1
|
Klassen T. Ethical patient engagement in healthcare governance. Healthc Manage Forum 2024:8404704241251898. [PMID: 38702875 DOI: 10.1177/08404704241251898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Health leaders are faced with a lack of public trust in healthcare governance. This waning trust relationship was further solidified through the pandemic. Improving the relationship between health organizations and the community/citizens/patient partners is a moral imperative of which ethical governance is a significant factor. This article will structure the ethical analysis of patient partners in governance through reviewing who we are, how we function, and what we do on governance boards. Taking an ethical approach will enable the promise of the value and impact of the patient partner to be actualized. Ethical governance that recognizes the significant contributions and value of engaged patient partners can be achieved and may be one of the significant levers required to transform healthcare.
Collapse
Affiliation(s)
- Treena Klassen
- Palliser Primary Care Network, Medicine Hat, Alberta, Canada
| |
Collapse
|
2
|
Turner K, Lahey T, Gremmels B, Lesandrini J, Nelson WA. Organizational Ethics in Healthcare: A National Survey. HEC Forum 2024:10.1007/s10730-023-09520-3. [PMID: 38231425 DOI: 10.1007/s10730-023-09520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Organizational ethics-defined as the alignment of an institution's practices with its mission, vision, and values-is a growing field in health care not well characterized in empirical literature. To capture the scope and context of organizational ethics work in United States healthcare institutions, we conducted a nationwide convenience survey of ethicists regarding the scope of organizational ethics work, common challenges faced, and the organizational context in which this work is done. In this article, we report substantial variability in the structure of organizational ethics programs and the settings in which it is conducted. Notable findings included disagreement about the activities that comprise organizational ethics and a lack of common metrics used to assess organizational ethics activities. A frequently cited barrier to full engagement in these activities was poor institution-wide understanding about the role and function of organizational ethics resources. These data suggest a tension in the trajectory of organizational ethics' professionalization: while some variability is appropriate to the field's relative youth, inadequate attention to definitions of organizational ethics practice and metrics for success can impede discussions about appropriate institutional support, leadership context, and training for practitioners.
Collapse
Affiliation(s)
- Kelly Turner
- Gnaegi Center for Health Care Ethics, Saint Louis University, Saint Louis, MO, USA.
| | - Tim Lahey
- University of Vermont Medical Center, Burlington, VT, USA
| | | | | | - William A Nelson
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| |
Collapse
|
3
|
Mohindra R. 'Value, values and valued': a tripod for organisational ethics. J Med Ethics 2022; 48:154-159. [PMID: 33741679 DOI: 10.1136/medethics-2020-106837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
Public benefit corporations are National Health Service, that is, state, entities whose function to provide healthcare in discharge of public duties. If we regard value as the output of such organisations, it seems logical to connect the values of the organisation to the value produced by such organisations. But, on closer examination there are competing underlying logics in play: (1) those based on promoting organisational efficiency and efficacy; and (2) those based on the idea of building service provision around the clinician-patient relationship. Underlying these logics are differing value sets. These clash. Because of the clashing of underlying moral frameworks the connection between values and value becomes hard, if not impossible. This paper argues that (1) the clash in these moral frameworks must be addressed by the organisation rather than between individuals or groups of individuals within the organisation; (2) alloying duties within hybrid professionals submerges but does not resolve these conflicts; (3) one approach could be to impose on the organisation itself an ethical imperative to promote, enhance and protect from deterioration the welfare of the patients; (4) a board ethics committee is a possible organisational structure that could transparently and fairly balance clashes within the competing moral frameworks in a way that could reconcile the competing logics and (5) if such conflicts can be better resolved at the organisational level what the organisation must do to achieve its objectives will become clearer because what needs to be valued would naturally emerge connecting values, value and what is valued.
Collapse
|
4
|
Ngiam LXL, Ong YT, Ng JX, Kuek JTY, Chia JL, Chan NPX, Ho CY, Abdurrahman ABHM, Kamal NHA, Cheong CWS, Ng CH, Tan XH, Tan LHE, Chin AMC, Mason S, Jumat MR, Chiam M, Krishna LKR. Impact of Caring for Terminally Ill Children on Physicians: A Systematic Scoping Review. Am J Hosp Palliat Care 2020; 38:396-418. [PMID: 32815393 DOI: 10.1177/1049909120950301] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Caring for terminally ill children influences nurses' and allied health provider's quality of life, ability to provide personalized, dignified and empathetic care and even their concepts of personhood. In the absence of data this review utilizes the Ring Theory of Personhood (RToP) to evaluate how a physician's concept of personhood is affected caring for terminally ill children in order to better support them holistically. METHODS Using PRISMA Guidelines, 14 researchers carried out independent searches of PubMed, CINAHL, PsycINFO, Cochrane Library and gray literature databases for articles published between 2000 to 2019. Concurrent and independent employment of content and thematic analysis (Split Approach) was used to enhance the trustworthiness of the analysis. RESULTS 13,424 titles and abstracts were retrieved, 188 full texts were evaluated, and 39 articles were included and analyzed. Identical categories and themes identified using the Split Approach suggest that caring for dying children in PPC impacts the physician's professional identity, clinical decision making, personal well-being and relationships. The data also suggests that the magnitude of these effects depends on the presence of protective and risk factors. CONCLUSION Aside from providing a novel insight into the upon the physician, this review proffers a unique approach to accounting for the presence, magnitude and influence of incoming catalysts, resultant conflicts, and protective and risk factors upon the physician's personhood. Further studies into the changes in personhood are required. Design of a personalized assessment tool based on the RToP will help direct timely, appropriate and personalized support to these physicians.
Collapse
Affiliation(s)
- Lisa Xin Ling Ngiam
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jun Xuan Ng
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Joshua Tze Yin Kuek
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jeng Long Chia
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Natalie Pei Xin Chan
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Chong Yao Ho
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Nur Haidah Ahmad Kamal
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Clarissa Wei Shuen Cheong
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Cheng Han Ng
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Xiu Hui Tan
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Lorraine Hui En Tan
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, United Kingdom
| | | | - Min Chiam
- Division of Cancer Education, 68751National Cancer Centre Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore.,Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, United Kingdom.,Duke-NUS Medical School, 63751National University of Singapore, Singapore.,Division of Cancer Education, 68751National Cancer Centre Singapore, Singapore.,Centre of Biomedical Ethics, 37580National University of Singapore, Singapore.,PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore
| |
Collapse
|
5
|
Abstract
Resumo O artigo tem como objetivo reforçar a importância da ética organizacional para as organizações de saúde. Como primeiro passo, distingue-se a ética organizacional de outras áreas da ética aplicada as quais são mobilizadas por questões éticas relacionadas à saúde. Em seguida, são apresentados os objetos de estudo e de intervenção que a caracterizam. Finalmente, o artigo enfoca alguns elementos centrais de uma abordagem ética organizacional particularmente rica e relevante.
Collapse
|
6
|
Abstract
Multidrug resistant organisms (MDROs) are a public health threat that have reduced the effectiveness of many available antibiotics. Antimicrobial stewardship programs (ASPs) have been tasked with reducing antibiotic use and therefore the emergence of MDROs. While fecal microbiota transplant (FMT) has been proposed as therapy to reduce patient colonization of MDROs, this will require additional evidence to support an expansion of the current clinical indication for FMT. This article discusses the evidence and ethics of the expanded utilization of FMT by ASPs for reasons other than severe recurrent or refractory Clostridioides (formerly Clostridium) difficile infection.
Collapse
Affiliation(s)
- Thomas S Murray
- Thomas S. Murray, M.D., Ph.D., is affiliated with Yale School of Medicine, Department of Pediatrics Section Infectious Diseases, New Haven CT. Jennifer Herbst, J.D., M.Bioethics, LL.M., is affiliated with Quinnipiac University School of Law and Frank H. Netter, MD, School of Medicine, North Haven CT
| | - Jennifer Herbst
- Thomas S. Murray, M.D., Ph.D., is affiliated with Yale School of Medicine, Department of Pediatrics Section Infectious Diseases, New Haven CT. Jennifer Herbst, J.D., M.Bioethics, LL.M., is affiliated with Quinnipiac University School of Law and Frank H. Netter, MD, School of Medicine, North Haven CT
| |
Collapse
|
7
|
Salloch S, Apitzsch B, Wilkesmann M, Ruiner C. Locum physicians' professional ethos: a qualitative interview study from Germany. BMC Health Serv Res 2018; 18:333. [PMID: 29739411 PMCID: PMC5941762 DOI: 10.1186/s12913-018-3118-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/12/2018] [Indexed: 12/03/2022] Open
Abstract
Background In contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. Locums are a special type of self-employed professionals who are only temporally embedded in organisational contexts of hospitals, and this might have consequences for their professional practice. Therefore, questions arise regarding how locums perceive their ethical duties as medical professionals. Methods In this first qualitative study on German locum physicians, the locums’ own perspective is complemented by the viewpoint of permanently employed physician colleagues. Eighteen semi-structured interviews were conducted in 2014 to explore the professional practice of locum physicians from both groups’ perspectives with respect to doctor-patient-relationship, cooperation with colleagues and physicians’ role in society. The data were analysed using qualitative content analysis, including a deductive application and an inductive development of codes. The results were related to key tenets of medical professionalism with respect to the question: how far do locums fulfil their ethical duties towards patients, colleagues and the society? Results The study indicates that although ethical requirements are met broadly, difficulties remain with respect to close doctor–patient contact and the sustainability of hiring locums as a remedy in times of staff shortage. Conclusions Further qualitative and quantitative research on locum physicians’ professional practice, including patient perspectives and economic health care system analyses, is needed to better understand the ethical impact of hiring independent contractors in the hospital sector. Electronic supplementary material The online version of this article (10.1186/s12913-018-3118-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sabine Salloch
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany.
| | - Birgit Apitzsch
- Sociological Research Institute (SOFI) Göttingen, 37085, Göttingen, Germany
| | - Maximiliane Wilkesmann
- Faculty of Business, Economics, and Social Sciences, TU Dortmund University, 44221, Dortmund, Germany
| | - Caroline Ruiner
- Institute of Work Science, Ruhr University Bochum, 44801, Bochum, Germany
| |
Collapse
|
8
|
Kaposy C, Maddalena V, Brunger F, Pullman D, Singleton R. The interactions of Canadian ethics consultants with health care managers and governing boards during times of crisis. AJOB Empir Bioeth 2017; 8:128-136. [PMID: 28949838 DOI: 10.1080/23294515.2016.1260664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health care organizations can be very complex, and are often the setting for crisis situations. In recent years, Canadian health care organizations have faced large-scale systemic medical errors, a nation-wide generic injectable drug shortage, iatrogenic infectious disease outbreaks, and myriad other crises. These situations often have an ethical component that ethics consultants may be able to address. Organizational leaders such as health care managers and governing boards have responsibilities to oversee and direct the response to crisis situations. This study investigates the nature and degree of involvement of Canadian ethics consultants in such situations. METHODS This qualitative study used semi-structured interviews with Canadian ethics consultants to investigate the nature of their interactions with upper-level managers and governing board members in health care organizations, particularly in times of organizational crisis. We used a purposive sampling technique to identify and recruit ethics consultants throughout Canada. RESULTS We found variability in the interactions between ethics consultants and upper-level managers and governing boards. Some ethics consultants we interviewed did not participate in managing organizational crisis situations. Most ethics consultants reported that they had assisted in the management of some crises and that their participation was usually initiated by managers. Some ethics consultants reported the ability to bring issues to the attention of upper-level managers and indirectly to their governing boards. The interactions between managers and ethics consultants were characterized by varying degrees of collegiality. Ethics consultants reported participating in or chairing working groups, participating in incident management teams, and developing decision-making frameworks. CONCLUSIONS Canadian ethics consultants tend to believe that they have valuable skills to offer in the management of organizational crisis situations. Most of the ethics consultants we interviewed believed that they play an important role in this regard.
Collapse
Affiliation(s)
- Chris Kaposy
- a Division of Community Health and Humanities , Memorial University
| | - Victor Maddalena
- a Division of Community Health and Humanities , Memorial University
| | - Fern Brunger
- a Division of Community Health and Humanities , Memorial University
| | - Daryl Pullman
- a Division of Community Health and Humanities , Memorial University
| | | |
Collapse
|
9
|
Abstract
This article describes a qualitative study of models of ethics consultation used by ethics consultants in Canada. We found four different models used by Canadian ethics consultants whom we interviewed, and one sub-variant. We describe (1) the lone ethics consultant model, (1a) the hub-and-spokes sub-variant of this model; (2) the ethics committee model; (3) the capacity-building model; and (4) the facilitated model. Previous empirical studies of ethics consultation describe only two or three of these models.
Collapse
Affiliation(s)
- Chris Kaposy
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
| | - Fern Brunger
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Victor Maddalena
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | | |
Collapse
|
10
|
Sabin JE. How Can Clinical Ethics Committees Take on Organizational Ethics? Some Practical Suggestions. The Journal of Clinical Ethics 2016. [DOI: 10.1086/jce2016272111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
11
|
Svantesson M, Karlsson J, Boitte P, Schildman J, Dauwerse L, Widdershoven G, Pedersen R, Huisman M, Molewijk B. Outcomes of moral case deliberation--the development of an evaluation instrument for clinical ethics support (the Euro-MCD). BMC Med Ethics 2014; 15:30. [PMID: 24712735 PMCID: PMC4234013 DOI: 10.1186/1472-6939-15-30] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 03/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers' experiences and perceived importance of outcomes of Moral Case Deliberation. METHODS A multi-item instrument for assessing outcomes of Moral Case Deliberation (MCD) was constructed through an iterative process, founded on a literature review and modified through a multistep review by ethicists and health care providers. The instrument measures perceived importance of outcomes before and after MCD, as well as experienced outcomes during MCD and in daily work. A purposeful sample of 86 European participants contributed to a Delphi panel and content validity testing. The Delphi panel (n = 13), consisting of ethicists and ethics researchers, participated in three Delphi-rounds. Health care providers (n = 73) participated in the content validity testing through 'think-aloud' interviews and a method using Content Validity Index. RESULTS The development process resulted in the European Moral Case Deliberation Outcomes Instrument (Euro-MCD), which consists of two sections, one to be completed before a participant's first MCD and the other after completing multiple MCDs. The instrument contains a few open-ended questions and 26 specific items with a corresponding rating/response scale representing various MCD outcomes. The items were categorised into the following six domains: Enhanced emotional support, Enhanced collaboration, Improved moral reflexivity, Improved moral attitude, Improvement on organizational level and Concrete results. CONCLUSIONS A tentative instrument has been developed that seems to cover main outcomes of Moral Case Deliberation. The next step will be to test the Euro-MCD in a field study.
Collapse
Affiliation(s)
- Mia Svantesson
- Centre for Health Care Sciences, Örebro University hospital and School of Health and Medical Sciences, Örebro university, Örebro, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Moral distress has been widely reviewed across many care contexts and among a range of disciplines. Interest in this area has produced a plethora of studies, commentary and critique. An overview of the literature around moral distress reveals a commonality about factors contributing to moral distress, the attendant outcomes of this distress and a core set of interventions recommended to address these. Interventions at both personal and organizational levels have been proposed. The relevance of this overview resides in the implications moral distress has on the nurse and the nursing workforce: particularly in regard to quality of care, diminished workplace satisfaction and physical health of staff and increased problems with staff retention.
Collapse
|
13
|
|
14
|
Abstract
The aim of the study was to report the results of a systematically conducted literature review of empirical studies about healthcare organizations’ ethics and management or leadership issues. Electronic databases MEDLINE and CINAHL yielded 909 citations. After a two stage application of the inclusion and exclusion criteria 56 full-text articles were included in the review. No large research programs were identified. Most of the studies were in acute hospital settings from the 1990s onwards. The studies focused on ethical challenges, dilemmas in practice, employee moral distress and ethical climates or environments. Study samples typically consisted of healthcare practitioners, operational, executive and strategic managers. Data collection was mainly by questionnaires or interviews and most of the studies were descriptive, correlational and cross-sectional. There is need to develop conceptual clarity and a theoretical framework around the subject of organizational ethics and the breadth of the contexts and scope of the research needs to be increased.
Collapse
|
15
|
Brazil K, Kassalainen S, Ploeg J, Marshall D. Moral distress experienced by health care professionals who provide home-based palliative care. Soc Sci Med 2010; 71:1687-91. [PMID: 20832923 DOI: 10.1016/j.socscimed.2010.07.032] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 07/19/2010] [Accepted: 07/26/2010] [Indexed: 11/21/2022]
Abstract
Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice.
Collapse
|
16
|
Mukherjee D, Brashler R, Savage TA, Kirschner KL. Moral Distress in Rehabilitation Professionals: Results From a Hospital Ethics Survey. PM R 2009; 1:450-8. [DOI: 10.1016/j.pmrj.2009.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/23/2009] [Accepted: 03/08/2009] [Indexed: 11/20/2022]
|
17
|
Foglia MB, Pearlman RA, Bottrell M, Altemose JK, Fox E. Ethical challenges within Veterans Administration healthcare facilities: perspectives of managers, clinicians, patients, and ethics committee chairpersons. Am J Bioeth 2009; 9:28-36. [PMID: 19326309 DOI: 10.1080/15265160802716795] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions.
Collapse
Affiliation(s)
- Mary Beth Foglia
- National Center for Ethics in Health Care, Veterans Health Administration, Seattle, WA 98108, USA.
| | | | | | | | | |
Collapse
|
18
|
McGrath P, Henderson D. “Oh, that’s a really hard question”: Australian Findings on Ethical Reflection in an Accident and Emergency Ward. HEC Forum 2009; 20:357-73. [DOI: 10.1007/s10730-008-9083-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|