrie.I critically explore the assumption of the DSM and theorists such as Wakefield and Gert that mental disorder must be attributed to an individual rather than a group of people. This assumption is especially problematic in child and adolescent psychiatry where very often the focus of clinical attention is the family system. There is of course substantial evidence that some mental disorders of individuals are caused by their relationships with other people and that their recovery is greatly facilitated by treating the group, such as a family, as a whole. However, there has been much less conceptual work on defining what it might be for a couple, family or other group to itself be attributed a mental disorder. To address this issue, I employ a debate between Wakefield , Murphy and Woolfolk on whether it is part of the concept of a mental disorder that it is caused by an internal malfunction of a person. I also discuss the proposal of Bolton that we do away with the concept of mental disorder altogether and instead use a broader concept of mental health problem. I argue that ultimately it is not an a priori conceptual truth that mental disorders are individual, and we need to bring in pragmatic considerations to decide whether it is helpful to restrict ourselves to such a definition or whether we could be better served by a more expansive definition. I link this to the philosophical view of pragmatism and argue that a pluralistic nonreductive approach is especially appropriate in child and adolescent psychiatry. (shrink)

For decades, Christiane Northrup has been helping women navigate their lives with grace and joy. This elegant, compact volume offers her trademark wisdom in a fresh form, filled with pointed reminders "to help you develop a deeper respect for, and connection to, your own body and its exquisite guidance system [to] create a vibrantly healthy body, mind, and spirit." Each beautifully designed black-and-white page carries a quote that touches on a topic of deep significance: everything from heart-listening to epigenetics to (...) the importance of knowing that your decisions about medical treatment are not irreversible. Examples include:You are an ever-renewing, ever-changing, ever-growing being, born with an inner guidance that helps you create and maintain vibrant health and happiness. / When faced with a dilemma, take a moment to sit with the issue. Don't rush to decide what to do. Intend to let Divine inspiration flow to you, and it will be so! The next time you get an ache or a pain, soften the area around it with compassion. Ask your body what it needs. Listen deeply for the answer. (shrink)

A consumer health information system must be able to comprehend both expert and non-expert medical vocabulary and to map between the two. We describe an ongoing project to create a new lexical database called Medical WordNet (MWN), consisting of medically relevant terms used by and intelligible to non-expert subjects and supplemented by a corpus of natural-language sentences that is designed to provide medically validated contexts for MWN terms. The corpus derives primarily from online health information sources targeted to (...) consumers, and involves two sub-corpora, called Medical FactNet (MFN) and Medical BeliefNet (MBN), respectively. The former consists of statements accredited as true on the basis of a rigorous process of validation, the latter of statements which non-experts believe to be true. We summarize the MWN / MFN / MBN project, and describe some of its applications. (shrink)

To identify motivational factors linked to child health status that affected the likelihood of parents’ allowing their child to participate in pediatric research.

BackgroundValue sensitivity – the ability to recognize value-related issues when they arise in practice – is an indispensable competence for medical practitioners to enter decision-making processes related to ethical questions. However, the psychological competence of value sensitivity is seldom an explicit subject in the training of medical professionals. In this contribution, we outline the traditional concept of moral sensitivity in medicine and its revised form conceptualized as value sensitivity and we propose an instrument that measures value sensitivity.MethodsWe developed an instrument (...) for assessing the sensitivity for three value groups in a four step procedure: 1) value identification ; 2) value representation ; 3) vignette construction and quality evaluation ; and 4) instrument validation by comparing nursing professionals with hospital managers.ResultsWe find that nursing professionals recognize and ascribe importance to principle-related issues more than professionals from hospital management. The latter are more likely to recognize and ascribe importance to strategy-related issues.ConclusionsThese hypothesis-driven results demonstrate the discriminatory power of our newly developed instrument, which makes it useful not only for health care professionals in practice but for students and people working in the clinical context as well. (shrink)

BackgroundWhile neighborhood safety and stranger danger have been mostly canonized to play a part in parents’ physical activity avoidance, less is known about the impact of parental stress and perceived risk on children’s PA avoidance and consequently on children’s level of PA and wellbeing. Understanding the contributors to children’s wellbeing during pandemic disease is the first critical step in contributing to children’s health during epidemic diseases.MethodsThis study employed 276 healthy children, aged 10–12 years, and their parents. Data were collected (...) in October and November 2020, about 9 months after the local closing of schools due to the coronavirus disease 2019 pandemic. Parents and children answered a separate set of questions. Besides the demographic information, the parents responded to questions on their stress level, perceived risk of COVID-19, and PA avoidance for children. Children responded to questions on their PA and wellbeing in the last week. Data were analyzed using SmartPLS and IBM SPSS 22.ResultsThe result of the study supported the four directional research hypotheses of the sequential study model. As hypothesized, parents’ stress and perceived risk levels of COVID-19 negatively affected children’s PA. The PA level was shown to predict children’s wellbeing and mental health. Housing type, parents’ job security, number of siblings, number of members living together in-home, and history of death or hospitalization of relatives or family members due to COVID-19 were found to be associated with parents’ stress and children’s mental health.ConclusionThis study sheds light on parents’ role in children’s wellbeing and mental health during the COVID-19 pandemic. Parents with higher stress and high restrictive behaviors might put their children at risk of mental disorders in the end. (shrink)

In participatory activities in the workplace, employees are invited to raise problems and suggest improvements to the management. Although it is widely acknowledged that employees rarely control decisions in these settings, little is known about the interactional resources that employees and managers draw upon when negotiating consensus about which initiatives to pursue in the future. We analyse interactions from participatory meetings in an industrial setting in relation to the topic of work shoes, showing how the participants orient to both their (...) relative deontic rights and epistemic rights. The analysis suggests that besides their low deontic status, employees’ fragile epistemic status constitutes an important but overlooked challenge to achieving improved working conditions through the participatory activities. (shrink)

The use of evidence in medicine is something we should continuously seek to improve. This book seeks to develop our understanding of evidence of mechanism in evaluating evidence in medicine, public health, and social care; and also offers tools to help implement improved assessment of evidence of mechanism in practice. In this way, the book offers a bridge between more theoretical and conceptual insights and worries about evidence of mechanism and practical means to fit the results into evidence assessment (...) procedures. (shrink)

This article proposes the use of technological frames (TF) as an analytical tool to support the investigations within value sensitive design. TF can help to identify values that are consistent or conflicting within and between stakeholders, which is exemplified with a case of patient accessible electronic health records in Sweden. The article concludes that TF can help to identify values, which may then help to understand and address possible concerns in the design process.

Few studies have considered in detail the ethical issues surrounding research in which investigators ask community members to engage in research subject recruitment within their own communities. Peer-driven recruitment and its variants are useful for accessing and including certain populations in research, but also have the potential to undermine the ethical and scientific integrity of community-based research. This paper examines the ethical implications of utilizing community members as recruiters of human subjects in the context of PDR, as well as the (...) authors' experience with a variant of PDR in a research project in South Africa. The importance of situating PDR in a comprehensive community engagement process that is responsive to the constraints of science and local needs and interests is emphasized. The paper will have relevance to bioethicists, health researchers, and research regulators concerned about the appropriate use of peer-driven recruitment strategies in health research. (shrink)

City-scale urban greening is expanding wildlife habitat in previously less hospitable urban areas. Does this transformation also prompt a reckoning with the longstanding idea that cities are places intended to satisfy primarily human needs? I pose this question in the context of one of North America's most ambitious green infrastructure programmes to manage urban runoff: Philadelphia's Green City, Clean Waters. Given that the city's green infrastructure plans have little to say about wildlife, I investigate how wild animals fit into urban (...) greening professionals’ conceptions of the urban. I argue that practitioners relate to urban wildlife via three distinctive frames: 1) animal control, 2) public health and 3) biodiversity, and explore the implications of each for peaceful human– wildlife coexistence in ‘greened’ cities. (shrink)

Zusammenfassung Die enge Widerspruchslösung in Österreich erlaubt eine postmortale Organspende bei fehlendem Widerspruch zu Lebzeiten, da von einer mutmaßlichen Zustimmung ausgegangen wird. Liegt kein Eintrag im Widerspruchsregister vor, wird die Familie zum mutmaßlichen Willen der verstorbenen Person befragt. Um die praktische Umsetzung der Widerspruchslösung in Österreich zu beschreiben, sollen relevante Aspekte der Angehörigengespräche und die Rolle der Familie im Entscheidungsprozess zur postmortalen Organspende identifiziert werden. Es wurden insgesamt zehn leitfadengestützte Expert:inneninterviews mit Ärzt:innen und Pflegepersonen an einer österreichischen Krankenanstalt durchgeführt, die (...) mithilfe der qualitativen Inhaltsanalyse nach Mayring unter Anwendung von MAXQDA ausgewertet wurden. Herausforderungen beim Ermitteln des mutmaßlichen Patient:innenwillens im Angehörigengespräch können aufgrund von unterschiedlichen Kulturen/Religionen, Uneinigkeit und Entscheidungsunfähigkeit in der Familie aufgrund von Trauer und der Schwierigkeit der Angehörigen, das Hirntodkonzept zu begreifen, entstehen. Daher ist eine gute Vorbereitung, ausreichend Zeit, interdisziplinäre Zusammenarbeit, das Schaffen von Vertrauen und professionelle Gesprächsführung sowie das Eingehen auf Fragen und Bedürfnisse von Angehörigen durch Ärzt:innen und Pflegepersonen in einem geeigneten Setting notwendig. Die Kommunikation mit Angehörigen bezüglich einer postmortalen Organspende ist sowohl für das Gesundheitspersonal als auch die Familie belastend. Anhand der Ergebnisse wird die Anwendung des Kommunikationsleitfadens der Gesundheit Österreich mit Erweiterung um die Information zur Gesetzeslage sowie regelmäßige Kommunikationsschulungen des Gesundheitspersonals empfohlen. Zudem wird eine flächendeckende Information der Bevölkerung zur Förderung der intrafamiliären Diskussion gefordert. (shrink)