Involuntary commitment links the healthcare, public health, and legislative systems to act as a “carceral health-service.” While masquerading as more humane and medicalized, such coercive modalities nevertheless further reinforce the systems, structures, practices, and policies of structural oppression and white supremacy. We argue that due to involuntary commitment’s inextricable connection to the carceral system, and a longer history of violent social control, this legal framework cannot and must not be held out as a viable alternative to the criminal (...) legal system responses to behavioral and mental health challenges. Instead, this article proposes true alternatives to incarceration that are centered on liberation that seeks to shrink the carceral system’s grasp on individuals’ and communities’ lives. In this, we draw inspiration from street-level praxis and action theory emanating from grassroots organizations and community organizers across the country under a Public Health Abolition framework. (shrink)

The provision of mental health services to women has come sharply into focus for providers of secure psychiatric services in the UK. Women's services are being developed in response to the known risks of mixed-sex provision, and a growing appreciation of the ways that women in secure services can be further disadvantaged by their minority status. Our intention here is to present evidence and reflections to help inform this development. The evidence is drawn from our (...) recent work in this field, which includes carrying out a review of local mental health services for ‘difficult’ women, and developing and piloting a national training programme for staff working with women in secure services. The reflections we offer are informed by the conviction that taking social inequalities into account is central to making sense of women's mental health difficulties, and improving service responses to women's needs. While there are signs that many mental health workers in secure services are beginning to share these convictions, the challenge now is to provide the necessary authorization, training and support that will enable them to translate these understandings into empowerment practice with women. (shrink)

A significant number of inmates with mental illness reside within the New York State Department of Corrections (NYSDOCS). New York State has taken the initiative to provide mentally ill inmates with necessary services through a collaboration of the New York State Department of Correctional Services and the New York State Office of Mental Health (NYSOMH). The collaboration results in a mental health delivery system that provides many essential services to mentally ill inmates. This paper focuses (...) on the organization of mental health services within NYSDOCS, best practices, past and current litigation, and staff responsibilities. As the population of mentally ill inmates continues to grow, implications for the Human Services professions of OMH and DOCS needs to continue to address and provide adequate mental health care and resources for this special population. (shrink)

Protection of human participants is a fundamental facet of biomedical research. We report the activities of a health service research study in which there were three institutional review boards (IRBs), three legal departments and one research administration department providing recommendations and mandating changes in the study methods. Complying with IRB requirements can be challenging, but can also adversely affect study outcomes. Multiple protocol changes mandated from multiple IRBs created a research method that was not reflective of how substance use (...) screening would be performed in a clinical setting. There was direct conflict between the IRBs' perceptions of participants' protection with the researchers' need to use research methodology that assures the clinical relevancy of results. (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)

It is nearly 20 years since Tony Hope wrote an editorial in this journal on Empirical Medical Ethics,1 arguing for both a recognition of the increasing amount of work being done in ‘empirical ethics’ and for its importance as a new direction for medical ethics research. Since then empirical ethics has flourished, with debates over the role of ‘empirical’ data in ethical reasoning producing a growing body of literature and the JME and other bioethics journals regularly publishing empirical studies. While (...) bio/medical ethics has grappled with ‘incorporating’ or using more empirical data in ethical analysis, with varying degrees of success, and some criticism, there has not been a corresponding willingness of more empirical disciplines to embrace ethical analysis. This is a particular lack for applied research areas that see their role as predominately influencing policy and practice, such as health services research. Health services research ‘is the integration of epidemiological, sociological, economic, and other analytic sciences in the study of health services.’ Whose ‘main goals … are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety’.2 Health services research brings together a wide variety of disciplines and would seem ideally placed to include ethics. However, if you search health services research journals and conference programmes there is very little consideration of ethics as a substantive topic and often scant attention paid to the ethical issues that might be raised by an intervention or policy. Ethics and ethical issues are generally confined to discussions over priority setting, and occasionally health technology assessment, with other areas of health service research seldom engaging in ethical debate. In the Encyclopaedia of Health Services Research,3 ethics …. (shrink)

A commentary on “‘Ever Vigilant’ in ‘Ethically Impossible’: Structural Injustice and Responsibility in PHS Research in Guatemala,” from the May‐June 2013 issue.

It is an article of almost religious faith in the United Kingdom that the National Health Service is far superior to a competitive market in health care services. In this brief and informal paper I show that the opposite is true. In contrast to market provision, the existence of the National Health Service entails the following. First, consumer sovereignty is virtually destroyed, since what services the consumer receives and how much he pays (through taxation) are (...) determined by the government of the day in consultation with vested and ideological interests. Second, a person may be denied a life-saving service despite having contributed more than his fair share to National Health Service over the course of his working life. Third, people often spend less on health care than they would like to spend, because any additional contributions (via increased taxes) are not linked to any benefit specifically for the person who makes them. Fourth, provision of services free at the point of need which is not linked to what a person pays encourages a wasteful misuse of resources. Fifth, absence of competition between health care providers leads to high cost and poor quality of service and a tendency to produce a standardised service rather than a tailored one; and government attempts to address this problem usually make it worse. Sixth, people’s freedom to engage in particular activities or lifestyles is likely to be curtailed because the costs of those activities are artificially socialised. I also point out that issues of inequality or poverty are much better addressed by means other than a nationalised health service. (shrink)

Compulsory (health) service contracts have recently received considerable attention in the normative literature. The service contracts are considered and offered as a permissible and liberal alternative to emigration restrictions if individuals relinquish their right to exit via contract in exchange for the state‐funded tertiary education. To that end, the recent normative literature on the service programmes has particularly focused on discussing the circumstances or conditions in which the contracts should be signed, so that they are morally binding on the (...) part of the skilled workers. However, little attention is devoted to the relevance of the right to exit for the debate on compulsory service programmes. In this paper, I argue that even if the service contracts are voluntary, and thus the would‐be medical students voluntarily relinquish their right to exit, the reasons behind the right should be taken into account for the contracts to be morally valid. A clear understanding of the right to exit is a must in order not to breach its basic components and for the service contracts to be morally binding. To that end, I provide two accounts of the reasons to value the right to exit by presenting Patti Lenard's discussion of the right to exit and by reconstructing James Griffin's account of human rights. I conclude by offering brief ethical considerations for compulsory health service programmes grounded in the reasons to value the right to exit. (shrink)

Last year (1998) saw the celebration of the 50th Anniversaryof the British National Health Service (NHS). One ofthe few completely nationalised systems of health carein the world, the NHS is seen by many as a moralbeacon of what it means to provide equitable medicaltreatment to all citizens on the basis of need andneed alone. However, others argue that it has failedto achieve the overall goals for which it was created.Because of scarce resources, some urgently needed careis not available (...) at all, while that which is receivedis sometimes second class. For these reasons, it isclaimed that the NHS should be scrapped and replacedby other systems of health care delivery.This paper outlines the history of the NHS,indicating some of the problems and innovations whichhave led to its current organization and structure.The philosophical foundations of the NHS are then articulated and defended on the grounds that it stillrepresents a morally coherent and economicallyefficient approach to the delivery of health care.Scarce resources are the key problem facing the NHS,making rationing inevitable and it is shown thatthis is not incompatible with the moral foundations ofthe service. However, there can be little doubt thatthe NHS is now becoming dangerously under-funded. Thepaper concludes with arguments about why this is soand what might be done about it. (shrink)

The Norwegian Parliament has decided to give priority to ethics in municipal health services. This priority is supposed to raise competence in ethics within municipal health services. As part of the national project, the participating municipalities were encouraged to develop and carry out local projects. In this article, we present a local ethics project in one of the participating municipalities in central eastern Norway. The local project for raising competence in ethics was carried out in cooperation (...) with researchers at the Centre for Medical Ethics (CME) at the University of Oslo. Most people agree that ethics are important in health services. However, there are many ways to increase competence in ethics and to stimulate ethical reflection. In this article we present a broad overview of this local ethics project, but special focus will be put on presenting the actions that have been used for increasing the level of ethical competence and stimulating ethical reflection among the participants. We describe our evaluation of the project and the research we carried out. Explanations will be given for the thought process behind the decisions that were made. (shrink)

In this article, I will argue that the delivery of healthcare could be an act of resistance, that is, day‐to‐day, routine and perhaps mundane acts, undertaken in the course of the delivery of health services, which for many could also be considered otherwise routine care. I first consider how resistance has been conceptualised. How we understand resistance will determine if we believe healthcare could be conceptualised this way. I will show how resistance has been applied to day‐to‐day struggles (...) elsewhere and argue that it can clearly encompass open, collective dissent and more subtle, day‐to‐day action that does not necessarily make clear political demands. I go on to introduce some examples, where the delivery of health services could be conceptualised as resistance. While I advocate for a broad understanding of resistance, clearly not every act could be considered resistance; I will consider some points of tension and contention in utilising resistance to describe the delivery of health services, in particular discussing the issue of intent and opposition as they relate to resistance. Finally, while I hope that I make a convincing case, one final issue remains, namely, why turn to resistance at all, when many of the examples that I provide could be labelled using concepts that are more widely utilised. I will offer some general reflections on this point, speaking to the benefits and potential of resistance. (shrink)

Chapter 1 Who this book is for and who it is not for1 There are already too many books offering solutions to the problems of the health service. ...

In Turkey, city hospitals play a significant role in the provision of healthcare services. This survey looked at the level of satisfaction with various hospitals. In the study, social media was one of the tools. The hospitals' websites were used to compile satisfaction ratings. After that, content analysis was used to look at the hospitals' indicators for technological, communicative, and physical quality. The study considered hospitals with 1200 beds or greater as a sampling factor in hospital selection. Hospitals are (...) classified with the designation "Hospital" in objectives of information security and ethics. Encoding was carried out like Hos1, Hos2, Hos3, etc. for every hospital. The results of this article, which are considered significant research findings, are believed to had an important effect on improving hospital service requirements. Additionally, improvements can be made in health service delivery in line with the opinions of stakeholders. Additionally, the importance of patient satisfaction in terms of health tourism was emphasized. (shrink)

Many countries, including Australia, have established a national scheme that supports the recognition of a single ethical review for multi-centre research conducted in publicly funded health services. However, local site-specific governance review processes remain decentralised and highly variable. This short report describes the ethics and governance processes required for a negligible risk national survey of physiotherapy-led airway clearance services in Australia. We detail inconsistencies in research governance document preparation and submission (platforms, processes, forms and signatories) and report (...) the time cost and likely impact of these inconsistencies on health services research outcomes. Processes and strategies that facilitated success in this project are identified and summarised as helpful hints to other researchers looking to embark on negligible risk research in public health facilities. (shrink)

Systematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health , - from the perspectives of employees participating in the groups, the group facilitators and the service managers. The reflection groups were implemented as part of a research and development project.

The "Socialist Calculation Debate" is little known outside the economics profession, yet this inter-war debate between liberal and socialist economists on the practical feasibility of socialism has important implications for all contemporary public sector bureaucracies. This article applies the Mises-Hayek critique of central planning that emerged from this debate to the crisis presently facing the British National Health Service. The Mises-Hayek critique suggests that the UK government's plan for a renewal of the National Health Service will fail because (...) of the epistemological pathologies that face any centrally planned system. It is argued that the key lesson of the Socialist Calculation Debate is that market prices and private property rights are essential for the efficient allocation of resources and the attainment of the best possible health outcomes. (shrink)

This article reviews practitioners’ evaluations of in-hospital ethics seminars. A qualitative study included 11 innovative in-hospital ethics seminars, preceded and followed by interviews with most participants. The settings were obstetric, neonatal and haematology units in a teaching hospital and a district general hospital in England. Fifty-six health service staff in obstetric, neonatal, haematology, and related community and management services participated; 12 attended two seminars, giving a total of 68 attendances and 59 follow-up evaluation interviews. The 11 seminars facilitated (...) by an ethicist addressed the key local concerns of staff about the social and ethical consequences of advances in genetics and their impact on professional policies and practice. Seminar agendas were drawn from prior interviews with 70 staff members. During evaluation interviews, participants commented on general aspects that they had enjoyed, how the sessions could be improved, timing, the mix of participants, the quality of the facilitation, whether sessions should be more challenging, after-effects of sessions, and interest in attending seminars and contacting the ethicist in future. Participants valued the increased interprofessional understanding and coherent discussion of many pressing issues that addressed important though seldom discussed ethical questions. The seminars worked well in the different hospitals and specialties. (shrink)

ZusammenfassungVon Vertragsärzten in ihren Praxen angebotene oder hier von Patienten nachgefragte "individuelle Gesundheitsleistungen" sind in unserem Gesundheitswesen zu einer häufigen Erscheinung geworden. Es hat sich ein "zweiter Gesundheitsmarkt" mit einem erheblichen ökonomischen Potential entwickelt. Die Leistungen umfassen ein weites Spektrum; sie adressieren ganz unterschiedliche Gesundheitsstörungen, Ziele und Hoffnungen und sind extrem heterogen. Auch dies erschwert eine einheitliche Definition. Aus Patientensicht scheint das wichtigste Merkmal, dass IGeL vollständig privat bezahlt werden müssen. Der Beitrag diskutiert IGeL unter normativen Gesichtspunkten und adressiert 6 (...) Fragen: welche Risiken und Chancen beinhalten IGeL für das hergebrachte Bild des Arztes und seine Profession, das Verständnisder wissenschaftlichen Grundlagenärztlicher Untersuchungs- und Behandlungsmethoden, das Verständnis der Medizin und ihrer Ziele, die bisherige Rolle der Patienten, die Beziehung zwischen Arzt und Patient und das Bild der Gesetzlichen Krankenversicherung? Einerseits sind IGeL aus unterschiedlichen Gründen für Patienten und Vertragsärzte attraktiv. In Zeiten einer zunehmenden Regulierung der Medizin erhöhen sie Freiheitsgrade und Wahlmöglichkeiten beider Seiten. Andererseitshaben sie das Potential, vor allem die Rolleund Profession des ArztesimSystemderGKVund ihreWahrnehmungtiefgreifendzu verändern. Obsich der IGeL-Markt bei uns kontrollieren und regulieren lässt, ist eine zurzeit offene Frage. (shrink)

Although there is extensive information about why people participate in clinical trials, studies are largely based on quantitative evidence and typically focus on single conditions. Over the last decade investigations into why people volunteer for health research have become increasingly prominent across diverse research settings, offering variable based explanations of participation patterns driven primarily by recruitment concerns. Therapeutic misconception and altruism have emerged as predominant themes in this literature on motivations to participate in health research. This paper contributes (...) to more recent qualitative approaches to understanding how and why people come to participate in various types of health research. We focus on the experience of participating and the meanings research participation has for people within the context of their lives and their health and illness biographies. (shrink)

Reforms in the German health care system in the attempt to bring more competition into health care have increased the sovereignty of the insured or patients, who have finally been allowed to make choices. “The start of a reorientation of the statutory health insurance system and hospital care are to be welcomed as first steps towards a supply of health services that reflects individual preferences.” The authors can be contacted care of Prof. Dr. Oberender at (...) Rechts‐ und Wirtschafswissenschaftliche Fakulät, Universität Bayreuth, 95440 Bayreuth, Germany, where Dr Oberender is Professor in the Faculty of Law and Economics, and Ansgar Hebborn is his Assistant. The authors wish to record their gratitude to Jan Hacker for translating this article. (shrink)

Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient‐centered approaches. But as we argue in this paper, the recovery‐oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became more established, (...) more codified, and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change. (shrink)

A socialist health service cannot be a socialist island in a sea of capitalism, as the record of the British National Health Service shows. Nonetheless, since health is a basic need, it can be a key component of the advocacy of socialism. I propose two central socialist principles. On the basis of these I suggest that a socialist health system would emphasise care rather than service; insist on democratic structures and control of resources; and require the (...) prohibition of private medicine. (shrink)

(1996). Designing mental health services to improve ethnic relations. World Futures: Vol. 47, Unity and Diversity in Contemporary Systems Tinking: Systematic Pictures at an Exhibition, pp. 15-23.

Mobile health services have been widely used in medical services and health management through mobile devices and multiple channels, such as smartphones, wearable equipment, healthcare applications, and medical platforms. However, the number of the users who are currently receiving the mHealth services is small. In China, more than 70% of internet users have never used mHealth services. Such imbalanced situation could be attributed to users’ traditional concept of medical treatment, psychological factors and privacy concerns. (...) The purpose of this study is to explore the direct and indirect effects of mHealth users’ self-efficacy and privacy concerns on their intention to adopt mHealth services, providing guidelines for mHealth service providers to enhance users’ intention of adoption. A questionnaire was designed by the research team and 386 valid responses were collected from domestic participants in China. Based on the unified theory of acceptance and use of technology model, a research model integrated self-efficacy and privacy concerns was constructed to investigate their effects on users’ intention to adopt mobile mHealth services. The results show that self-efficacy could facilitate users’ intention to adopt mHealth services, and had a significantly positive effect on perceived ubiquity, effort expectancy, performance expectancy and subjective norm. This study verifies the direct and indirect effects of self-efficacy and privacy concerns on users’ intention to adopt mHealth services, providing a different perspective for studying mHealth adoption behavior. The findings could provide guidelines for mHealth service providers to improve their service quality and enhance users’ intention of adoption. (shrink)

We explore whether a Rawlsian approach might provide a guiding philosophy for the development of a healthcare system, in particular with regard to resolving tensions between different groups within it. We argue that an approach developed from some of Rawls’ principles – using his ‘veil of ignorance’ and both the ‘difference’ and ‘just savings’ principles which it generates – provides a compelling basis for policy making around certain areas of conflict. We ask what policies might be made if those making (...) them did not know if one was patient, doctor, nurse or manager – in this generation or the next. We first offer a brief summary of Rawls’ approach and how we intend to extrapolate from it. We examine how this adapted Rawlsian framework could be applied to specific examples of conflict within healthcare; we demonstrate how this framework can be used to develop a healthcare service which is both sustainable (in its training and treatment of staff, and in encouraging research and innovation) and open (to protect the powers and opportunities of those using the health service). We conclude that while Rawls’ approach has previously been rejected as a means to address specific healthcare decisions, an adapted veil of ignorance can be a useful tool for the consideration of how a just health service should be constructed and sustained. Turning the theoretical into the practical (and combining Rawls’ thought experiment with Scanlonian contractarianism), managers, doctors, patients, carers and nurses could come together and debate conflicting issues behind a hypothetical veil. (shrink)

The New Zealand health service has been extensively changed over the past four years, with the introduction of Jour new Regional Health Authorities, required to purchase services on behalf of the Government from a range of providers. In order to ensure fairness across the four regions a Core Services Committee has been set up to define which services must be purchased. However, no clear agreement has emerged about a “core” and no list, either positive or (...) negative has been defined. Instead general criteria have been suggested and steps have been taken to consult the community on their priorities. This paper describes seven workshops run by the author in an effort to discover how the community would reach decisions on the rationing of scare resources. The outcome of these workshops is that there is virtually no community support for an approach based on the social utility of individuals in need. (shrink)

The aim of this study was to gain a deeper understanding of privacy in occupational health services. Data were collected through in-depth theme interviews with occupational health professionals (n=15), employees (n=15) and employers (n=14). Our findings indicate that privacy, in this context, is a complex and multilayered concept, and that companies as well as individual employees have their own core secrets. Co-operation between the three groups proved challenging: occupational health professionals have to consider carefully in which (...) situations and how much they are entitled to release private information on individual employees for the benefit of the whole company. Privacy is thus not an absolute right of an individual, but involves the idea of sharing responsibility. The findings open up useful new perspectives on ethical questions of privacy and on the development of occupational health practices. (shrink)

Machine generated contents note: Introduction. -- Acknowledgments. -- The Author. -- 1 Ethical Theories and Bioethics in a Global Perspective. -- Theories of Ethics. -- Are Theories of Ethics Global? -- Can Theories of Ethics Encourage People to Do the Right Thing? -- 2 Autonomy and Informed Consent in Global Perspective. -- Ethical Principles and Practical Issues of Informed Consent. -- Does Informed Consent Really Matter to Patients? -- Is Informed Consent a Universal Principle or a Cultural Value? -- 3 (...) Withholding or Withdrawing Treatment and Physician-Assisted Suicide. -- Withholding or Withdrawing Treatment at the End of Life. -- Assisting Patients in Committing Suicide. -- 4 Ethical Issues in Reproductive Health. -- Ethics of Abortion in Different Times, Places, and Cultures. -- Current Ethical Issues in Abortion. -- Assisted Reproductive Technology and Stem Cell Research. -- Emergency Contraception. -- Ethics of Imposing Conditions on Funding. -- 5 Ethical Issues of Female Genital Mutilation. -- The Facts About FGM. -- FGM as a Challenge to Ethical Relativism. -- Ethics of FGM for Adult Women. -- 6 Ethical Issues of Research with Human Subjects. -- Background Information and the Belmont Report. -- Autonomy and Voluntary Informed Consent. -- Beneficence and Cost-Benefit Analysis. -- Issues of Justice and Fairness for Human Subjects. -- 7 The Right to Health Care, and Ethical Obligations to Provide Care. -- Is There an Ethical Right to Health Care? -- Ethical Obligations of Health Care Professionals. -- Ethical Obligations of for-Profit Health Care Providers. -- 8 Ethical Issues in Rationing and Allocation of Limited Resources. -- Levels of Allocating Resources. -- Methods of Rationing Health Resources. -- Comparative Effectiveness Research and Cost-Effectiveness Analysis. -- 9 Ethical Issues of Health Insurance and Health System Reform. -- Ethical Issues in Financing Health Services and Designing Insurance Systems. -- Fundamental Values of Health Systems. -- 10 Ethical Issues in the Movement of Patients Across National Borders. -- Ethical Duties to Provide Health Care to Undocumented Aliens. -- Ethical Issues in Medical Tourism. -- 11 Ethical Issues in the Movement of Health Care Professionals Across National Borders. -- Ethical Issues in the Migration of Health Professionals. -- Proposed Solutions and Their Ethical Implications. -- Fair Treatment of Health Care Workers from Other Countries. -- 12 Corruption and Informal Payments in Health Systems. -- Payment of Informal Fees by Patients and Their Families. -- Is Corruption Bad for Your (and Other People's) Health? -- References. -- Index. (shrink)

Contemporary mental health professionals exhibit interest in integrating spirituality into the services they provide to clients. This clinical integration raises questions about both the goals of mental health services and the professional relevance of mental health providers’ spiritual competency. Drawing on the Christian anthropology of St. Thomas Aquinas, Benedict Ashley’s approach to psychotherapy differentiates psychopharmacological, psychotherapeutic, and spiritual approaches on the basis of the different domains of a client’s personality. These domains are the focus of (...) different professions, and Ashley’s account suggests that mental health providers who lack additional spiritual-moral training should adopt a clinical model that recognizes their work is spiritually oriented but not spiritually directive. (shrink)

Privacy is a key ethical principle in occupational health services. Its importance is emphasised in several laws, in ethical codes of conduct as well as in the literature, yet there is only very limited empirical research on privacy in the occupational health context. Conceptual questions on privacy in the occupational health context are discussed. The baseline assumption is that, in this context, privacy cannot be approached and examined only from the employee’s vantage point but the employer’s (...) point of view must also be taken into account, and that the concept has several dimensions . Even though privacy is a basic human need, there is no universally accepted definition of the concept and no consensus on whether an organisation can have privacy in the same way as people do. Many of the challenges surrounding privacy in the context of occupational health seem to be associated with the dual loyalties of occupational health professionals towards the employee and employer and with their simultaneous duties of disseminating and protecting information . Privacy is thus not an absolute value, but more research is needed to understand its multidimensional nature in the context of occupational health. (shrink)

Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh and examines its determinants. Data from a baseline survey of UP Community Mobilization project was utilized. A cross-sectional sample of currently married women who delivered a baby 15 months prior to the survey was included. Information (...) was collected from 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care, delivery and postnatal care services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates. Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group membership had no association with the utilization of maternal health services. Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group. (shrink)

Respiratory illness continues to be a leading cause of paediatric morbidity and mortality in Indonesia. The Indonesian government is moving towards a more managed care-based approach as it reforms its health care system following the 1997 financial crisis. In order to better design contractual relationships between the payor and different providers, there needs to be a better understanding of the patterns and predictors of health services utilization for respiratory illness. This study uses the Indonesia Demographic and (...) class='Hi'>Health Survey to study the determinants of private, public and non-formal provider utilization for respiratory illness. Multinomial logistic regression models for predicting use were constructed using the Andersen Behavioural Model as the conceptual framework. The findings indicate that age, household size, maternal education, religion, the asset index, location and illness severity play a role in determining use of private, public or non-formal providers. The results indicate that from a policy perspective, the Indonesian government needs be inclusive rather than exclusive in the choice of providers that are contracted by the managed care plans, in order to safeguard the health of the under-five population. (shrink)

This paper analyses the role chaplaincy plays in providing religious and spiritual care in the UK’s National Health Service. The approach considers both the current practice of chaplains and also the wider changes in society around beliefs and public service provision. Amid a small but growing literature about spirituality, health and illness, I shall argue that the role of the chaplain is changing and that such change is creating pressures on the identity and performance of the chaplain as (...) a religiously authorised health worker. I shall question whether either orthodox belief or religious belonging have any significant bearing on the patients’ demand for chaplaincy services. Utilising an example of chaplaincy work I shall argue that patient need constitutes the strongest platform for both practice development and an articulated understanding of what chaplains bring to health care. Drawing on a case study the definition and interpretation of spiritual need will be discussed in relation to chaplaincy practice. In conclusion, I shall set out the case for effective research to establish with greater precision the detail of the chaplain’s practice within a state-funded health system. (shrink)

Barriers to mental health interventions globally remain a health concern; however, these are more prominent in low- and middle-income countries. The barriers to accessibility include stigmatization, financial strain, acceptability, poor awareness, and sociocultural and religious influences. Exploring the barriers to the utilization of mental health services might contribute to mitigating them. Hence, this research aims to investigate these barriers to mental health service utilization in depth at the Kabutare District Hospital of the Southern Province of (...) Rwanda. The qualitative approach was adopted with a cross-sectional study design. The participants were patients with mental illnesses seeking mental health services at the hospital. Ten interviews were conducted in the local language, recorded, and transcribed verbatim and translated by the researchers. Thematic analysis was applied to analyze the data collected. The results revealed that the most common barriers are fear of stigmatization, lack of awareness of mental health services, sociocultural scarcity, scarcity of financial support, and lack of geographical accessibility, which limit the patients to utilize mental health services. Furthermore, it was revealed that rural gossip networks and social visibility within the communities compounded the stigma and social exclusion for patients with mental health conditions. Stigmatization should be reduced among the community members for increasing their empathy. Then, the awareness of mental disorders needs to be improved. Further research in Rwanda on the factors associated with low compliance to mental health services with greater focus on the community level is recommended. (shrink)

When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for (...) healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored. (shrink)