1
|
Outram SM, Ackerman SL, Norstad M, Koenig B. The Challenge of Recruiting Diverse Populations into Health Research: An embedded social science perspective. NEW GENETICS AND SOCIETY 2022; 41:216-226. [PMID: 36968265 PMCID: PMC10035592 DOI: 10.1080/14636778.2022.2115349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/03/2022] [Indexed: 05/25/2023]
Abstract
Addressing health disparities has become a central remit for conducting health research. In the following paper, we explore the conceptual and methodological challenges posed by the call to recruit medically underserved populations. This exploration of challenges is undertaken from the perspective of social science researchers embedded in a large within a clinical genomics research study. We suggest that these challenges are found in respect to the development of recruiting strategies, analysis of the data in respect to understanding and interpreting the experiences of being medically underserved, and in comparing the experiences of being medically underserved compared to not being underserved. By way of conclusion, it is argued that there is important role for social scientists with large health research studies which, if achieved successfully, can benefit study teams and society as a whole.
Collapse
Affiliation(s)
- Simon M Outram
- Program in Bioethics, Institute for Health & Aging, University of California, San Francisco, California, USA
| | - Sara L Ackerman
- Department of Social & Behavioral Sciences, University of California, San Francisco, California, USA
| | - Matthew Norstad
- Program in Bioethics, Institute for Health & Aging, University of California, San Francisco, California, USA
| | - Barbara Koenig
- Program in Bioethics, Institute for Health & Aging, University of California, San Francisco, California, USA
| |
Collapse
|
2
|
Forschendes Lernen in der Empirischen Medizinethik. Ethik Med 2022. [DOI: 10.1007/s00481-022-00712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDer Erwerb von Fach- und Forschungskompetenzen kann im besonderen Maße in Lehrveranstaltungen gefördert werden, die Studierende mit der Bewältigung komplexer Probleme konfrontieren. In diesem Artikel stellen wir didaktische Überlegungen zum Forschenden Lernen in der Empirischen Medizinethik dar. Ausgehend von der Theorie des Pragmatismus zeigen wir auf, wie Forschendes Lernen in Lehrangeboten verwirklicht und für die Förderung medizinethischer Kompetenzen genutzt werden kann. Wir fokussieren dabei auf Lehr- und Lernprojekte, in denen die selbstorganisierte Durchführung empirisch-ethischer Forschung für Studierende prozesshaft erfahrbar gemacht werden kann. Solche Lehrangebote bieten große Potenziale, vor allem im Hinblick auf die Erweiterung von Reflexionskompetenzen der Studierenden. Eine Aufnahme solcher Lehrangebote in die fakultative Medizinethik-Lehre wird im Hinblick auf kontextuelle Herausforderungen diskutiert.
Collapse
|
3
|
Frenette M, Laliberté M, Payment JP. La gestion des plaintes : quelle place pour l’éthique ? CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1092951ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
4
|
Schürmann J, Mühleck M, Perler C, Schmeck K, Reiter-Theil S. Ethische Herausforderungen in der forensischen Kinder- und Jugendpsychiatrie. Eine qualitative Beobachtungsstudie und ein Instrument zur Früherkennung und Frühintervention. Ethik Med 2021. [DOI: 10.1007/s00481-021-00605-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ZusammenfassungDie forensische Kinder- und Jugendpsychiatrie steht in einem komplexen Spannungsfeld medizinischer, rechtlicher und sozialer Anforderungen. Die ethischen Herausforderungen, die sich daraus für den stationären Maßnahmenvollzug ergeben, sind bisher kaum untersucht, spezifische Hilfestellungen für Behandelnde fehlen. Diese Studie hat zum Ziel, ethische Themenfelder und Probleme in diesem Bereich zu identifizieren und ein Instrument zur Früherkennung und -intervention ethischer Probleme im Klinikalltag zu entwickeln. Methode: Eine systematische Literaturrecherche sowie eine Beobachtungstudie in der Jugendforensik der Universitären Psychiatrischen Kliniken Basel werden durchgeführt. Die Beobachtungsdaten werden mittels qualitativer Inhaltsanalyse ausgewertet. Das Instrument wird auf der Basis der Resultate nach einer neuen Methode entwickelt. In der Literaturrecherche wurden 14 valide Publikationen identifiziert, die hauptsächlich ethische Probleme der Gerichtspsychiatrie thematisieren wie professionelle Rollenkonflikte, ethische Probleme der Diagnostik und Begutachtung oder der Umgang mit vertraulichen Informationen. Empirische oder empirisch-normative Studien fehlen. In der Beobachtungsstudie wurden 24 ethische Themen und spezifische Probleme identifiziert, besonders häufig sind ethische Fragen zu Moralkompetenzen der Jugendlichen, zur Behandlungsqualität, zum Umgang mit Regeln und Sanktionen und zur Freiheits- und Privatsphäre. Das Instrument zur Früherkennung und -intervention ethischer Probleme (FIEP) enthält die vier Kernelemente Risikofaktoren, Indikatoren, Interventionsplanung und Entscheidungsfindung. Der Maßnahmenvollzug der forensischen Kinder- und Jugendpsychiatrie offenbart ein breites Spektrum ethischer Themen mit spezifischen ethischen Problemen, welche in der Literatur bisher nur unzureichend untersucht sind. Das hier entwickelte Instrument FIEP unterstützt Behandelnde dabei, ethische Probleme frühzeitig zu erkennen und effizient zu bearbeiten.
Collapse
|
5
|
Winkler EC. Do Researchers in Empirical Ethics Studies Have a Duty to Act Upon their Findings? Case Study in End-of-Life Decision Making. J Empir Res Hum Res Ethics 2019; 14:438-440. [PMID: 31779540 DOI: 10.1177/1556264618822603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The outlined empirical study on the decision-making process concerning the limitation of life-prolonging treatment (DLT) in patients with advanced cancer at a University hospital setting triggered some new questions for research ethics with respect to studies using empirical methods in medical ethics. The analyzed data of the study showed that less than half of the patients were involved in DLT. Deciding against CPR (cardiopulmonary resuscitation) and transferal to the ICU (intensive care unit) without informing and explaining it to the perfectly competent patient can be regarded as a violation of the ethical principle of respect for autonomy. This is what the embedded researcher witnessed throughout the study recruitment and data acquisition, as the noninvolvement of patients was not just a result of the final data analysis. The ethical question raised in this situation was as follows: Does the embedded researcher has a moral duty to intervene when she witnesses that ethical standards are not upheld?
Collapse
Affiliation(s)
- Eva C Winkler
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Program for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
6
|
Muggli M, De Geyter C, Reiter-Theil S. Shall parent / patient wishes be fulfilled in any case? A series of 32 ethics consultations: from reproductive medicine to neonatology. BMC Med Ethics 2019; 20:4. [PMID: 30621671 PMCID: PMC6325683 DOI: 10.1186/s12910-018-0342-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/26/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Questions concerning the parent/ patient's autonomy are seen as one of the most important reasons for requesting Ethics Consultations (ECs). Respecting parent/ patient's autonomy also means respecting the patient's wishes. But those wishes may be controversial and sometimes even go beyond legal requirements. The objective of this case series of 32 ECs was to illustrate ethically challenging parent / patients' wishes during the first stages of life and how the principle of patient's autonomy was handled. METHODS The case series has a qualitative retrospective approach. A documentary sheet was designed de novo and information was gained from EC minutes and medical charts. The cases originate from the following specialties: reproductive medicine, obstetrics and neonatology as well as two interdisciplinary cases. RESULTS Through the structured EC minutes aspects of patient / parents' wishes could be identified explicitly. Overall the patient / parents' wishes were not supported in 61% of the cases. Central reasons for rejection of patient / parent wishes were mainly the protection of the best interest of the unborn / new-born child as well as the rejection of clinical approaches that were regarded as being substandard treatment. CONCLUSION The study shows that treatment decisions in reproductive medicine, obstetrics and neonatology raise substantial ethical questions leading to the request for ethics consultation. The systematic case series presented here gives insight into the ethical reflection carried out to support the clinicians in their decision-making and counselling. It shows that clinicians, after using ethics consultation, make deliberate decisions that do not "automatically" fulfil the treatment requests of the patients and parents (to-be).
Collapse
Affiliation(s)
- Mirella Muggli
- Department of Clinical Ethics, Psychiatric Hospitals of the University Basel, University Hospital, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
- Institute of Reproductive Medicine and Gynaecological Endocrinology (RME), University Hospital, University of Basel, Vogesenstrasse 134, CH-4031 Basel, Switzerland
| | - Christian De Geyter
- Institute of Reproductive Medicine and Gynaecological Endocrinology (RME), University Hospital, University of Basel, Vogesenstrasse 134, CH-4031 Basel, Switzerland
| | - Stella Reiter-Theil
- Department of Clinical Ethics, Psychiatric Hospitals of the University Basel, University Hospital, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| |
Collapse
|
7
|
"Getting by" in a Swiss Tertiary Hospital: the Inconspicuous Complexity of Decision-making Around Patients' Limited Language Proficiency. J Gen Intern Med 2018; 33:1885-1891. [PMID: 30143979 PMCID: PMC6206329 DOI: 10.1007/s11606-018-4618-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/25/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND While the need to address language barriers to provide quality care for all is generally accepted, little is known about the complexities of decision-making around patients' limited language proficiency in everyday clinical encounters. OBJECTIVE To understand how linguistic complexities shape cross-cultural encounters by incorporating the perspective of both, patients and physicians. DESIGN A qualitative hospital study with semi-structured interviews and participant-observation in a Swiss University Hospital. Thirty-two encounters were observed and 94 interviews conducted. PARTICIPANTS Sixteen patients of Turkish and 16 of Albanian origin and all actors (administration, nurses, physicians, if required, interpreters) involved in the patients' entire process. MAIN APPROACH Interviews were audio-recorded and transcribed verbatim. A thematic content analysis was conducted using MAXQDA. For reporting, the COREQ guidelines were used. KEY RESULTS Three themes were relevant to patients and physicians alike: Assessment of the language situation, the use of interpreters, and dealing with conversational limits. Physicians tend to assess patients' language proficiency by their body language, individual demeanor, or adequacy of responses to questions. Physicians use professional interpreters for "high-stakes" conversations, and "get by" through "low-stakes" topics by resorting to bilingual family members, for example. Patients are driven by factors like fearing costs or the wish to manage on their own. High acceptance of conversational limits by patients and physicians alike stands in stark contrast to the availability of interpreters. CONCLUSIONS The decision for or against interpreter use in the "real world" of clinical care is complex and shaped by small, frequently inconspicuous decisions with potential for suboptimal health care. Physicians occupy a key position in the decision-making to initiate the process of medical interpreting. The development and testing of a conceptual framework close to practice is crucial for guiding physicians' assessment of patients' language proficiency and their decision-making on the use of interpreting services.
Collapse
|
8
|
Reijers W, Wright D, Brey P, Weber K, Rodrigues R, O'Sullivan D, Gordijn B. Methods for Practising Ethics in Research and Innovation: A Literature Review, Critical Analysis and Recommendations. SCIENCE AND ENGINEERING ETHICS 2018; 24:1437-1481. [PMID: 28900898 DOI: 10.1007/s11948-017-9961-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
This paper provides a systematic literature review, analysis and discussion of methods that are proposed to practise ethics in research and innovation (R&I). Ethical considerations concerning the impacts of R&I are increasingly important, due to the quickening pace of technological innovation and the ubiquitous use of the outcomes of R&I processes in society. For this reason, several methods for practising ethics have been developed in different fields of R&I. The paper first of all presents a systematic search of academic sources that present and discuss such methods. Secondly, it provides a categorisation of these methods according to three main kinds: (1) ex ante methods, dealing with emerging technologies, (2) intra methods, dealing with technology design, and (3) ex post methods, dealing with ethical analysis of existing technologies. Thirdly, it discusses the methods by considering problems in the way they deal with the uncertainty of technological change, ethical technology design, the identification, analysis and resolving of ethical impacts of technologies and stakeholder participation. The results and discussion of our literature review are valuable for gaining an overview of the state of the art and serve as an outline of a future research agenda of methods for practising ethics in R&I.
Collapse
Affiliation(s)
- Wessel Reijers
- ADAPT Centre, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - David Wright
- Trilateral Research and Consulting, 72 Hammersmith Rd, London, W14, UK
| | - Philip Brey
- Department of Philosophy, University of Twente, Drienerlolaan 5, 7522NB, Enschede, The Netherlands
| | - Karsten Weber
- Institute for Social Research and Technology Assessment (IST), OTH Regensburg, Galgenbergstraße 24, 93053, Regensburg, Germany
| | - Rowena Rodrigues
- Trilateral Research and Consulting, 72 Hammersmith Rd, London, W14, UK
| | - Declan O'Sullivan
- ADAPT Centre, Department of Computer Science, Trinity College Dublin, O'Reilly Institute, Dublin 2, Ireland
| | - Bert Gordijn
- Institute of Ethics, Dublin City University, Glasnevin, Dublin 9, Ireland
| |
Collapse
|
9
|
Ives J, Dunn M, Molewijk B, Schildmann J, Bærøe K, Frith L, Huxtable R, Landeweer E, Mertz M, Provoost V, Rid A, Salloch S, Sheehan M, Strech D, de Vries M, Widdershoven G. Standards of practice in empirical bioethics research: towards a consensus. BMC Med Ethics 2018; 19:68. [PMID: 29986689 PMCID: PMC6038185 DOI: 10.1186/s12910-018-0304-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 05/29/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This paper reports the process and outcome of a consensus finding project, which began with a meeting at the Brocher Foundation in May 2015. The project sought to generate and reach consensus on standards of practice for Empirical Bioethics research. The project involved 16 academics from 5 different European Countries, with a range of disciplinary backgrounds. METHODS The consensus process used a modified Delphi approach. RESULTS Consensus was reached on 15 standards of practice, organised into 6 domains of research practice (Aims, Questions, Integration, Conduct of Empirical Work, Conduct of Normative Work; Training & Expertise). CONCLUSIONS Through articulating these standards we outline a position that encourages responses, and through those responses we will be able to identify points of agreement and contestation that will drive the conversation forward. In that vein, we would encourage researchers, funders and journals to engage with what we have proposed, and respond to us, so that our community of practice of empirical bioethics research can develop and evolve further.
Collapse
Affiliation(s)
| | | | | | - Jan Schildmann
- Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Mertz M, Schildmann J. Beyond integrating social sciences: Reflecting on the place of life sciences in empirical bioethics methodologies. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:207-214. [PMID: 28733796 DOI: 10.1007/s11019-017-9792-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Empirical bioethics is commonly understood as integrating empirical research with normative-ethical research in order to address an ethical issue. Methodological analyses in empirical bioethics mainly focus on the integration of socio-empirical sciences (e.g. sociology or psychology) and normative ethics. But while there are numerous multidisciplinary research projects combining life sciences and normative ethics, there is few explicit methodological reflection on how to integrate both fields, or about the goals and rationales of such interdisciplinary cooperation. In this paper we will review some drivers for the tendency of empirical bioethics methodologies to focus on the collaboration of normative ethics with particularly social sciences. Subsequently, we argue that the ends of empirical bioethics, not the empirical methods, are decisive for the question of which empirical disciplines can contribute to empirical bioethics in a meaningful way. Using already existing types of research integration as a springboard, five possible types of research which encompass life sciences and normative analysis will illustrate how such cooperation can be conceptualized from a methodological perspective within empirical bioethics. We will conclude with a reflection on the limitations and challenges of empirical bioethics research that integrates life sciences.
Collapse
Affiliation(s)
- Marcel Mertz
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.
| | - Jan Schildmann
- Institute for Ethics, Wilhelm Löhe University of Applied Science, Fürth Merkurstraße 41/Südstadtpark, 90763, Fürth, Germany
- Department of Medicine III, Klinikum der Universität München, Campus Großhadern, Munich, Germany
| |
Collapse
|
11
|
Cheetham M, Wiseman A, Khazaeli B, Gibson E, Gray P, Van der Graaf P, Rushmer R. Embedded research: a promising way to create evidence-informed impact in public health? J Public Health (Oxf) 2018. [DOI: 10.1093/pubmed/fdx125] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Cheetham
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
- Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK
| | - A Wiseman
- Gateshead Council, Public Health Team, Gateshead NE8 1NN, UK
| | - B Khazaeli
- Gateshead Council, Public Health Team, Gateshead NE8 1NN, UK
| | - E Gibson
- Gateshead Council, Public Health Team, Gateshead NE8 1NN, UK
| | - P Gray
- Gateshead Council, Public Health Team, Gateshead NE8 1NN, UK
| | - P Van der Graaf
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
- Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK
| | - R Rushmer
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
- Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK
| |
Collapse
|
12
|
Vindrola-Padros C, Pape T, Utley M, Fulop NJ. The role of embedded research in quality improvement: a narrative review. BMJ Qual Saf 2016; 26:70-80. [PMID: 27129492 PMCID: PMC5256405 DOI: 10.1136/bmjqs-2015-004877] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/30/2016] [Accepted: 04/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Cecilia Vindrola-Padros
- Department of Applied Health Research, University College London, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Tom Pape
- University College London Hospitals NHS Foundation Trust, London, UK.,Clinical Operational Research Unit, University College London, London, UK
| | - Martin Utley
- Clinical Operational Research Unit, University College London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| |
Collapse
|
13
|
Knight R, Small W, Shoveller J. How do 'Public' Values Influence Individual Health Behaviour? An Empirical-Normative Analysis of Young Men's Discourse Regarding HIV Testing Practices. Public Health Ethics 2015; 9:264-275. [PMID: 27790291 DOI: 10.1093/phe/phv031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Philosophical arguments stemming from the public health ethics arena suggest that public health interventions ought to be subject to normative inquiry that considers relational values, including concepts such as solidarity, reciprocity and health equity. As yet, however, the extent to which 'public' values influence the 'autonomous' decisions of the public remains largely unexplored. Drawing on interviews with 50 men in Vancouver, Canada, this study employs a critical discourse analysis to examine participants' decisions and motivations to voluntarily access HIV testing and/or to accept a routine HIV test offer. Within a sub-set of interviews, a transactional discourse emerged in which the decision to test features an arrangement of 'giving and receiving'. Discourses related to notions of solidarity emphasize considerations of justice and positions testing as a 'public' act. Lastly, 'individualistic' discourses focused on individual-level considerations, with less concern for the broader public 'good'. These findings underscore how normative dimensions pertaining to men's decisions to test are dialectically interrelated with the broader social and structural influences on individual and collective health-related behaviour, thereby suggesting a need to advance an explicit empirical-normative research agenda related to population and public health intervention research.
Collapse
Affiliation(s)
- Rod Knight
- Simon Fraser University, University of British Columbia, and British Columbia Centre for Excellence in HIV/AIDS
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University
| | | |
Collapse
|
14
|
Knight R. Empirical population and public health ethics: A review and critical analysis to advance robust empirical-normative inquiry. Health (London) 2015; 20:274-90. [PMID: 25956917 DOI: 10.1177/1363459315583156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The field of population and public health ethics (PPHE) has yet to fully embrace the generation of evidence as an important project. This article reviews the philosophical debates related to the 'empirical turn' in clinical bioethics, and critically analyses how PPHE has and can engage with the philosophical implications of generating empirical data within the task of normative inquiry. A set of five conceptual and theoretical issues pertaining to population health that are unresolved and could potentially benefit from empirical PPHE approaches to normative inquiry are discussed. Each issue differs from traditional empirical bioethical approaches, in that they emphasize (1) concerns related to the population, (2) 'upstream' policy-relevant health interventions - within and outside of the health care system and (3) the prevention of illness and disease. Within each theoretical issue, a conceptual example from population and public health approaches to HIV prevention and health promotion is interrogated. Based on the review and critical analysis, this article concludes that empirical-normative approaches to population and public health ethics would be most usefully pursued as an iterative project (rather than as a linear project), in which the normative informs the empirical questions to be asked and new empirical evidence constantly directs conceptualizations of what constitutes morally robust public health practices. Finally, a conceptualization of an empirical population and public health ethics is advanced in order to open up new interdisciplinary 'spaces', in which empirical and normative approaches to ethical inquiry are transparently (and ethically) integrated.
Collapse
Affiliation(s)
- Rod Knight
- Simon Fraser University, Canada; The University of British Columbia, Canada
| |
Collapse
|
15
|
What does empirical research contribute to medical ethics? A methodological discussion using exemplary studies. Camb Q Healthc Ethics 2012; 21:425-35. [PMID: 22828037 DOI: 10.1017/s0963180112000205] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
16
|
|
17
|
Hauke D, Reiter-Theil S, Hoster E, Hiddemann W, Winkler E. The role of relatives in decisions concerning life-prolonging treatment in patients with end-stage malignant disorders: informants, advocates or surrogate decision-makers? Ann Oncol 2011; 22:2667-2674. [DOI: 10.1093/annonc/mdr019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
18
|
Dreyer A, Førde R, Nortvedt P. Ethical decision-making in nursing homes: Influence of organizational factors. Nurs Ethics 2011; 18:514-25. [DOI: 10.1177/0969733011403553] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article we report findings from a qualitative study that explored how doctors and nurses in nursing homes describe professional collaboration around dying patients. The study also examined the consequences this can have for the life-prolonging treatment of patients and the care of them and their relatives. Nine doctors and 10 nurses from 10 Norwegian nursing homes were interviewed about their experience of decision-making processes on life-prolonging treatment and care. The findings reveal that the frameworks for the professional collaboration and organization of physicians and nurses prevent patient treatment and care complying with ethical considerations and the law. These conditions have a challenging impact on the care of dying patients and their relatives.
Collapse
|
19
|
|
20
|
Wong S. Tales from the frontline: the experiences of early childhood practitioners working with an 'embedded' research team. EVALUATION AND PROGRAM PLANNING 2009; 32:99-108. [PMID: 19036451 DOI: 10.1016/j.evalprogplan.2008.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 09/29/2008] [Accepted: 10/11/2008] [Indexed: 05/27/2023]
Abstract
In late 2006, SDN Children's Services, an Australian not-for-profit provider of services for children, families and communities, engaged a research team that was 'embedded' within the organisation for 1 year. This action represented a significant investment of resources, such as staff time and organisational funds, and demonstrates SDN's strong commitment to research and evaluation as a means of supporting organisational learning and development. This paper highlights the innovative nature of the approach by positioning the role of the embedded researcher within the current theoretical and socio-political context. It also provides evidence of the success of the approach by reporting on the findings of a study that investigated staff's experiences of being involved in this type of collaborative investigation of their work. I argue that the employment of an embedded researcher can have positive benefits both for the organisation and the practitioners--but who the researchers are really matters.
Collapse
Affiliation(s)
- Sandie Wong
- SDN Children's Services, Inc, Broadway, NSW, Australia
| |
Collapse
|
21
|
Winkler EC, Reiter-Theil S, Lange-Rieß D, Schmahl-Menges N, Hiddemann W. Patient Involvement in Decisions to Limit Treatment: The Crucial Role of Agreement Between Physician and Patient. J Clin Oncol 2009; 27:2225-30. [PMID: 19307508 DOI: 10.1200/jco.2008.17.9515] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The aim of this study was to describe, first, the decision-making process concerning the limitation of life-prolonging treatment (DLT); second, the extent to which patients are actually involved in these decisions; and third, to detect medical and ethical factors that affect patient involvement. Patients and Methods This prospective qualitative study enrolled 76 patients with incurable cancer with whom the limitation of life-prolonging treatment was discussed. Embedded researchers on the wards recorded the patient's history, medical condition, type of treatment limitation discussed, patient wishes, decision-making capacity, and patient involvement using an in-depth documentation procedure. Results While the majority of patients were informed about their diagnosis, therapy, and course of disease (99%, 97%, 90%, respectively), only 47% were involved in DLT. Two thirds of the patients preferred palliative care, and one third wished to extend their lifetime. If patients preferred palliative care, they were more often in line with physicians' treatment goals than patients who were striving for longer survival (91.4% v 46.7%; P = .001). They also were involved significantly more often in DLT. Multivariate analysis showed that age, Karnofsky performance index or decision-making capacity had no impact on patient involvement. Conclusion Only half of the patients were involved in DLT. Surprisingly, the main predictor of patient involvement was not their medical condition, but agreement with physicians' palliative treatment goals. These results show that if physicians switch to comfort care in terminally ill patients and patients are not yet prepared to follow this line, treatment limitations are often decided without involving the patient.
Collapse
Affiliation(s)
- Eva C. Winkler
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
| | - Stella Reiter-Theil
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
| | - Dorothee Lange-Rieß
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
| | - Nina Schmahl-Menges
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
| | - Wolfgang Hiddemann
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
| |
Collapse
|
22
|
Halvorsen K, Førde R, Nortvedt P. Value choices and considerations when limiting intensive care treatment: a qualitative study. Acta Anaesthesiol Scand 2009; 53:10-7. [PMID: 19032565 DOI: 10.1111/j.1399-6576.2008.01793.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To shed light on the values and considerations that affect the decision-making processes and the decisions to limit intensive care treatment. METHOD Qualitative methodology with participant observation and in-depth interviews, with an emphasis on eliciting the underlying rationale of the clinicians' actions and choices when limiting treatment. RESULTS Informants perceived over-treatment in intensive care medicine as a dilemma. One explanation was that the decision-making base was somewhat uncertain, complex and difficult. The informants claimed that those responsible for taking decisions from the admitting ward prolonged futile treatment because they may bear guilt or responsibility for something that had gone wrong during the course of treatment. The assessments of the patient's situation made by physicians from the admitting ward were often more organ-oriented and the expectations were less realistic than those of clinicians in the intensive care unit who frequently had a more balanced and overall perspective. Aspects such as the personality and the speciality of those involved, the culture of the unit and the degree of interdisciplinary cooperation were important issues in the decision-making processes. CONCLUSION Under-communicated considerations jeopardise the principle of equal treatment. If intensive care patients are to be ensured equal treatment, strategies for interdisciplinary, transparent and appropriate decision-making processes must be developed in which open and hidden values are rendered visible, power structures disclosed, employees respected and the various perspectives of the treatment given their legitimate place.
Collapse
Affiliation(s)
- K Halvorsen
- Faculty of Nursing Education, Akershus University College, Lillestrøm, Norway.
| | | | | |
Collapse
|
23
|
Reiter-Theil S, Mertz M, Meyer-Zehnder B. The complex roles of relatives in end-of-life decision-making: an ethical analysis. HEC Forum 2008; 19:341-64. [PMID: 18075771 DOI: 10.1007/s10730-007-9054-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stella Reiter-Theil
- Institute for Applied Ethics and Medical Ethics, University of Basel, Missionsstr. 21, CH-4055, Basel, Switzerland.
| | | | | |
Collapse
|
24
|
Reiter-Theil S, Agich GJ. Research on clinical ethics and consultation. Introduction to the theme. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2008; 11:3-5. [PMID: 17943459 DOI: 10.1007/s11019-007-9095-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 08/29/2007] [Indexed: 05/25/2023]
Abstract
Clinical ethics consultation has developed from local pioneer projects into a field of growing interest among both clinicians and ethicists. What is needed are more systematic studies on the ethical challenges faced in clinical practice and problem solving through ethics consultation from interdisciplinary perspectives. The Thematic Issue covers a range of topics and includes five recent studies from various European countries and the USA, focusing on issues such as the ethical difficulties of end of life decisions, experiences with newly developed or well established ethics consultation services, and the expectations of physicians in various clinical fields who are still unfamiliar with clinical ethics consultation. The papers included illustrate the interface between different socio-cultural contexts and their ways of dealing with clinical ethics consultation. They deepen the dialogue on clinical ethics consultation that has emerged at the European and International level.
Collapse
Affiliation(s)
- Stella Reiter-Theil
- Institute for Applied Ethics and Medical Ethics (IAEME), Medical Faculty, University of Basel, Switzerland.
| | | |
Collapse
|
25
|
Meyer-Zehnder B, Pargger H, Reiter-Theil S. Folgt der Ablauf von Therapiebegrenzungen auf einer Intensivstation einem Muster? ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s00390-007-0813-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Reiter-Theil S, Albisser Schleger H. Alter Patient – (k)ein Grund zur Sorge? Notf Rett Med 2007. [DOI: 10.1007/s10049-007-0895-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
27
|
Lehoux P, Williams-Jones B. Mapping the integration of social and ethical issues in health technology assessment. Int J Technol Assess Health Care 2007; 23:9-16. [PMID: 17234011 DOI: 10.1017/s0266462307051513] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background:Since its inception, the field of health technology assessment (HTA) has stressed the need for consideration of ethical and social issues. However, few concepts or analytic tools have been developed, and because of the complexity of the endeavor and a lack of integration of work already produced, such concepts remain difficult to apply in HTA.Objectives:Through a descriptive “map” of concepts, tools, and processes, we summarize the most tangible efforts on the part of HTA producers to address social and ethical issues.Methods:A literature review and content analysis of HTA reports in the Centre for Reviews and Dissemination database enables a synthesis of the reflections on, initiatives around, and gaps in knowledge related to the integration of social and ethical issues in HTA.Results:We examine: (i) the aim of integrating ethical and social issues in HTA, (ii) the theoretical approaches used, (iii) the methods and processes applied, and (iv) the implications for HTA producers. We highlight two levels at which social and ethical issues can be considered: throughout the production process of HTA reports and as part of the organizational structure of HTA agencies.Conclusions:Given the profound societal changes that occur in relation to healthcare technology development, HTA producers have a responsibility to inform and enlighten technology-related public and policy debates. Fulfilling this role, though, requires that socioethical dimensions of technologyandHTA are made explicit.
Collapse
Affiliation(s)
- Pascale Lehoux
- Department of Social and Preventive Medicine, University of Montreal, Branch Centre-ville, Montreal, Quebec, Canada.
| | | |
Collapse
|
28
|
Hentschel R, Lindner K, Krueger M, Reiter-Theil S. Restriction of ongoing intensive care in neonates: a prospective study. Pediatrics 2006; 118:563-9. [PMID: 16882808 DOI: 10.1542/peds.2005-1615] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this work was to record the current practice of restricting ongoing intensive care in severely ill newborns. METHODS This was a prospective observational study over a 30-month period of consecutive newborns for whom restriction of ongoing intensive care was taken into consideration, discussed, or decided on. A standardized form recorded patients' medical condition, the type of restriction decided on, parents' wishes, and their information level. The research was conducted in a neonatal unit of a level III university children's hospital, with no interventions. RESULTS Forty patients were enrolled, 25 were preterm, 21 had either a genetic defect or an inborn malformation. Restriction of ongoing intensive care was decided on for 32 patients with a great variety of specified recommendations. Thirty-six patients died during the observation period. In general, parents were well informed; however, their wishes concerning restriction of ongoing intensive care were unknown in approximately 25% of cases. CONCLUSIONS The decision-making process for restriction of ongoing intensive care is well established, but the role of parents needs to be defined.
Collapse
MESH Headings
- Cerebral Hemorrhage/epidemiology
- Cerebral Hemorrhage/therapy
- Congenital Abnormalities/epidemiology
- Congenital Abnormalities/therapy
- Decision Making
- Ethics Committees, Clinical
- Genetic Diseases, Inborn/epidemiology
- Genetic Diseases, Inborn/therapy
- Germany/epidemiology
- Gestational Age
- Hospital Mortality
- Hospitals, University/statistics & numerical data
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/therapy
- Intensive Care, Neonatal/ethics
- Intensive Care, Neonatal/statistics & numerical data
- Medical Futility
- Parents/psychology
- Patient Discharge
- Physicians/psychology
- Prognosis
- Prospective Studies
- Quality of Life
- Refusal to Treat/ethics
- Refusal to Treat/statistics & numerical data
Collapse
Affiliation(s)
- Roland Hentschel
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, University of Freiburg, Mathildenstrasse 1, 79106 Freiburg, Germany.
| | | | | | | |
Collapse
|
29
|
van Zuuren FJ, van Manen E. Moral dilemmas in neonatology as experienced by health care practitioners: a qualitative approach. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2006; 9:339-47. [PMID: 17082871 DOI: 10.1007/s11019-005-5641-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
During the last two decades there has been an enormous development in treatment possibilities in the field of neonatology, particularly for (extremely) premature infants. Although there are cross-cultural differences in treatment strategy, an overview of the literature suggests that every country is confronted with moral dilemmas in this area. These concern decisions to initiate or withhold treatment directly at birth and, later on, decisions to withdraw treatment with the possible consequence that the child will die. Given that the neonate cannot express his or her own will, who will decide? And on the basis of what information, values and norms? We explored some of these issues in daily practice by interviewing a small sample of health care practitioners in a Dutch university Neonatal Intensive Care Unit (NICU). It turned out that experiencing moral dilemmas is part of their daily functioning. Nurses underline the suffering of the newborn, whereas physicians stress uncertainty in treatment outcome. To make the best of it, nurses focus on their caring task, whereas physicians hope that future follow-up research will lead to more predictable outcomes. As for their own offspring, part of these professionals would hesitate to bring their own extremely premature newborn to a NICU. For the most oppressing dilemma reported - terminating an already initiated treatment - we propose the concept of 'evidence shift' to clarify the ambiguous position of uncertainty in decision making.
Collapse
Affiliation(s)
- Florence J van Zuuren
- Department of Clinical Psychology, Universiteit van Amsterdam, Roetersstraat 15, 1018 WB, Amsterdam, The Netherlands.
| | | |
Collapse
|