The introduction of Western healthcare, via colonialism, into Africa facilitated a confrontation of indigenous and exogenous “medical” knowledge as well as the attendant praxis. Although colonialism has been expunged from the shores of Africa, the epistemic and ideological frictions it introduced into the sphere of healthcare linger and raise different dilemmas. Against this background, this paper explores pragmatic and ethical approaches that may help engage these tensions in the context of drug development based on validated traditional phytomedicines.

Christian Munthe, David Fumagalli and Erik Malmqvist argue that well-known healthcare resource allocation principles, such as need, prognosis, equal treatment and cost-effectiveness, should be supplemented with a principle of sustainability.1 Employing such a principle would entail that the allocation of healthcare resources should take into account whether a specific allocation causes negative dynamics, which would limit the amount of resources available in the future. As examples of allocation decisions, which may have such negative dynamics, they mention those who (...) cause a lack of vaccines, anti-bioethics resistance and drug shortages. Thus, the overall thought is that we can spend and allocate healthcare resources in a certain way at t1, which means that we will have fewer resources available at a later point, t2. The authors argue that we should include a principle of sustainability to justify allocations, which avoids or diminishes the negative dynamics. The authors argue that existing principles cannot sufficiently include proper regard for how our current decisions affect future allocation decisions and, therefore, the people who need healthcare resources in the future. I am sympathetic to the developed argument and believe that the authors are correct that negative dynamics provide reasons to take our ability to meet future health needs …. (shrink)

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

Development is concerned with the transformation of people to foster their health, wholeness and growth. The link between health and development points to religion as potential social capital for development. There is an ongoing debate about the role of pastoral care as a religious resource in global healthcare contexts. This is unfortunately not the case in Africa, as pastoral care has not received sufficient attention for its role in healthcare and development in development discourses. The limited research on (...) pastoral care in healthcare contexts in Africa has implications for African healthcare systems, pastoral care and the delivery of an effective, holistic and quality healthcare service. Taking as its point of departure a thesis about the potential of religion as a social capital resource for development, the article argues for pastoral care as a viable religious resource for healthcare and development. Osmer’s theological task of good practice is employed as an interdisciplinary engagement in dialogue with selective perspectives in the disciplines of development and health and social sciences for appropriate analysis. (shrink)

Serving as a healthcare worker in a conflict zone is an experience that is characterized by peculiar and unimaginable challenges. This commentary is an exposition on twelve collated stories of healthcare providers currently serving or who have previously served in war. The stories bring to bear the heaviness of emotions such as fear and guilt that the authors grappled with, while concurrently showing that they embody virtues such as altruism, self-sacrifice, courage, and solidarity. In these stories, we see (...) highlighted recurrent ethical themes including the tension between the duty to others and the duty to self, prioritization and allocation of scarce health resources, ethics of research in war, ethics of virtue and the lasting effects of war. This commentary thus explores and heightens our awareness of the interplay between personal morals and the translation of these into ethics of healthcare provision in war. In so doing, the commentary urges us to reflect on ways by which we can engage the discourse pertaining to war and healthcare ethics. (shrink)

Background Fecal microbiota transplant (FMT) is a treatment modality that involves the introduction of stool from a healthy pre-screened donor into the gastrointestinal tract of a patient. It exerts its therapeutic effects by remodeling the gut microbiota and treating microbial dysbiosis-imbalance. FMT is not regulated in Jordan, and regulatory effort for FMT therapy in Jordan, an Islamic conservative country, might be faced with unique cultural, social, religious, and ethical challenges. We aimed to assess knowledge, attitudes, and perceptions of ethical and (...) social issues of FMT use among Jordanian healthcare professionals. Methods An observational, cross-sectional study design was used to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT among 300 Jordanian healthcare professionals. Results A large proportion (39 %) thought that the safety and efficacy of this technique are limited and 29.3 % thought there is no evidence to support its use. Almost all (95 %) responded that they would only perform it in certain cases, if ethically justified, and 48.3 % would use it due to treatment failure of other approaches. When reporting about reasons for not using it, 40 % reported that they would not perform it due to concerns about medical litigation, fear of infections (38 %), and lack of knowledge of long safety and efficacy (31.3 %). Interestingly, all practitioners said they would perform this procedure through the lower rather than upper gastrointestinal tract modality and the majority will protect the patient’s confidentiality via double-blinding (43.3 %). For a subset of participants (n = 100), the cultural constraints that might affect the choice of performing FMT were mainly due to donor’s religion, followed by dietary intake, and alcohol consumption. Conclusions Our healthcare practitioners are generally reluctant to use the FMT modality due to religious and ethical reasons but would consider it if there was a failure of other treatment and after taking into consideration many legislative, social, ethical and practice-based challenges including safety, efficacy and absence of guidelines. (shrink)

This book is open access under a CC BY 4.0 license. This book examines the current state of elective placements of medical undergraduate students in developing countries and their impact on health care education at home. Drawing from a recent case study of volunteer deployment in Uganda, the authors provide an in-depth evaluation of the impacts on the students themselves and the learning outcomes associated with placements in low resource settings, as well as the impacts that these forms of student (...) mobility have on the host settings. In addition to reviewing the existing literature on elective placements, the authors outline a potential model for the future development of ethical elective placements. As the book concurs with an increasing international demand for elective placements, it will be of immediate interest to universities, intermediary organizations, students as consumers, and hosting organisations in low-resource settings. (shrink)

This paper assesses the relational effects of perceived organizational support, fear of COVID-19, and work-related stress on the safety performance of healthcare staff. The sample for this research was extracted from the University College Hospital in the Oyo State of Nigeria. The participants were midwives, doctors, auxiliary services staff, and nurses who functioned in a COVID-19 hospital ward, fever or respiratory ICU, Auxiliary services, or outpatient clinics. This investigation espoused a clinical cross-sectional survey involving self-reported surveys. Of the 150 (...) questionnaires distributed, 147 were fit for scrutiny and analyzed with Statistical Packages for the Social Sciences. This paper established a relationship between POS and safety performance. Besides, it showed a significant positive correlation between FOC-19 and SP. It further noted that work-related stress negatively relates to safety performance. Moreover, this study showed the significant joint strong influence of POC, FOC-19, and WRS on the safety performance of healthcare workers. Hence, healthcare institutions are encouraged to create adequate support for healthcare workers, particularly during a global health crisis. Government and healthcare institutions should also develop an awareness program on the danger and consequences of getting infected by the virus or infecting other significant others. This will increase the fear of COVID-19 and, consequently, health workers’ safety performance. Besides, it is recommended that the management of healthcare institutions provides a proper work structure and schedule to help reduce workloads, consequently reducing WRS, as lowering it improves healthcare workers’ safety performance. (shrink)

This pilot study is the first formal exploration of the concept of “Organizational Professionalism” (OP) among health system leaders in high-performing healthcare organizations. Semi-structured key informant interviews with 23 leaders from 8 healthcare organizations that were recipients of the Malcolm Baldrige National Quality Award (MBNQA) or Baldrige-based state quality award programs explored conceptualization, operationalization, and measurement of OP. Further exploration and understanding of OP in healthcare organizations has the potential to establish and sustain professional and ethical organizational (...) cultures that bolster trust through the sound implementation of laws, policies, and procedures to support the delivery of high-quality patient care. (shrink)

Background: Priority setting is necessary in current healthcare services. Discussion of fair process has highlighted the value of developing reasons for allocation decisions on the basis of experience gained from real cases.Aim: To identify the reasons that those with experience of real decision-making concerning resource allocation think relevant in deciding on the priority of a new but expensive drug treatment.Methods: Semistructured interviews with members of committees with responsibility for making resource allocation decisions at a local level in the British (...) National Health Service, analysed using modified grounded theory.Results: 22 interviews were carried out. 14 reasons were identified. Four reasons were almost universally considered most important: cost effectiveness; clinical effectiveness; equality and gross cost. No one reason was considered dominant. Some considerations, such as political directives and fear of litigation, were thought by many participants to distort decision-making. There was a substantial lack of agreement over the relevance of some reasons, such as the absence of alternative treatment for the condition.Conclusions: There is a clear consensus on the importance and role of a limited number of reasons in allocation decisions among participants. A focus on the process of decision-making, however, does not obviate the need for those involved in the process to engage with problematical ethical issues, nor for the importance of further ethical analysis. (shrink)

On June 3, 2003, the European Council of health ministers rejected a proposal from the European Commission to allow drug manufacturers to advertise directly to particular groups of patients; the proposal had already been rejected by the European Parliament subsequent to a heated public debate in which consumer and patient groups almost unanimously argued that it was not the role of drug companies to provide information to patients. The pilot scheme suggested by the Commission would only have applied to patients (...) with three chronic diseases, AIDS, diabetes, and asthma, and would, it was argued, not undermine an overall ban. Drug companies would have been required to abide by a special code of conduct and clear any information given to patients—on web sites or in specialized publications—with national authorities. (shrink)

Research ethics is always important. However, it is especially crucial with sensitive research topics such as family violence. The aim of this article is to describe and discuss some crucial issues regarding intimate partner violence and child maltreatment, based on the authors’ own research experiences. We focus on and discuss examples concerning the definition of family violence, research design, ethical approval, participant recruitment and safety and data collection and processing. During the research process, the significance of teamwork is emphasized. Support (...) provided by the participants to each other and support given by experienced researchers within the team is very important for high ethical standards. (shrink)

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

The single greatest challenge facing managers in the developed countries of the world is to raise the productivity of knowledge and service workers. This challenge, which will dominate the management agenda for the next several decades, will ultimately determine the competitive performance of companies. Even more important, it will determine the very fabric of society and the quality of life of every industrialized nation. … Unless this challenge is met, the developed world will face increasing social tensions, increasing polarization, increasing (...) radicalization, possibly even class war. (shrink)

RésuméIntroductionLa motivation est. un thème crucial et répandu en médecine. Que. ce soit pour un scénario clinique ou chirurgical, l’acceptation de prendre une pilule ou de se rendre à une consultation est. essentielle au succès du traitement médical. La “décennie du cerveau” a fourni aux praticiens des données neuroscientifiques substantielles sur le comportement humain, a aidé à expliquer pourquoi les gens font ce qu’ils font et a créé le concept de “cerveau motivé”. Les résultats de la psychologie empirique ont stratifié (...) la motivation en étapes de changement, qui sont devenues plus complexes au fil des décennies. Cette recherche vise à améliorer la compréhension de la façon dont les gens prennent des décisions concernant leur santé et comment mieux comprendre les stratégies et les techniques pour les aider à résoudre les problèmes d’ambivalence de manière efficace et ciblée.MéthodesNous établissons un dialogue avec la phénoménologie de la volonté de Ricoeur afin de comprendre le sens de ces découvertes scientifiques. À partir de la phénoménologie husserlienne, Paul Ricoeur a développé sa pensée en s’éloignant de l’idéalisme transcendantal en émancipant les structures intentionnelles de la volonté du domaine de la perception. Résultats: En introduisant les concepts de volontaire et d’involontaire, Ricoeur s’est. écarté du dualisme cartésien, qui fait du corps un corps d’objet, cible de vicissitudes naturelles. Le nouveau dualisme entre volontaire et involontaire est. traité par référence à ce que Ricoeur a appelé le mystère central de l’existence incarnée, qui considère l’homme “double dans l’humanité, simple dans lavitalité”. Cette dualité permet de considérer le cerveau comme l’organe naturel du comportement dans le corps humain et d’utiliser la psychologie empirique comme moyen d’échapper aux subjectivations superficielles des concepts.ConclusionLa simplicité (ou unité) d’existence invite la médecine à repenser certaines de ses hypothèses philosophiques, de telle sorte que les patients puissent être considérés comme des sujets autonomes avec des projets de vie d’auteur. L’anthropologie ricourienne a un impact éthique profond sur la manière dont la médecine devrait utiliser la technologie, ce qui découle de résultats de psychologie empirique. L’utilisation de ces nouvelles connaissances doit également faire l’objet d’une inspection minutieuse, car elle modifie le rôle social de la science médicale. (shrink)

In writing this paper I am reminded of a conference that I once attended. On that panel, the Jewish scholar spoke first. he began, and he gave a wonderful talk full of references to the legal rulings and stories of the Jewish tradition. Then the Catholic priest spoke. he began, and he gave a wonderful talk carefully attentive to the moral tradition of the Catholic Church. Finally, a Protestant spoke. he began, I didn't know whether to laugh or cry, but (...) now I find myself in a similar situation. (shrink)

The hypothesis that administering a diagnostic test to an asymptomatic population can detect a relevant proportion of prevalent cases in an early phase and therefore improve the chances of curing disease dates back to the sixties and has been tested and applied mainly to neoplastic diseases. Meanwhile, the practice of screening has benefitted from the progress of diagnostic technology and from the development, particularly in Europe, of efficient national health systems.Half a century later, two Swedish researchers, Niklas Juth and Christian (...) Munthe, undertake the task of reexamining various aspects of screening practices in light of the ethical justification of this secondary prevention tool. Their analysis encompasses all public health actions in which the personal benefit is contrasted with collective health considerations. Screening generates such doubts and conflicts, which are inherently ethical.The publication could be split in two parts. The first is a long section, mainly infor .. (shrink)

The following Acknowledgments were omitted in the original publication.

Clinical medicine is an inexact science. In situations of uncertainty, we often ask an experienced colleague for a second opinion. But what if one could effectively call upon the experience of thou...

This collection of essays, brings together essays from leading figures in the field of medical law and ethics. The compilation of articles undertaken by Prof. Sheila A.M. McLean, University of Glasgow, UK, address the key issues currently challenging scholars in the field.

Healthcare workers are at a high risk of psychological morbidity in the face of the COVID-19 pandemic. However, there is significant variability in the impact of this crisis on individual healthcare workers, which can be best explained through an appreciation of the construct of resilience. Broadly speaking, resilience refers to the ability to successfully adapt to stressful or traumatic events, and thus plays a key role in determining mental health outcomes following exposure to such events. A proper understanding (...) of resilience is vital in enabling a shift from a reactive to a proactive approach for protecting and promoting the mental well-being of healthcare workers. Research in the past decade has identified six areas that provide promising leads in understanding the biological basis of individual variations in resilience. These are: the key role played by the monoamines noradrenaline and serotonin, the centrality of the hypothalamic-pituitary-adrenal axis in influencing stress vulnerability and resilience, the intimate links between the immune system and stress sensitivity, the role of epigenetic modulation of gene expression in influencing the stress response, the role played by certain neuropeptides as a natural “brake” mechanism in the face of stress, and the neurobiological mechanisms by which environmental factors, such as exercise, diet, and social support, influence resilience to subsequent life events. Though much of this research is still in its early stages, it has already provided valuable information on which strategies – including dietary changes, lifestyle modification, environmental modification, psychosocial interventions, and even pharmacological treatments – may prove to be useful in fostering resilience in individuals and groups. This paper examines the above evidence more closely, with a specific focus on the challenges faced by healthcare workers during the COVID-19 pandemic, and provides suggestions regarding how it may be translated into real-world interventions, as well as how the more tentative hypotheses advanced in this field may be tested during this critical period. (shrink)

The ethics of artificial intelligence and machine learning exemplify the conceptual struggle between applying familiar pathways of ethical analysis versus generating novel strategies. Mel...