In aged societies, the rise of chronic diseases and the health care costs from the aging population are becoming social and economic problems. The emergence of these problems in health care provides an opportunity to shift from a disease paradigm to a preventive paradigm. A preventive paradigm is realized in the form of patient-centered care, and ICT is recommended in health care services as an appropriate alternative. This article analyzes the ethical problems that could arise in ICT healthcare for (...) the elderly in aged societies by applying the ethics of e-Medicine. The ethics of e-Medicine consists of the principle of the doctor-patient relationship, the principle of responsibility, and the principle of autonomy. (shrink)

The impact and use of Information and Communication Technologies (ICTs) in healthcare settings has been increasing since 2019. This is greatly due to the COVID‐19 pandemic. But beyond accommodating an extraordinary and complex situation in terms of healthcare services, or beyond replacing personalised care delivered by healthcare professionals (HCPs), has there been a process of information and consultation for communities and HCPs? Do we have the basic requirements needed to make such use commonplace in health care? What (...) will the impact be on communities and their governance? Have we arrived here by consensus or by imposition? Our purpose has been to conduct a transnational analysis by approaching communities, social actors, and healthcare professionals in three territories in a pilot study following a qualitative methodology. The aim being to discover the potential impact of such measures beyond the right to health and if such measures are compatible with the purpose of population settling in rural areas. Furthermore, to identify if this entails a conflict of value and priorities or if we need new ethical reviews both for communities and healthcare professionals. (shrink)

Semantic interoperability can be defined as the ability of two or more computer systems to exchange information in such a way that the meaning of that information can be automatically interpreted by the receiving system accurately enough to produce useful results to the end users of both systems. Several activities are currently being performed by a variety of stakeholders to achieve semantic interoperability in healthcare. Many of these activities are not beneficial, because they place too great a focus on (...) business aspects and not enough on involvement of the right sorts of researchers, in particular those that are able to see how the data and information relate to the entities of concern on the side of the patient. The lack of a central focus on the patient, and the associated focus on ‘concepts’, have spawned a variety of mutually incompatible terminologies exhibiting non-resolvable overlap. The predominance of the healthcare IT industry in the writing and selection of semantic interoperability standards mitigates against the benefits that standards, when well designed, can bring about. (shrink)

Industrial engineering is a field dealing with optimization of complex processes, systems, or organizations by developing, improving and implementing integrated systems of people, money, knowledge, information, equipment, energy, and materials. Hence, the scope of industrial engineering is wide and includes various fields, from manufacturing, through banking, different types of services, to administration and healthcare. Various industrial engineering tools could be implemented in healthcare settings. The use of such tools is popular in western economies. For example, simulation modelling of (...) services is popular in the US. However, there is still a very limited number of case studies on the application of such tools in healthcare that would consider the Polish economy. The aim of this paper is to present selected successful applications of lean management tools in the Polish healthcare. This may serve as an inspiration for healthcare organizations to search for and implement methodological approaches to improve their services. (shrink)

Despite the great expansion and many benefits of information and communication technologies in healthcare, the attitudes of Polish general practitioners to e-health have not been explored. The aim of this study was to determine the GPs’ perception of ICT use in healthcare and to identify barriers to the adoption of EMR in the Podlaskie Voivodeship. Online and telephone surveys were conducted between April and May 2013. Responses from 103 GP practices, 43% of all practices in the region, were (...) analysed. The results showed that 67% of the respondents agreed that IT systems improve quality of healthcare services. In the GP group who declared at least partial EMR implementation, 71.4% see the positive impact of IT on practice staff processes and 66.1% on personal working processes. In this group, more than three-quarters of GPs did not see any positive impact of ICT on the average number of patients treated per day, number of patients within the practice or scope of services. The four most common barriers to EMR implementation were: lack of funds, risk of a malfunction in the system, resistance to change, and lack of training and proper information. Although the use of ICT by Polish GPs is limited, their attitude to e-health is generally positive or neutral and resembles the overall pattern in Europe. Barriers identified by GPs need to be taken into account to ensure the effective implementation of e-health across the country. (shrink)

As modern information and communication technologies (ICT) now offer new possibilities for improving almost every aspect of health care, their implementation is a very relevant and fast accelerating process around Europe and internationally. The processes themselves vary greatly from scattered single initiatives of various IT solutions to large national programmes. Often treated as purely technical in nature, ICT implementation in health care should gravitate towards the “softer/complex” i.e. people-related issues end of the change. The approach taken by the Informing (...) class='Hi'>Healthcare programme in Wales broadens understanding on the value that engagement of stakeholders can bring to the process. (shrink)

As new information and communication technologies (ICTs) are being applied in healthcare, the most obvious and seemingly the only questions to ask would be if they are clinically effective and if they deliver positive outcomes for patients. In the medical tradition, outcomes are usually assessed in randomized controlled trials (RCTs) through clear and well-understood criteria of safety and clinical effectiveness. These seem to be suitable and fully adequate for evaluating drugs. (Although, of course, drug prescribing is more complex and (...) includes, among others, economic considerations.) But are these criteria useful or sufficient when applied to the evaluation of ICTs in healthcare? In this paper we argue that they are not. ICT-related applications are complex and diverse and require a different and more encompassing approach to evaluation. (shrink)

The medical use of computing and information and communication technologies (ICTs) has a history of several decades, but the emergence of the internet, and especially the web and social media, created a new situation. As a result, currently the term eHealth is widely used – and the usage of the internet (and mobile) “technologies” in healthcare (among the patients and professionals, too) tends to be usual practice. There are more and more signs of the institutionalization of this new sub-disciplinary (...) field of medicine, such as social organizations, healthcare institutes, scientific journals, regular conferences, etc. In this paper, collecting the most relevant developments we will try to characterize this state of affairs in the field. Moreover, as it is well-known, the use of the internet has an enormous impact on society, social systems and subsystems, and even on the everyday life of people. This extended practice also influences medicine and healthcare as social subsystems, and fundamentally transforms some of their characteristics. In this paper, we try to show several important dimensions of these changes. (shrink)

Human Specialization in Design and Technology explores emerging trends in learning and training-standardization, customization, personalization-with a unique focus on human needs and conditions. Analyzing evidence from current academic research as well as the popular press, this concise volume defines and examines the trajectory of instructional design and technologies toward more human-centered and specialized products, services, processes, environments, and systems. Examples from education, healthcare, business, and other sectors offer real-world demonstrations for scholars and graduate students of educational technology, instructional design, (...) ICT, and business development. (shrink)

Purpose This paper aims to focus on the role of information and communication technologies in preparation for and management of human and/or nature induced disasters. Design/methodology/approach Drawing from the phenomenal growth of ICTs, initiatives aimed at disaster management, stakeholder theory, prior research and the successful development and implementation of 9-1-1, this paper explores ICTs in the context of human and/or nature induced disasters. Findings This paper discusses a new ICT for mitigating disaster management, scans, using stakeholder theory, relevant initiatives and (...) prior research to identify the stakeholders relevant for successful preparation for and management of disasters, and draws from the 9-1-1 example to discuss how ICTs can be successfully developed and adopted. Research limitations/implications There are opportunities for researchers to develop ICTs that can make countries, developing and developed, more efficient and effective in their preparation for and management of nature and human induced disasters. In addition, researchers can investigate the role of stakeholders in facilitating the adoption of new ICTs developed for disaster management. Researchers could also help public policy in designing the most efficient and effective programs for the adoption of new ICTs. Practical/implications As an example of new ICTs that can potentially mitigate the effect of disasters, this paper discusses the E711 text-message mobile phone service and provides a description of how this protocol operates and can be implemented. There are tremendous opportunities to develop new ICTs in the context of disaster management. Social/implications This paper argues that ICTs such as E711 can have a major impact on all countries in general and poor and developing nations in particular. Specifically, in the bottom of the pyramid markets, developing ICTs for BOP market in the context of managing human and nature induced disasters and ensuring the diffusion of such ICT innovations is both critical and challenging. Originality/value This paper discusses the role and importance of ICTs in disaster management, identifies relevant stakeholders, discusses how ICTs can be diffused and implemented and calls on and hopes to provide an impetus to research on ICTs that can aid in the preparation for and the management of disasters. (shrink)

It is unclear whether someone’s responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we (...) indicate here what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour. (shrink)

Technology is an essential aspect of everyday life, thus the growth and integrationof information and communication technology (ICT) in learning and teaching isexpected. Beginning with the origins of technology based on mathematics as a science,we narrow our focus in this scholarly study on the use of ICT in the teaching andlearning of mathematics in elementary education. We focused on studying the impactof ICT on the teaching and learning process, as well as the usage of ICT tools in thedevelopment of knowledge (...) in mathematics. The goal of this systematic analysis is toshow the benefits of integrating ICT into mathematics teaching and learning, as well asthe constraints and challenges that elementary school teachers and students encounter.Our comprehensive analysis of pertinent theoretical and empirical findings ledus to the general conclusion that teacher proficiency with the new technology plays amajor role in the integration of ICT. The positive impact of ICT on mathematics teachingand learning is undeniable, because technology reduces logistics in the planningand implementation of instruction, increases interaction in the classroom, and encouragesmathematics learning through the visualization of abstract concepts and processes,while also allowing for independent study. (shrink)

In the advent of the 21st century there can be no doubt that we have entered uncharted territory as we continue to employ diverse information and communication technologies within healthcare. This is simply a matter of fact, at least for the Western world. But, as a question of value, what are the ethical and social ramifications of this healthcare trek? What assessments can we render on this murky, barely explored topography? A utopian answer is that ICT would deliver (...) us to a technologic garden of healthcare delights. Here, health-related information and services abound and healthcare professionals and patients, under the protection of an electronic, global umbrella, operate in perfect harmony for the good of patients. (shrink)

Information and Communication Technologies have profoundly changed many aspects of life, including the nature of entertainment, work, communication, education, healthcare, industrial production and business, social relations and conflicts. They have had a radical and widespread impact on our moral lives and hence on contemporary ethical debates. The Cambridge Handbook of Information and Computer Ethics, first published in 2010, provides an ambitious and authoritative introduction to the field, with discussions of a range of topics including privacy, ownership, freedom of speech, (...) responsibility, technological determinism, the digital divide, cyber warfare, and online pornography. It offers an accessible and thoughtful survey of the transformations brought about by ICTs and their implications for the future of human life and society, for the evaluation of behaviour, and for the evolution of moral values and rights. It will be a valuable book for all who are interested in the ethical aspects of the information society in which we live. (shrink)

In recent years we may observe increasing interest in the development of social innovation both regarding theory as well as the practice of responding to social problems and challenges. One of the crucial challenges at the beginning of the 21st century is population ageing. Various new and innovative initiatives, programs, schemes, and projects to respond to negative consequences of this demographic process are emerging around the world. However, social theories related to ageing are still insufficiently combined with these new practices, (...) social movements, organisational models, and institutions. Many scholars are still using notions and tools from classical theories of social gerontology or the sociology of ageing such as disengagement theory, activity theory, and successful and productive ageing. Such theories do not sufficiently explain ageing in the context of, for example, a broad use of the information and communications technologies including robotics and automation, new healthcare and long-term care models, advancements in the development and governance of age-friendly environments, and public engagement of older adults into co-production of services delivered by public, private, non-governmental as well as non-formal entities. (shrink)

This paper offers a general approach to ethics before considering its implications for the question of how to respond to religious preferences in healthcare, especially those of patients and healthcare workers. The first section outlines the two main components of the approach: (1) demoralizing, that is, seeking to avoid moral terminology in the discussion of reasons for action; (2) welfarism, the view that our ultimate reasons are grounded solely in the well-being of individuals. Section 2 elucidates the notion (...) of religious preferences and describes the history and importance of their protection by human rights legislation. The following section defends the ‘Preference Principle’, according to which there is a reason to satisfy any preference (in so far as that satisfaction advances well-being). Section 4 discusses the implications of this principle for religious preferences in healthcare, again seeking to bring out the special social and political importance of respect, and respect for such preferences in particular. The paper ends with a brief description of how to approach such problems from the perspective of a demoralized welfarism. (shrink)

In a welcome broadening of the discussion surrounding responsibility in healthcare, Rebecca Brown and Julian Savulescu propose that standard philosophical accounts of responsibility are too narrow to be useful. Although these accounts of course differ with respect to the exact conditions they posit as necessary and sufficient for responsibility, they are nonetheless relatively united in their focus on a single individual at a single moment in time. Suppose a subject S performs an action a at a time t that (...) has harmful consequences for their health. Is S responsible for a and derivatively their condition? Brown and Savulescu argue that answers to this question that fail to consider both what S was or was not doing at times other than t and what people other than S were doing to encourage or discourage S from performing a cannot do justice to actions which are habitual and socially influenced—such as unhealthy patterns of eating, exercise and substance use. Given that it is precisely these kinds of patterns of behaviour that typically inflame the discussion of responsibility in healthcare, Brown and Savulescu’s insistence on the need for a diachronic and socially contextualised account of responsibility is essential— if we are to consider the issue of responsibility in healthcare at all. But should we and, if so, why? With respect to this question, Brown and Savulescu hope to sit on the fence. This is both because they recognise the complexity and balance of arguments for and against the view …. (shrink)

Background Trust is an essential phenomenon of relationship between patients and healthcare professionals and can be described as an accepted vulnerability to the power of another person over something that one cares about in virtue of goodwill toward the trustor. This characterization of interpersonal trust appears to be adequate for patients suffering from chronic illness. Trust is especially important in the context of chronic cardiovascular diseases as one of the main global health problems. Research Aim The purpose of the (...) qualitative study was to gain a deeper understanding of how people with chronic cardiovascular disease experience and make sense of trust in healthcare professionals. Research Design Eleven semi-structured interviews with participants analysed using interpretative phenomenological analysis to explore in detail their lived experience of trust as a relational phenomenon. Participants and Research Context Participants with chronic cardiovascular disease were purposively recruited from inpatients on the cardiology ward of the university hospital located in central Slovakia. Ethical Considerations The study was approved by the faculty ethics committee. Participants gave their written informed consent. Findings Four Interrelated Group Experiential Themes Sense of co-existence; Belief in competence; Will to help; Ontological security with eight subthemes were identified. The findings describe the participants' experience with trust in healthcare professionals as a phenomenon of close co-existence, which is rooted in the participants’ vulnerability and dependence on the goodwill and competence of health professionals to help with the consequence of (re)establishing a sense of ontological security in the situation of chronic illness. Conclusion Findings will contribute to an in-depth understanding of trust as an existential dimension of human co-existence and an ethical requirement of healthcare practice, inspire patient empowerment interventions, support adherence to treatment, and person-centred care. (shrink)

Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support inspired by Habermas’ theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim (...) of this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved. (shrink)

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis (...) on the family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

Dementia will soon be ranked as the world’s largest economy. At present, it ranges from the 16th to 18th place, with countries such as Indonesia, the Netherlands, and Turkey. Dementia is not only a financial challenge, but also a philosophical one. It provokes a paradigm shift in the traditional view of healthcare and expands the classic concepts of human personhood and autonomy. A promising response to these challenges is the idea of cooperative solidarity. Cooperative solidarity, contrary to its ‘humanitarian’ (...) version, promotes spontaneous teamwork and individual initiative. It obliges us not only to help 'the suffering, the troubled and the disadvantaged’, but above all to support those who already do so for spontaneous moral or affective reasons. In the field of dementia study, solidary initiatives are described within the framework of supportive care. (shrink)

Multimedia technologies and ICT in organising e-portfolio for students An electronic portfolio, also known as an e-portfolio or digital portfolio, is a collection of electronic evidence assembled and managed by a user, usually on the Web. Such electronic evidence may include inputted text, electronic files such as Microsoft Word and Adobe PDF files, images, multimedia, Blog entries, and hyperlinks.One of the approaches, which can be used for improving the attractiveness of the e-portfolio is presented, and it is an implementation of (...) the multimedia technologies in it. In this case we are speaking about multimedia electronic portfolio. What makes them very different from the traditional portfolios is that they can include scanned or digital photos, video and sound clips, animations, recordings of the students, text, traditional writings and drawings.Two main groups of tools for creating multimedia e-portfolio are presented. (shrink)

This paper develops an account of how the implementation of ML models into healthcare settings requires revising the methodological apparatus of philosophical bioethics. On this account, ML models are cognitive interventions that provide decision-support to physicians and patients. Due to reliability issues, opaque reasoning processes, and information asymmetries, ML models pose inferential problems for them. These inferential problems lay the grounds for many ethical problems that currently claim centre-stage in the bioethical debate. Accordingly, this paper argues that the best (...) way to make progress in remedying these ethical problems is to distil their epistemic core and to identify appropriate epistemic norms as guardrails. The viability of this approach will be highlighted based on four key issues: trust, responsibility, paternalism, and fairness. In that respect, the paper also contributes to a more pronounced view of the specific methodological challenges for ethical theorizing, when the point of reference are complex statistical models that make predictions, rather than individual agents, acting for reasons. (shrink)

This article arises in the Ecuadorian context of Higher Education where the insertion of Information and Communication Technologies (ICT) has a considerable impact on the knowledge and attitudes of students. The purpose of the research is to analyze the integration of ICT in attitudes and knowledge in students of the Bolivar State University in the careers of Accounting and Business Administration. The methodology used in a sample of 150 students presents a quantitative research design, exploratory type, correlational scope and cross-sectional; (...) in addition, an exploratory factor analysis, KMO sample adequacy and Bartlett’s test were used, central trend and dispersion measures, Pearson’s correlation. The results show that, despite the direct relationship between the variables, there are no statistically significant differences between knowledge and attitude, that is, the perception and understanding of ICTs between the two cohorts of students are similar. It is concluded that students have an average level of knowledge about ICT and their attitude to the use of them is indifferent. (shrink)

Conscientious objection in healthcare is often granted by many legislations regulating morally controversial medical procedures, such as abortion or medical assistance in dying. However, there is virtually no protection of positive claims of conscience, that is, of requests by healthcare professionals to provide certain services that they conscientiously believe ought to be provided, but that are ruled out by institutional policies. Positive claims of conscience have received comparatively little attention in academic debates. Some think that negative and positive (...) claims of conscience deserve equal protection in terms of measures that institutions ought to take to accommodate them. However, in this issue of The Journal of Clinical Ethics (JCE), Abram Brummett argues against this symmetry thesis. He suggests that the relevant distinction is not between negative and positive claims of conscience, but between negative and positive rights of conscience. He argues that conscientious refusals and positive claims of conscience are both already protected as negative rights of conscience, but that this does not require institutions to accommodate positive claims of conscience. In this article I will argue that both Brummett and the authors he criticizes share a wrong view about the existence of conscience rights in healthcare. I will argue that there is no right to conscientious objection in healthcare, whether positive or negative. Thus, contra Brummett, I argue that the question whether such rights are positive or negative is as irrelevant as the question whether the claims of conscience are positive or negative. (shrink)

Various kinds of user and patient involvement are spreading in healthcare in most Western countries. The purpose of this study is to critically assess the actual conditions for patients’ involvement in healthcare practice in Greenland and to point to possibilities for development. Patients’ perspectives on their own conduct of everyday life with illness and their possibilities for participation when hospitalized are examined in relation to the conditions in a hospital setting dominated by biomedical practice. On a theoretical level, (...) it is argued that the concept of ‘participation’ is preferable to the concept ‘involvement’ in healthcare. The study shows that there are several interconnected areas for development: the structural frames of hospital practice, including professionals’ possibilities for handling patient participation, and the agency of the patients conducting their everyday lives when hospitalized. Consequences of the biomedical hegemony are discussed in relation to WHO ́s broader approach to disease, illness and health and the still existing postcolonial traces of power and hierarchy. Finally it is argued that patient participation during hospitalization will promote the patients ́ conduct of everyday life, the cultural knowledge of the professionals, and the democratization of the healthcare sector. Such changes might be connected to a more encompassing democratic societal development – in Greenland as well as globally. (shrink)

원격의료는 대개 의사와 환자가 떨어져 있는 상태에서 이루어지는 의료 행위 내지 환자와 의사 간의 비대면 의료행위를 지칭하며, 정보통신기술을 매개로 하는 것을 의미한다. 최근 원격의료가 활성화됨에 따라 보건의료 체계는 변화하고 있으며, 그 결과 이로 인해 발생하는 다양한 문제에 대한 신중한 논의가 요청되고 있다. 특히 원격의료 상에서는 컴퓨터를 이용한 의료 정보의 처리가 광범위하게 일어나게 되며, 이에 따라 환자의 의료 정보가 잘못 취급됨으로써 개인 정보 유출 및 사생활 침해 등이 심각한 문제로 떠올랐다. 또한 환자의 치료에 있어 환자와 의사의 신뢰 및 공감 형성이 매우 (...) 중요한 역할을 한다는 점에서 직접적인 대면 관계를 통해 환자에 대한 치료를 도모하지 않고 온라인 장치를 통해 환자와의 관계를 형성하는 원격 의료에서는 전통적인 환자-의사 관계 이상의 신뢰 및 책임감이 요청된다. 이러한 점에서 아리스토텔레스의 프로네시스는 원격의료에서 의료전문직의 실천 원리로서 중요한 의미를 가질 수 있을 것이다. 프로네시스는 훌륭한 행위를 하는 데 필요한 지식으로서의 ‘실천적 지혜’를 의미한다. 따라서 프로네시스는 상황의 특수성 및 개별성에 대한 고려를 바탕으로 보편적인 지식을 활용하여 지금 내가 행동해야 할 행위에 대한 판단을 내리고 지금 이 상황에서 내가 어떻게 행동하는가에 관심을 둔다. 원격의료에서 개별 환자의 다양성과 의료 체계의 복잡성 속에서 의료전문직의 유능함은 과학적인 의학 기술의 습득과 더불어 환자의 상태 및 맥락을 적절하게 해석하는 능력과 여러 가지 대안들 가운데 최선의 치료 행위를 선택하는 통찰력에 달려 있다고 할 수 있을 것이다. 따라서 의료인은 원격의료 시 개별 환자에게 적절한 최선의 치료 행위를 결정하기 위해 구체적인 상황에서 요구하는 특수한 행동 과정을 숙고해야 한다는 점에서 프로네시스는 의료인에게 중요한 실천원리가 된다. (shrink)

A recent focus of the debate on conscientious objection in healthcare is the question of whether practitioners should have to justify their refusal to perform certain functions. A recent article by Cowley addresses a practical aspect of this controversy, namely the question of whether doctors claiming conscientious objector status in relation to abortion should be required, like their counterparts claiming exemption from military conscription, to defend their claim before a tribunal. Cowley argues against the use of tribunals in the (...) medical case, on the grounds that there are likely to be fewer unjustified claims to conscientious objection in this context than in the military, and that in any case tribunals will not be an effective way of distinguishing genuine and false cases. I reject these arguments and propose a different conception of the role of a medical conscientious objection tribunal. (shrink)

Increasingly, students and professionals within healthcare are faced with difficult questions and decisions: this book meet those ethical needs by providing an accessible guide to ethical theories and practices, which does not presuppose any background or training in philosophy.

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance (...) in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

Compassion in Healthcare gives an account of the nature and content of compassion and its role in healthcare based on notions of pilgrimage and civic life. Drawing on the author's real-world collaborations, the book proposes strategies for an improved understanding of compassionate relationships in healthcare practice.

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

Moral Theory and Theorizing in Healthcare Ethics Content Type Journal Article Category Editorial Pages 365-368 DOI 10.1007/s10677-011-9291-x Authors Mike McNamee, College of Human and Health Sciences, Swansea, SA28PP UK Thomas Schramme, Universität Hamburg, Philosophisches Seminar, Von-Melle-Park 6, 20146 Hamburg, Germany Journal Ethical Theory and Moral Practice Online ISSN 1572-8447 Print ISSN 1386-2820 Journal Volume Volume 14 Journal Issue Volume 14, Number 4.

Managing Complexity in Healthcare introduces the ComEntEth (Complex Entropic Ethical) model as an integrated bio-medical and philosophical approach to understanding how people get things done in healthcare. Drawing on the complexity sciences, studies of entropy in living organisms, and the ethics of Emmanuel Levinas, healthcare is theorised as energetic relational exchanges between people as entropic and ethical entities that unfold around a central attractor: Reduction in elevated entropy or suffering in patients. Living entities are engaged in a (...) continuous struggle against the tendency to produce entropy. From the cellular to the collective of human endeavours, the tendency of complex systems is to disorder and decay. Yet in the micro-activity of healthcare enterprise, people resist this tendency by expending energy to create order and sustain life. Making sense of how this miraculous work is made possible is the foundation of this book. Through practical examples - from analysis of practitioner burnout, rural and remote healthcare, the functioning of emergency departments, to government, social and institutional responses to the COVID-19 pandemic -this new integral philosophy provides practitioners, managers, policy designers, and scholars an effective way to understand the dynamics of daily processes and practices that link the micro of everyday interactions with the macro-trends of healthcare. (shrink)

For years now, autonomy has been discussed as one of the central values in health care. Understood as self-realization, it is opposed to paternalism which is conceived as an intolerable occurrence of heteronomy. Although different concepts have been developed to nuance this opposition, when it comes to health care discourse, heteronomy is still the enemy of autonomy. In our article, we defend the thesis that autonomy is only achievable as heteronomy. We are not arguing for an expansion of the meaning (...) of autonomy, but are attempting to conduct an analysis which lays bare the ‘disrupting’ attendance of heteronomy within the principle of autonomy. Autonomy does not begin where heteronomy ends, but can only begin if heteronomy is already involved. To emphasize this, we prefer to elaborate a new concept: ‘oughtonomy’. This concept is inspired by Jacques Derrida’s distinction between ‘difference’ and ‘differance’. We will develop the concept of oughtonomy from a deconstructive reading of Kant’s idea of autonomy, inspired by philosophers such as Jacob Rogozinski, Jean-Luc Nancy and others. In addition to a first exploration of this concept, this article also discusses the possible consequences of oughtonomy for current debates concerning health care. Our quest for a new understanding of autonomy is motivated by the concern that, although the accent on autonomy as self-realization and independence has many advantages, we should also bear in mind the countless disadvantages. (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)

Bioethics, Volume 36, Issue 3, Page 233-234, March 2022.

Healthcare providers face enormous pressure to save healthcare resources where possible. In this paper I explore the response that we should allocate resources fairly. What is a fair allocation of healthcare resources for children? First, I consider the luck egalitarianism approach of limiting resources to adult patients who are responsible for their conditions. A luck egalitarian distribution of healthcare resources to adults faces significant problems in application. I maintain that when we consider these problems with a (...) focus on the just distribution of healthcare resources to children, we gain valuable insights into the fairness of healthcare allocation for adults. (shrink)

Good communication is vital in healthcare both among healthcare professionals and be tween healthcare professionals and their patients And well written documents describing and or explaining the information in structured databases may be easier to comprehend more edifying and even more convincing than the structured data even when presented in tabu lar or graphic form Documents may be automatically generated from structured data using techniques from the eld of natural language generation These techniques are concerned with how (...) the content organisation and language used in a document can be dynamically selected depending on the audience and context They have been used to generate health education ma terials explanations and critiques in decision support systems and medical reports and progress notes.. (shrink)

Socially assistive devices such as care robots or companions have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. An important part of the ethical evaluation is to understand how users interact with these devices and how interaction influences users’ perceptions and their ability to express themselves. In this review, we report and critically appraise findings of non-comparative empirical studies with regard to these effects from an ethical perspective.Electronic databases and (...) other sources were queried using a comprehensive search strategy generating 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 22 reports on 21 datasets using a non-comparative design a narrative synthesis was performed.Data shows positive findings in regard to attitudes and emotional reactions of users. Varying perception of a social relation and social presence are the most commonly observed traits of interaction. Users struggle with understanding technical complexities while functionality of the devices is limited. This leads to a behavioral alignment of users towards the requirements of the devices to be able to make use of them.This evidence adds to three important ethical debates on the use of socially assistive devices in healthcare in regard to (1) reliability of existing empirical evidence to inform normative judgements, (2) ethical significance of the social presence of devices and (3) user autonomy in regard to behavioral alignment. (shrink)

The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare (...) providers on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience. (shrink)

Introduction The starting point is that ethical competence is the basis for ethical healthcare practices and quality of care. Simultaneously, there is a need for research and development from a holistic multi-professional perspective. Aim The aim is to create a proposed model for multi-professional ethical competence grounded in clarified meanings and dimensions of ethical competence studied from a multi-professional healthcare perspective. The research questions are, what is ethical competence from a multi-professional healthcare perspective and what strengthens a (...) multi-professional ethical healthcare practice? Research design The research has a qualitative approach and hermeneutic application research design. Two groups with six participants from clinical practice and two scientific researchers in each group met four times for dialogue. Thematic analysis was used as an analysis method. Ethical considerations The research is approved by the Declaration of Helsinki, the General Data Protection Regulations, and ethical permission was asked from the Norwegian Centre for Research Data (NSD). Results The proposed model for multi-professional ethical competence encompasses a three-dimensional ethical value base that is underpinned by: Ethical attitude – a personal desire to do good; Ethical basis – the best for the patient as a common goal and Ethical culture – common goals and values in the organization. Multi-professional ethical competence is strengthened by: Reflection – to see with new wondering eyes; Time for talk – interdisciplinary teamwork and Leadership – an ethical role model and support. Discussion Ethical competence has a strong link to the core of caring ethics and a deeper personal value base and attitude. Ethical competence involves the whole culture and is seen as a shared value base and a responsibility to do the best for the patient as a multi-professional team and organization. Ethical competence becomes active in healthcare practice by opening up for meaningful multi-professional talks and reflections. (shrink)

Philosophical and scientific understandings of compassion converge, both stressing its necessity for the moral life and human flourishing. I conceptualise a dynamic and frangible account of professional virtues, including compassion, and propose that mechanistic organisational systems of care and the biomedical paradigm create a strong risk of dehumanisation and the obliteration of compassion in healthcare. Additionally, the neoliberal market ideology, with its instrumental approach to individuals and commodification of healthcare creates a corrosive influence that alienates clinicians from their (...) patients and severely curtails the scope for compassionate practice. The tension between efficiency and patient orientated care – although they need not be mutually exclusive – has become more acute in the current economic climate, at a time when the boundaries of medicine have broadened and expectations for healthcare have risen. This has created an unsustainable dynamic within which alienated healthcare professionals struggle to fulfil their healing roles and patients experience abandonment and more anxiety. (shrink)

Informed consent is at the core of the clinical relationship. With the introduction of machine learning (ML) in healthcare, the role of informed consent is challenged. This paper addresses the issue of whether patients must be informed about medical ML applications and asked for consent. It aims to expose the discrepancy between ethical and practical considerations, while arguing that this polarization is a false dichotomy: in reality, ethics is applied to specific contexts and situations. Bridging this gap and considering (...) the whole picture is essential for advancing the debate. In the light of the possible future developments of the situation and the technologies, as well as the benefits that informed consent for ML can bring to shared decision-making, the present analysis concludes that it is necessary to prepare the ground for a possible future requirement of informed consent for medical ML. (shrink)

An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections (...) are deemed acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional. (shrink)

Most discussions of conscientious objection in healthcare assume that the objection is universal: a doctor objects to all abortions. I want to investigate selective objections, where a doctor objec...

Background: Severity plays an essential role in healthcare priority setting. Still, severity is an under-theorised concept. One controversy concerns whether severity should be risk- and/or time-sensitive. The aim of this article is to provide a normative analysis of this question. Methods: A reflective equilibrium approach is used, where judgements and arguments concerning severity in preventive situations are related to overall normative judgements and background theories in priority-setting, aiming for consistency. Analysis, discussion, and conclusions: There is an argument for taking (...) the risk of developing a condition into account, and we do this when we consider the risk of dying in the severity assessment. If severity is discounted according to risk, this will ‘dilute’ severity, depending on how well we are able to delineate the population, which is dependent on the current level of knowledge. This will potentially have a more far-reaching effect when considering primary prevention, potentially the de-prioritisation of effective preventive treatments in relation to acute, less-effective treatments. The risk arguments are dependent on which population is being assessed. If we focus on the whole population at risk, with T 0 as the relevant population, this supports the risk argument. If we instead focus on the population of as-yet (at T 0 ) unidentified individuals who will develop the condition at T 1, risk will become irrelevant, and severity will not be risk sensitive. The strongest argument for time-sensitive severity (or for discounting future severity) is the future development of technology. On a short timescale, this will differ between different diagnoses, supporting individualised discounting. On a large timescale, a more general discounting might be acceptable. However, we need to also consider the systemic effects of allowing severity to be risk- and time-sensitive. (shrink)