Postmodernism and poststructuralism challenge fundamental positions in social theory. This book sets out some of the components of a postmodern social theory of health and healing, deriving from theorists including Derrida, Deleuze and Guattari, Foucault, Cixous and Kristeva. Nicholas J. Fox observes that the knowledge of the medical profession about the body, illness and health supplies the basis for medical dominance. The body of the patient is inscribed by discourses of professional `care,' an interaction which subjectifies the patient. (...) Fox explores the character of this power - and how it may be, and is, resisted. The book illustrates with detailed examples how the organization of health care and the caring relationship itself are sites for this contestation of power. Elements of feminist theory, and Derridean concepts of diffrance and intertextuality, supply the framework for the politics and ethics of the postmodern position on health. Deleuze and Guattari's radical challenge to psychoanalysis and familial repetitions within the healer/patient contact allows a re-reading of central ideas in medical sociology. While focusing upon the possibilities of postmodern social theory, the book demands a reappraisal of issues of structure, identity and knowledge in modernist medical sociology. Modernist sociology, Fox suggests, has been complicit in the creation of `the patient,' and of 'health' and 'illness.' Written with an emphasis on accessibility, this book explores the practical consequences of postmodern theory as well as familiarizing the reader with the concepts of postmodernism. (shrink)

This pioneering new book suggests how different traditions of sociological thought can contribute to an understanding of the theory and practice of rights. Rights: Sociological Perspectives provides a sociological treatment of a wide range of substantive issues but without losing sight of key theoretical questions. It considers some varied cases of public intervention, including welfare, caring, mental health provisions, pensions, justice and free speech, alongside the rights issues they raise. Similarly, it examines the question of rights from the point (...) of view of distinctive population groups, such as prisoners and victims, women, ethnic minorities, indigenous peoples, and lesbians and gays. It also contains two specifically theoretical chapters, which provide a critical overview of the existing approaches to the construction and implementation of rights. Rights: Sociological Perspectives offers a diverse and detailed exploration of the contribution sociological thought can make to this increasingly important aspect of social life and will be an invaluable aid to students. (shrink)

In this article, following on from earlier debates in the journal regarding the ‘thorny issue’ of epochē and bracketing in sociological phenomenological research, we consider more generally the challenges of engaging in reflexivity and bracketing when undertaking ethnographic ‘insider’ research, or research in familiar settings. We ground our discussion and illustrate some of the key challenges by drawing on the experience of undertaking this research approach with a group of competitive swimmers, who were participating in a British university performance swimming (...) programme at the time of the doctoral study. The primary researcher was highly familiar with the phenomenon of competitive swimming, having been both a competitive swimmer and swimming coach. Some of the key elements of a sociological phenomenological approach to studying physical-cultural embodiment are first delineated, before addressing the considerable challenges of engaging in sustained reflexivity and bracketing, using the swimming research for illustrative purposes. We suggest some practical ways in which researchers in sport and physical cultures might approach epochē and bracketing in ethnographic ‘insider’ research. -/- KEYWORDS: Sociological phenomenology, competitive swimming, insider research, epochē/bracketing. (shrink)

Deindustrialization is a major burden on workers’ health in many countries, calling for theoretically informed sociological analysis. Here, we present a novel neoclassical sociological synthesis of the lived experience of deindustrialization. We conceptualize industry as a social institution whose disintegration has widespread implications for the social fabric. Combining Durkheimian and Marxian categories, we show that deindustrialization generates ruptures in economic production, which entail job and income loss, increased exploitation, social inequality, and the disruption of services. These ruptures spill over (...) to the field of social reproduction, generating material deprivation, job strain, fatalism, increased domestic workload, anomie, community disintegration, and alienation. These ruptures in social reproduction are sources of psychosocial stress, through which deindustrialization gets embodied as ill health and dysfunctional health behavior. We substantiate this framework through the extensive qualitative thematic analysis of 82 life history interviews in Hungary’s rust belt. (shrink)

The article examines recent debates surrounding public sociology in the context of a UK based Department of Applied Social Sciences. Three areas of work within the department form the focus of the article: violence against women and children; community-based oral history projects and health ethics teaching. The article draws on Micheal Burawoy’s typology comprising public, policy, professional and critical sociology, and argues that much of the work described in the case studies more often lies somewhere in between, (...) in the interstices, rather than within one or other of the four types. The result is not without its tensions and dilemmas, some of which are identified and explored, notably those arising from attempts to appeal to diverse audiences and meet the sometimes conflicting expectations of each. (shrink)

Machine generated contents note: Chapter 1. Environmental Problems and Society Part I: The Material Chapter 2. Consumption and Materialism Chapter 3. Money and Machines Chapter 4. Population and Development Chapter 5. Body and Health Part II: The Ideal Chapter 6. The Ideology of Environmental Domination Chapter 7. The Ideology of Environmental Concern Chapter 8. The Human Nature of Nature Chapter 9. The Rationality of Risk Part III: The Practical Chapter 10. Mobilizing the Ecological Society Chapter 11. Governing the Ecological (...) Society . (shrink)

Foundations of medical ethics and law -- Professionalism and medical ethics -- The doctor, the patient, and society -- Ethics and law at the beginning and end of life -- Healthcare commissioning and resource allocation -- Introduction to sociology and disease -- Experience of health and illness -- Organization of health care provision in the UK -- Inequalities in health and health care provision -- Epidemiology and public health -- Clinical governance.

In this paper two fears about health promotion are identified. The first concerns the ability to choose between proliferating expert advice, and the second concerns the fear of government interference in personal life. The paper goes on to outline the current place of health promotion in British health policy, and to discuss the relevance of recent research on health beliefs. The paper argues that work on ‘lay epidemiology’ has been overlooked by both critics and supporters of (...) health promotion. From this vantage point the fears about health promotion can be seen to be exaggerated. (shrink)

What kinds of contributions can sociologists make to debates about ethics? What makes sociological investigation of morality and ethical issues distinct from philosophical concerns? Is there a place for a separate subfield within the discipline of sociology that deals specifically with questions of ethics and morality? This book places these questions on the sociological agenda. The first part of the book addresses the 'ethical turn' in sociology, and includes chapters on defining ethics and morality, lay understandings of ethics, (...) sociological accounts of moral life, and the relation of sociology to bioethics. These chapters examine alternative conceptions to mainstream discussions regarding embodiment and ethics. The book provides insight into both recent debates in the humanities and social sciences about the circulation and transfer of bodily fluids, tissues, and organs, and the gift-exchange, reciprocity practices, and institutions that make these body economies possible. (shrink)

‘Client involvement’ has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how ‘client involvement’ is practised in home‐care services. The aim of this article is to analyse ‘client involvement’ in practise seen from the positions of healthcare professionals, an elderly person and his relative in a home‐care setting. A sociologically inspired single case study was conducted, consisting of three weeks of observations and interviews. The study has a (...) focus on the relational aspects of home care and the structural, political and administrative frames that rule home‐ care practice. Client involvement is shown within four constructed analytical categories: ‘Structural conditions of providing and receiving home care’; ‘Client involvement inside the home: performing a professional task and living an everyday life’; ‘Client involvement outside the home: liberal business and mutual goal setting’; and ‘Converting a home to a working place: refurnishing a life’. The meaning of involvement is depending on which position it is viewed from. On the basis of this analysis, we raise the question of the extent to which involvement of the client in public home‐care practice remains limited. (shrink)

Social theory plays an important role in the nursing discipline and nursing inquiry as it helps conceptually embed nursing in the larger picture of the social world. For example, a broad category of critical theory provides a unique lens for uncovering social conditions of inequity and oppression. Among the sociological theories, actor‐network theory (ANT) is an approach to research and analysis that has recently gained interest among nurse philosophers and researchers. Studies guided by ANT seek to understand phenomena of interest (...) as constituted within the relationships between human and nonhuman actors to understand how care practices are co‐created/enacted and how they can be made more humane. In this paper, we describe the benefits of ANT for examining healthcare access for incarcerated individuals with life‐limiting illnesses accessing palliative care and for people using illicit drugs. We argue that attention to the materiality of care practices can contribute to efforts of advancing health equity for these groups. (shrink)

This article explored health determinants on successful, healthy ageing in sub-Saharan Africa, using the case of Ramotswa in Botswana. The study used contextual, descriptive and qualitative approaches. It also explored the integrative nature of determinants to healthy and successful ageing by examining the biopsychological and physiological challenges. The article made use of the pastoral theological approach in understanding the complexity of ageing and revealing solutions for mitigating the health challenges encountered by older persons. While the article was theological (...) in its approach, it acknowledged the interconnectedness with other disciplines, such as sociology and psychology, as fundamental in dealing with this topic. The findings revealed the elderly caregivers’ need for emotional support. This study maintained that emotional support could minimise the burden on elderly caregivers, because reports during the study indicated that elderly caregivers experienced a mixture of emotions such as loneliness, frustration, anger, depression, guilt, anxiety, love, acceptance and warmth, which could have negative consequences on them. Contribution: In conclusion, the article suggested that given the complexity of the understanding of successful and healthy ageing, as well as the integrative nature of determinants of successful ageing, it is crucial for caregivers and policymakers to avoid a blanket approach in dealing with elderly persons in a context of care. (shrink)

Religion constitutes an important element in every society as regards coping with the demands as well as vicissitudes of life. Mental health issues are becoming a recurrent decimal in societies overwhelmed by stress and other social factors. This paper examines how the presence of religious beliefs affects how some Christians respond to cases that have to do mental health. At the same time, it surveys how a near absence of religious attitude, that is, clinical medicine approach to mental (...) health issues betters the state of those suffering from these psychopathologies. This work sees participatory partnership approach as an effective means of correcting unhealthy biases that prevent a better understanding of mental health care. Sociological theory of structural functionalism will be used in assessing how religion can reinvent itself in areas that are associated with mental health. Ethnographic methodology through quantitative analysis of administered questionnaire is used as a research tool for this research. Three persons were also interviewed. The research findings show that religion is a crucial agent of socialization that can change how religious beliefs impact on mental health and there is need for medical professionals to collaborate with pastoral agents. (shrink)

‘I’ll tell you what suits me best if you don’t mind me saying’: ‘lay participation’ in health‐careIncreasing ‘lay participation’ in healthcare has become a popular notion in recent years and is generally considered to be a good thing in both nursing and wider policy circles. Yet despite the widespread acceptance of this overall idea, there is a dearth of theorising in this area. This has resulted in a lack of conceptual clarity which has not only hamstrung the development of (...) empirical work in the field, but has also led to a tendency by both nurses and policy‐makers to assume that greater ‘lay participation’ in health will lead to a concomitant increase in lay power vis‐à‐vis health professionals. The data presented in this paper indicate that this is, at best, an over‐simplistic assumption and, at worst, an erroneous one. Drawing on sociological theories of the division of labour, I suggest that one way in which we might begin to clarify our thinking in this area is by differentiating between the ‘role’ and ‘task’ components of ‘lay participation’. I illustrate my argument with reference to two separate ethnographic studies undertaken between 1994 and 1998 in which participation at the level of the individual was examined. (shrink)

The ethical principle of autonomy is among the most fundamental in ethics, and it is particularly salient for those in public health, who must constantly balance the desire to improve health outcomes by changing behavior with respect for individual freedom. Although there are some areas in which there is a genuine tension between public health and autonomy—childhood vaccine mandates, for example—there are many more areas where not only is there no tension, but public health and autonomy (...) come down to the same thing. These areas of overlap are often rendered invisible by a thin understanding of autonomy. Better integrating newer theoretical insights about autonomy into applied ethics can make discussions of public health ethics more rigorous, incisive, and effective. Even more importantly, bringing modern concepts of autonomy into public health ethics can showcase the many areas in which public health and autonomy have the same goals, face the same threats, and can be mutually advanced by the same kinds of solutions. This article provides a schema for relational autonomy in a public health context and gives concrete examples of how autonomy can be served through public-health interventions. It marshals insights from sociology, psychology, and philosophy to advance a theory of autonomy and coercion that recognizes three potential threats to autonomy: threats to choice sets, threats to knowledge, and threats to preferences. (shrink)

What do we mean when we talk about rights in relation to health? Where does the language of health rights come from, and what are the implications of using such a discourse? During the last 20 years there have been an increasing number of initiatives and efforts for instance in relation to HIV/AIDS which draw on the language, institutions and procedures of human rights in the field of global health. This book explores the historical, cultural and social (...) context of public health activists' increasing use of rights discourse and examines the problems it can entail in practice. Structured around three interlinked themes, this book begins by looking at how and why some health issues came to be framed as human rights issues. It goes on to look at what health as a human right means for our understandings of citizenship and the political landscape. The final part of the book investigates what happens when health rights are put into practice implemented, realised, cited, ignored and resisted. Health Rights in Global Context provides an in-depth discussion of the historical, social and political context of rights in health and develops much needed critical perspectives on the human rights approach to global health. It will be of interest to scholars of public health and human rights within health care as well as sociology and anthropology"--Provided by publisher. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Public Health Ethics: Health by the NumbersMartina Darragh (bio) and Pat Milmoe McCarrick (bio)Hippocrates had nothing to say about public health. Rather, the idea that a government should protect its citizens from disease by maintaining sanitary conditions has its origin in Renaissance humanities texts, and the notion that physicians have public health responsibilities emerged in the works of such Enlightenment authors as Johann Peter Frank, (...) Benjamin Rush, and John Gregory (II, Coughlin and Beauchamp 1996). When the spread of infectious diseases such as typhoid and cholera accompanied the growth of the Industrial Revolution, England was the first to respond by passing the Public Health Act of 1848. The motivation for this reform was not based in humanitarian concerns but in the realization that unsanitary conditions were costly to industry. “... [The] founders of the public health movement were guided by nineteenth century utilitarian moral theories... the greatest good for the greatest number... accompanied by a growing appreciation for the innate value and dignity of mankind... however, the rights and autonomy of individuals have not always been respected in pursuing these important objectives” (I, Coughlin 1995, p. 1).Public health projects have dramatically improved global health status. One measure of their success is that “... most poor people now live longer, on average, than the wealthiest people a century ago” (I, Beaglehole and Bonita 1997, p. 13) These projects are not limited to such activities as disinfecting sewers. “Public health is what we, as a society, do to collectively assure the conditions in which people can be healthy. This requires that continuing and emerging threats to the health of the public be successfully countered. These threats include immediate crises, such as the AIDS epidemic; enduring problems, such as injuries and chronic illness; and impending crises foreshadowed by such developments as the toxic by-products of a modern economy” (I, Institute of Medicine (IOM) 1988, p. 1) The practice of public health has embraced this IOM challenge and includes the subspecialties of epidemiology, health promotion and education, public health administration, international health, maternal and child health, biostatistics, environmental health, and nutrition. This annotated bibliography focuses on epidemiology, [End Page 339] health promotion and education, and public health administration, and includes a wide variety of opinions on each topic.EpidemiologyAt first glance, it is hard to see what ethical issues could arise in population studies of the causes and control of illness. Disclosure of risk information in the clinical encounter is complicated by issues of uncertainty with regard to the data itself. Causation and causal inference may be affected by “wish bias,” leading to studies that use the same data but reach widely varying conclusions (II, Weed 1997). Given the complexity of the statistical calculations used to validate public health recommendations, and mass media’s portrayal of them, the public may be unintentionally deceived by population-based recommendations (V, Seedhouse 1997; II, Lupton 1995). With the addition of genetic screening, another layer of statistical complexity is added to this mix (VI, Stone and Steward 1996).Health Promotion and EducationIncreased life expectancy brought about by advances in public health has raised a new set of problems. With the realization that illness can be promoted in part by individual life-style choices, population-based recommendations about risk factors become important in the clinical encounter. This shift is not without difficulties; one author notes that he has yet to receive any risk information from his physicians, even when he asks “the experts” (V, Dugdale 1998). This may be due in part to the fact that “... public health lacks a vocabulary with which to speak about and identify commonalities among health problems experienced by very different populations” (IV, Mann 1997, p. 8). Furthermore, the mix of disciplines informing health promotion activities (sociology, psychology, recreation medicine, and the like) creates an illusion of shared ethics where none exists, which in turn leads to programs based on value systems that may not be meaningful for the populations they serve (V, Seedhouse 1997).Given these factors, a number of authors are skeptical of introducing public health measures into the clinical encounter. “We might do well to encourage people to live lives of modified hedonism so that they might... (shrink)

Between the 14 and 18 March 2016, the Institute for Ethics, History and Theory of Medicine, in cooperation with the Institute for Sociology at Ludwig-Maximilians-University, Munich, hosted an interdisciplinary workshop on migrant and refugee health in Germany and the UK. Fifteen participants from four countries met to discuss ethical issues surrounding the health of migrants and refugees in Europe, with particular emphasis on a comparison of the different approaches taken by Germany and the UK. This report provides (...) an overview of the structure and purpose of the workshop, an outline of the topics discussed, its outcomes, and its objectives moving forward. (shrink)

Over the past twenty years there has been a shift in medical law and practise to increasingly distrust the judgement of health professionals. An increasing number of codes of conduct, disciplinary bodies, ethics committees and bureaucratic policies now prescribe how health professional and health researchers should act and relate to their patients. The result of this, Mark Henaghan argues, has been to undermine trust and professional judgement in health professionals, while simultaneously failing to trust the patient (...) to make decisions about their care. This book will look at the issue of health professionals and trust comparatively in a number of countries including the USA, Canada, Australia, New Zealand and the UK. The book will show by historical analysis of legislation, case law, disciplinary proceedings reports, articles in medical and law journals and protocols produced by management teams in hospitals, how the shift from trust to lack of trust has happened. Drawing comparisons between situations where trust is respected such as in emergency situations, and where it is not for example routine decisions such as obtaining consent for an anaesthetic procedure, the book shows how this erosion of trust has the potential to dehumanise the special nature of the relationship between healthcare professionals and patients. The effect of this is that the practice of health care is turned into a mechanistic enterprise controlled by "management processes" rather than governed by trust and individual care and judgement. This book will be an invaluable resource for students and scholars of medical law and medical sociology, public policy-makers and a range of associated professionals, from health service managers to medical science and clinical researchers. (shrink)

There is longstanding interest within anthropology and sociology in the meaning of humour, but little research that examines humour within fathers’ health experiences. This paper specifically analyses fathers’ stories about humour shared with other men, and the links between gender and health, in order to identify the implications for health‐care and future research. Findings indicate that humour is an important aspect of fathers’ experiences of social connectedness with other men. Indeed, for African‐Caribbean fathers specifically, humour was (...) an important aspect of their relationships with other ethnic minority men. Humour was also used to objectify, humiliate or ridicule others, for example in the form of sexualised or racist humour. However, fathers’ stories were also mediated by masculinities, it that masculinities enabled fathers to avoid disclosure of vulnerability regarding health experiences to others. The links between masculinities and health, the implications for interviewing fathers, and the implications for future research and healthcare practice with fathers are also discussed. (shrink)

This paper presents a novel perspective on an evolving policy area. The UK’s withdrawal from the EU has led to the creation of a new Agriculture Act and proposals for significant changes to the way farming subsidies are structured in England. Underpinned by a ‘public money for public goods’ approach, where public goods are those outputs from the farm system which are not rewarded by markets, yet which provide benefits to many members of society. New schemes include the Animal (...) class='Hi'>Health and Welfare Pathway, where certain aspects of farm animal health and welfare (FAHW) will be subsidised through government support, raising a much-debated issue in the literature regarding the representation of FAHW as a public good. For policy to be responsive to societal demands and accountable to citizens, understanding public attitudes and preferences towards FAHW as a public good, and how the public might prioritise this in relation to a wider suite of environmental public goods from farming, is important. An online survey of 521 members of the UK public was conducted and analysed with descriptive statistics and ordered logistic regression. Findings reveal low awareness of the changing agricultural policy context, but strong support for public money being used to provide public goods, particularly for FAHW. Findings also indicate a need for more effective public communication of farming and FAHW issues from farming stakeholders to ensure public policy in this domain is responsive and accountable to its citizens. Further work is needed to inform future debates and engagement surrounding FAHW, including through which combination of funding mechanisms (public or private) it is provided. (shrink)

This paper explores the notion of ‘expert’ health care practitioner in the context of critical thinking and health care education where scientific rather than philosophical inquiry has been the dominant mode of thought. A number of factors have forced are appraisal in this respect: the challenge brought about by the identification of complex ethical issues in clinical situations; medicine's `solving' of many of the simple health problems; the recognition that uncertainty is a common and perhaps innate feature (...) of clinical practice; debate about the concepts of illness and disease; plus insights from psychology,sociology and medical anthropology. Together these have prompted alternative ways of thinking which have the aim of identifying the best rather than the right decision (where best equates to good and right equates to correct in the sense of true or approved). It is argued that phronesis adds a necessary corrective dimension to modern Western medicine's over-emphasis on techne and is one of the factors that differentiates novice from expert practitioner. However, this attracts certain conflicts of interest: phronesis can only be gained and assessed from experience of praxis; agencies with legitimate interests in medicine such as government and professional registering bodies require more substantive criteria. (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)

There is a large literature exploring the concept of ‘health promotion’. However, the meaning of the term remains unclear and contested. This is for at least two reasons. First, any definition of ‘health promotion’ is going to have to outline and defend an account of the notoriously controversial concept of ‘health’, and then suggest how (and why) we should promote it. Second, health promotion clearly has some overlap with ‘public health’, but it is far from (...) clear how they are related. Is health promotion part of public health or is health promotion a radically different type of activity from public health? Answering this question requires engaging with tricky professional as well as contentious conceptual issues. Some advocates of health promotion talk as though public health is problematic: seen as medical, physiological in focus and reductionist in approach, whereas health promotion, on this view, is focused on the whole person in a social environment. However, to an outsider this looks more like an attempt to artificially (and rather crudely) define and protect professional boundaries, rather than a contribution to conceptual analysis. There seems no good reason why public health cannot take into account the role of social, political, economic and cultural factors and their impact on health. Indeed, much work in public health does precisely this, and uses a wide range of methodologies drawn from non-medical disciplines such as geography, sociology and psychology, not just epidemiology. It seems much more sensible to see health promotion as being one vitally important aspect of the work of public health, rather than something markedly distinct. We will assume here that this is the case and focus instead on the first issue: what is health promotion? (shrink)

Open any standard bioethics textbook, and therein can be found a host of subjects ranging from the abortion rights controversy to the morality of xenographic tissue transplantation. Just as there is a wide scope to the subject matter of bioethics, its practitioners come from a multitude of disciplines, including law, medicine, nursing, theology, philosophy, sociology, and anthropology. And yet, despite a rich variety of investigators and methods, bioethicists overlook numerous subjects that deserve to be addressed. In particular, they neglect (...) issues of public health, preventive medicine, and social medicine. Although topics such as physician-assisted suicide, prenatal genetic testing, and the ethics of new reproductive technologies constitute the contemporary canon of bioethics and deserve sustained analysis, these subjects are not so significant that they should eclipse other issues. For example, gun control policies, the regulation of food additives. immunization programs, prenatal care, leave programs enabling employees to care for dying relatives, the provision of nutrition and medical care to the homeless, and the use of emergency rooms by the most impoverished citizens are all topics neglected by bioethicists. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction:Developing Health Care in Severely Resource-Constrained SettingsPaul Farmer and Sadath SayeedThis symposium of Narrative Inquiry in Bioethics catalogues the experiences of health care providers working in resource-poor settings, with stories written by those on the frontlines of global health. Two commentaries by esteemed scholars Renee Fox and Byron and Mary-Jo Good accompany the narratives, helping situate the lived experiences of global health practitioners within the (...) frameworks of sociology and medical anthropology respectively.The burgeoning interest in global health among students, health science trainees, clinical practitioners, social entrepreneurs, philanthropists, and government officials is often linked with substantial moral claims. People working in global health often start with the rhetorical premise that each and every human being, regardless of economic, social, or political circumstances that lie beyond his or her control, deserves equal access to quality health care services. This is a bold position at risk of trivialization, in part because the sentiment is so commonplace among global health equity activists.Despite this relatively recent global outpouring of solidarity and concern, billions of poor people still lack access to basic health services. All too often, interventions that perpetuate existing trade practices and market economics are promoted, usually to the detriment of the poor. As our good friend and colleague Arthur Kleinman warns:The irrelevance of ethics can be seen when considering universal ethical formulations of justice and equity that do not begin with the local moral conditions of poor people, those experiencing the systematic injustice of higher disease rates and fewer health-care resources because of their positioning at the bottom of local social structures of power.(1999, p.72)If we are serious about reducing health disparities globally, we must be prepared to mobilize resources in Africa just as we would in the United States or in Europe. If we fetishize cost-effective (read: low-cost) interventions for the poor, we must ask whether we use the same metrics in other situations. In other words, we must always strive to address the fundamental structural and social causes of health inequity.We believe that global health must avoid the "iron cage of rationality," to use sociologist Max Weber's words. One unanticipated consequence of the growth of global health as a field is that the "audit culture"—which encourages accountability and effectiveness—can at times reinforce power differentials between donors (whether government agencies or multilateral foundations) and their intended beneficiaries. Agendas are often set not by community members but by global health leaders who rarely demonstrate sustained commitments to a local community. [End Page 73]As the guest editors of this issue, we hope to recapture the soul of global health work through the art of storytelling. Narratives, even when presented as raw and unrefined as many within this issue, remind us of the immense challenges—both programmatic and moral—involved in this work. The profound scarcity of resources available to health providers in poor countries forces ethical questions on doctors, nurses, pharmacists, social workers, and other health care workers, who make difficult choices every day about what to do with the few resources they have. These are the ethical dilemmas of mortal dramas at their most dire. Global health work demands of its practitioners an alternate mode of audit than academic methodologies can provide. Narratives return us to the basic human commitments that led many of us to this work, and they remind us to use words like equality and justice meaningfully.The narratives that follow offer unmitigated perspectives on the working lives of global health practitioners. They highlight the translation of the moral and programmatic challenges of health care delivery into real choices: for example, between a visiting surgeon's desire to treat a patient and his capacity (or really incapacity) to provide follow-up care. They acknowledge the necessity of interdisciplinary cooperation in resource-constrained settings, as well as the difficulties in collaborating across cultures and continents. Most importantly, they make the claim that a newborn in distress in a tent in Port-au-Prince merits the same resources and attention as one in Boston, and that his or her death merits the same indignation. They demonstrate the radical solidarity inherent in the... (shrink)

Volume 25, Issue 2, February 2025, Page 80-82.

The integration of ethical analysis in Health Technology Assessment (HTA) has proven difficult to implement even though it is explicitly recognized as an important component of such assessments in HTA literature. When compared to the standardized scientific method for systematic reviews in HTA, the diversity of ethical analysis has been characterized as a fundamental barrier to the integration of ethics. The present paper aims to identify the theoretical and practical differences between the approaches underpinning ethical analysis in HTA and (...) clarify the reasons for such diversity. Our systematic review of HTA literature pertaining to the barriers to the integration of ethics in HTA identified nine ethical approaches: Principlism, Casuistry, Coherence Analysis, Wide Reflective Equilibrium, Axiology, the Socratic approach, the Triangular model, Constructive Technology Assessment and Social Shaping of Technology. Citations pertaining to each approach were extracted and categorized according to three constitutive components of ethical argumentation established in a previous research evaluating nanotechnologies: i) the disciplinary foundation that grounds the validity of the ethical evaluation, ii) the characteristics of such evaluation, iii) the operational process involved in applying it to a particular case (i.e., its practical reasoning). This comparison shows that, 1) the difference between these approaches rests primarily on their disciplinary foundation (rooted in philosophy, philosophy/theology, or sociology), 2) their complexity can be observed in the distinct characteristics of ethical evaluation deriving from their differing disciplinary foundation, and 3) although four different types of operationalization procedure were identified, little information was available in regards to the practical reasoning associated with these approaches. (shrink)

Cass Sunstein and Richard Thaler have been arguing for what they named libertarian paternalism (henceforth LP). Their proposal generated extensive debate as to how and whether LP might lead down a full-blown paternalistic slippery slope. LP has the indubitable merit of having hardwired the best of the empirical psychological and sociological evidence into public and private policy making. It is unclear, though, to what extent the implementation of policies so constructed could enhance the capability for the exercise of an autonomous (...) citizenship. Sunstein and Thaler submit it that in most of the cases in which one is confronted with a set of choices, some default option must be picked out. In those cases whoever devises the features of the set of options ought to rank them according to the moral principle of non-maleficence and possibly to that of beneficence. In this paper we argue that LP can be better implemented if there is a preliminary deliberative debate among the stakeholders that elicits their preferences, and makes it possible to rationally defend them. (shrink)

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, autonomy-based bioethics (...) fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy. (shrink)

Accession Number: ATLA0001712151; Hosting Book Page Citation: p 253-270.; Language(s): English; General Note: Bibliography: p 269-270.; Issued by ATLA: 20130825; Publication Type: Essay.

The transgender experience predicts that the gender affirming pathway is undertaken. The gender affirmation process is not mandatory, and the process is not the same for all people. Affirmation of gender is a social determinant of transgender and gender diverse (TGD) health, but which also has a multidimensional structure: social, legal, psychological, and medical. At this point, however, it is necessary to understand the type of pathway that TGD people can undertake in Italy, so the purpose of this paper (...) is to make the articulation of the pathway known and explicit, trying to detect the sociological aspects and the impacts that the various components of the gender affirming pathway require. The gender affirming pathway in Italy is characterized by many critical issues: it is focused on the affirmation of medical, legal, and psychological dimensions; however, the affirmation of social gender is also important to promote their integration into society, their health and general well-being. In conclusion, it is necessary to develop and implement research and concrete impacts of social gender affirmation, the potential of which is to reduce inequalities, in general, and health, which negatively impact the Italian TGD individuals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Health Care Ethics: Theological Foundations, Contemporary Issues, and Controversial Cases, revised edition by Michael R. Panicola, David M. Belde, John Paul Slosar, and Mark F. Repenshek, and: On Moral Medicine: Theological Perspectives in Medical Ethics, third edition ed. by M. Therese Lysaught and Joseph J. Kotva Jr. with Stephen E. Lammers and Allen VerheyLindsey EsbensenReview of Health Care Ethics: Theological Foundations, Contemporary Issues, and Controversial Cases, (...) revised edition MICHAEL R. PANICOLA, DAVID M. BELDE, JOHN PAUL SLOSAR, AND MARK F. REPENSHEK Winona, MN: Anselm Academic, 2011. 438 pp. $37.95Review of On Moral Medicine: Theological Perspectives in Medical Ethics, third edition EDITED BY M. THERESE LYSAUGHT AND JOSEPH J. KOTVA JR. WITH STEPHEN E. LAMMERS AND ALLEN VERHEY Grand Rapids, MI: Eerdmans, 2012. 1180 pp. $61.55Health Care Ethics and On Moral Medicine are excellent resources for those studying and teaching in the field of medical ethics. Each text on its own provides a very good initial evaluation of contemporary conversations in health care ethics. Together they provide a thorough foundation for the study of health care ethics that encourages further exploration of topics in the field. They both provide an excellent overview for undergraduate students as well as anyone interested in the field of medical morality.Health Care Ethics is especially helpful for those entering the field of ethics in general and the more particular realm of medical morality. User-friendly, [End Page 211] the book is accessible to beginners while also being relevant to those already well-versed in medical ethics. The book provides case studies culled from the experiences of the authors throughout their careers in the practice of medical ethics. Perhaps even more useful, however, are the other exercises in which readers are given the opportunity to actively engage the text in order to discover and more fully articulate their own moral stance. Although Health Care Ethics approaches the topic from a theological perspective, using scriptural passages as well as broader religious themes and contexts, the book is accessible to those outside of the religious arena as well.The first three chapters lay the framework for general theological and ethical inquiry while the later chapters discuss more specific topics in applied health care ethics. The opening chapters by Michael Panicola are thought-provoking, especially since they encourage readers to participate in exercises to determine how they would respond to particular scenarios in their personal decision making. For example, after laying out the classic ethical theories, readers are asked to take a “quiz” by responding to multiple-choice questions to determine how they would respond to various ethical situations. The exercise demonstrates that moral discernment that relies on one ethical theory alone or one single approach to ethics is too narrow and confining for authentic dialogue in ethics. Another exercise calls upon readers to examine their fundamental bases for personal decision making by asking them to create a list of what they think are the ten things that constitute human flourishing and then narrow that list down to the top two. In addition to being engaging, these exercises help readers establish their personal moral stance by asking them to appropriate foundational norms in the process of moral discernment to the case studies throughout the book. They also help readers apply these norms to the specific topics in health care ethics presented in the later chapters.The authors of Health Care Ethics clearly identify human flourishing as the center and goal for all ethical inquiry. Demonstrating that “human flourishing” has different connotations for different people, they also argue that certain norms can be agreed upon to establish a framework for all conversations regarding moral decision making in health care. They especially emphasize a concern for the optimization of human flourishing in final chapters of the text. Chapters 4–12 provide detailed examinations of current topics in medical ethics. Each chapter includes case studies that raise questions concerning social ethics as well as health care morality, employing sources from law, sociology, philosophy, and theology. Each case underscores the complexity of moral decision making in health care ethics as well as the point that there is no one, pure approach to medical ethics that... (shrink)

Preventing War and Promoting Peace: A Guide for Health Professionals is an interdisciplinary study of how pervasive militarism creates a propensity for war through the influence of academia, economic policy, the defense industry, and the news media. Comprising contributions by academics and practitioners from the fields of public health, medicine, nursing, law, sociology, psychology, political science, and peace and conflict studies, as well as representatives from organizations active in war prevention, the book emphasizes the underlying preventable causes (...) of war, particularly militarism, and focuses on the methods health professionals can use to prevent war. Preventing War and Promoting Peace provides hard-hitting facts about the devastating health effects of war and a broad perspective on war and health, presenting a new paradigm for the proactive engagement of health professions in the prevention of war and the promotion of peace. (shrink)

Who should have access to assisted reproductive technologies? Which one of many seriously ill patients should be offered the next available transplant organ? When may a surrogate decision maker decide to withdraw life-prolonging measures from an unconscious patient? Questions like these feature prominently in the field of health care ethics and in the education of health care professionals. This book provides a concise introduction to the major concepts, principles and issues in health care ethics, using case studies (...) throughout to illustrate and analyse challenging ethical issues in contemporary health care. Topics range widely, from confidentiality and truthfulness to end-of-life care and research on human subjects. Ethics and Health Care will be a vital resource for students of applied ethics, bioethics, professional ethics, health law and medical sociology, as well as students of medicine, nursing and other health care professions. (shrink)

Beyond Health applies post-structuralist and postmodern ideas to issues of health and health care to provide a radical re-think of how health is to be understood. It offers a perspective in which health is seen as an affirmation of potential rather than as a narrow biopsychosocial construct. The author develops his notion of arche-health and in so doing provides a lucid account of a wide range of post-structuralist and postmodern theoretical perspectives and their relevance (...) to the field of health. This text explains complex ideas so even a reader with no previous background in the topic can grasp it. In each chapter the author explains and applies a selection of theoretical perspectives. (shrink)

Most social scientists and philosophers claim that sociology and philosophy are disjoint fields of inquiry. Some have wondered how to trace the precise boundary between them. Mario Bunge argues that the two fields are so entangled with one another that no demarcation is possible or, indeed, desirable. In fact, sociological research has demonstrably philosophical pre-suppositions. In turn, some findings of sociology are bound to correct or enrich the philosophical theories that deal with the world, our knowledge of it, (...) or the ways of acting upon it. While Bunge's thesis would hardly have shocked Mill, Marx, Durkheim, or Weber, it is alien to the current sociological mainstream and dominant philosophical schools. Bunge demonstrates that philosophical problematics arise in social science research. A fertile philosophy of social science unearths critical presuppositions, analyzes key concepts, refines effective research strategies, crafts coherent and realistic syntheses, and identifies important new problems. Bunge examines Marx's and Durkheim's thesis that social facts are as objective as physical facts; the so-called Thomas theorem that refutes the behaviorist thesis that social agents react to social stimuli rather than to the way we perceive them; and Merton's thesis on the ethos of basic science which shows that science and morality are intertwined. He considers selected philosophical problems raised by contemporary social studies and argues forcefully against tolerance of shabby work in academic social science and philosophy alike. (shrink)

The UK Supreme Court’s recent judgement inMcCulloch v Forth Valley Health Boardclarifies the standard for the identification of ‘reasonable’ alternative medical treatments. The required standard is that of a reasonable doctor: treatments that would be accepted as proper by a responsible body of medical opinion. Accordingly, the assessment of consent involves a two-stage test: first, a ‘reasonable doctor’ test for identifying alternative treatments; followed by a ‘reasonable person in the patient’s position’ test for identifying the material risks of these (...) reasonable alternative treatments. The separation of consent into two stages is consistent with not only a certain conception of freedom but also a nuanced construct of respect for autonomy that has a normative base. Furthermore, reliance on a reasonable doctor in the first stage is in keeping with a sociological account of medical professionalism, which posits that only doctors, and none others, can determine what is a proper treatment. Yet, reliance on a reasonable doctor permits a plurality of standards for reasonableness, because differences in opinion among doctors are pervasive. The reasons for some differences might be acceptable as unavoidable imperfections in medical decision-making to a reasonable person. But reasons for other differences might be objectionable; and the resultant inequalities in medical treatments would be considered unfair. One solution is to make the plurality of reasonable alternatives available to the patient, but this would introduce practical uncertainty and it is rejected by the Court. The Court’s approach may be pragmatic; however, it seems to allow avoidable injustice in healthcare. (shrink)

The clinical encounter between providers and patients is insufficient: most factors influencing health outcomes occur outside the clinic. Community Health Needs Assessments address this insufficiency via collaboration between hospitals and the communities they serve to address systemic sociological-economic variables impacting health outcomes. Considering this, why are Health Care Ethics Consultation services limited to the clinical setting? We can cultivate better ethics outcomes by addressing systemic sociological-economic factors that cause recurring ethics issues in the hospital. In this (...) article, I argue for the need for a Community Ethics Needs Assessment. CENA is a novel concept; thus, this article is exploratory. I argue for the necessity of a CENA and, more importantly, outline what methodology a CENA would use to both identify and address an ethics need. (shrink)