Tag: health care delivery

Bioethics Blogs

In the Journals – June 2017, part two by Aaron Seaman

The first part of the In the Journals post for June 2017 can be found here. And now, for part two…

 

Medical Humanities

SPECIAL ISSUE: Communicating Mental Health

Introduction: historical contexts to communicating mental health

Rebecca Wynter and Leonard Smith

Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage. Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue. Our introduction provides some framework for the history of communicating mental health over the past 300 years. We will show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, we argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology. However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness. While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Dear Mr. President: It’s Time for Your Bioethics Commission

by Craig Klugman, Ph.D.

Last week, seven Democratic members of the U.S. House Representatives sent a letter to the White House asking President Trump to appoint a director to the Office of Science and Technology Policy (OSTP), position that normally serves as the presidential science advisor. The impetus for writing the letter was a communication from the Deputy National Science Advisor that two hoax reports, that tried to undermine climate change, were circulating through the West Wing as “science.” The Congresspersons state “Where scientific policy is concerned, the White House should make use of the latest, most broadly-supported science…Relying on factual technical and scientific data has helped make America the greatest nation in the world.” Among the signers are a PhD in math and a PhD in physics. They hold that the U.S. faces strong questions that revolve around science, both opportunities and threats, and the need for a scientist who can understand and explain the importance of objective fact to the chief executive is essential.

This article led me to think that the U.S. also faces a lot of issues regarding health and medicine and their impact on society. Consider the task of creating a new health plan, CRISPR/CAS-9, in vitro gametogenesis, the threat of Zika, extra uterine gestational systems, legalized marijuana, digital medicine—pharmaceutical computing for treating disease, head transplants, and DYI science are among the bioethical issues that will effect policy in the coming few years. Thus, it is time for President Trump to call for his Presidential Bioethics Commission.

The last bioethics advisory body ended in January 2017, although many of the staff are still winding down the office and archiving the many reports and papers produced.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Special Issues! The Publics of Public Health in Africa | Anthropological Interrogations of Evidence-Based Global Health by Anna Zogas

I’d like to highlight a pair of Special Sections in the early 2017 issues of Critical Public Health. The first is “The Publics of Public Health in Africa,” guest edited by Ann H. Kelly, Hayley MacGregor, and Catherine M. Montgomery. The second is “Anthropological Interrogations of Evidence-Based Global Health,” guest edited by Elsa L. Fan and Elanah Uretsky. Here are the abstracts for the articles in both sections!

 

The Publics of Public Health in Africa 

The publics of public health in Africa (open access)
Ann H. Kelly, Hayley MacGregor & Catherine M. Montgomery

Excerpt: How do we understand the public character of public health in contemporary Africa? What are the parameters of community engagement in health care delivery, medical research and disease control programmes? To what extent is public health in Africa a project led by African Governments? Through what political processes and deliberative practices can African publics influence the priorities of research in health sciences and interventions which aim in broad terms to improve the health of such publics? Drawing insight from empirical research conducted with African scientists, nurses, community members, clinical trialists and policy-makers, this special section examines the multiple ways in which the publiccomes into being around public health provisioning and investigation in sub-Saharan Africa, its role and political reach. Collectively, these papers show how contestation and negotiation around different ideas about who the public is and what being public means can lead to the emergence of conflicting understandings, with implications for who and what is seen to represent the public interest, and for the acceptance of research and other interventions.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Ethics Liaison Program: Building a Moral Community

Guest Post: Sarah Bates
Article: The Ethics Liaison Program: Building a Moral Community

As challenges to health care delivery increase over time, it is becoming more and more important for hospitals to maintain a strong institution-wide moral culture. But the common model of employing one or a few “ethicists” can lead to the misconception that ethics is the responsibility of those individuals alone, rather than that of all staff throughout the hospital. Meanwhile, staff members who lack dedicated time for ethics-related work, but who are interested in contributing to that work to the extent that their schedules permit, lack a means by which to do so.

The Ethics Liaison Program at Beth Israel Deaconess Medical Center (BIDMC) helps to address those problems at our institution. The 75-plus Liaisons represent clinical and nonclinical areas throughout BIDMC. They spread awareness of Ethics Programs throughout the medical center, communicate between the three ethicists and colleagues in their own work areas, and take on ethics-related projects connected to their work. By “Ethics Programs,” we mean the three-person Ethics Support Service (who conduct ethics consults) and the Ethics Advisory Committee that oversees them, as well as the Liaison Program itself.

The Liaison Program is a win-win for both the Liaisons and BIDMC Ethics Programs. Liaisons join a supportive community that meets monthly to discuss the ethics consults conducted that month, as well as a related journal article. In addition to those monthly meetings, Liaisons can take advantage of educational opportunities, at BIDMC and beyond: monthly Ethics Case Conferences open to all BIDMC staff; ethics-related events and presentations at affiliated institutions; and an annual three-day bioethics course through the Harvard Medical School Center for Bioethics.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Musings on the Materiality of Health Care by Cristina A. Pop

Nightstand in a psychiatry hospital from Alba-Iulia, Romania. The picture was taken by Odeta Catana in November 2014, as part of a project initiated by the Center for Legal Resources. Reproduced with permission.

In October of 2014, Romanian mass-media featured the local story of a few dozen citizens—most of them Orthodox nuns—refusing their newly issued state health insurance cards, on the grounds that the term card imprinted on the card would spell, when read backwards, drac—the Romanian word for “devil.” It seemed that the nuns, along with a few Orthodox priests and monks and other laymen, rejected the cards because they saw in them instruments of population control imbued with malefic powers. In their view, anyone who would accept the biometric chip-enabled health insurance card would bear the “mark of the beast,” as prophesied in the Christian Book of Revelation. “The beast” would be the computerized data system of global surveillance, whose ultimate aim is to strip humans of their God-bestowed freedom.

Upon reading this news, I was not necessarily astonished by the fact that a narrow demographic group would express such apocalyptically articulated anxieties when facing the biopolitical regimes of health care provision. In Romania, as elsewhere, fundamentalist Orthodox websites disavow various biomedical procedures—like vaccination—on similar grounds, by equating them with receiving “the mark” and by evoking the millennialist opening of the seals that precede the coming of the Antichrist. What did surprise me was the backwards reading of the word card as drac. Why would someone read anything backwards? And how does one get the idea of reading in reverse in the first place?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – April 2016 Part I by Michelle Pentecost

Welcome to the first stack of ‘In the Journals’ for April! It’s a bumper crop, so find a cosy corner and some coffee to comb through it all. Happy reading!

Medicine Anthropology Theory

Is the 21st century the age of biomedicalization?

Eileen Moyer and Vinh-Kim Nguyen

(Excerpt from editorial )

The diverse contributions that make up this issue of MAT, we gingerly suggest, could initiate a provocative conversation in response to the following question: what if biomedicine, or to be more precise ‘biomedicalization’(Clarke 2003), is to the twenty-first century as industrialization was to the nineteenth? …. The question of whether biomedicalization will be the twenty-first-century equivalent to industrialization sprang to mind in reading Catherine Waldby and Melinda Cooper’s important book, Clinical Labor, reviewed in this issue by Neil Singh (and is also raised by another important volume, Lively Capital, edited by Kaushik Sunder Rajan). Singh underlines the central argument of the book: surrogacy, participation in clinical trials, donation of body parts, and other practices enabled by a global regime of biomedicine can be theorized together as forms of clinical labour that are derived from the body’s inherent potential for regeneration. There is, in this, a parallel to the assemblage of machines in factories, which enabled the emergence of a working class united by their engagement in industrial labour. Industrialization signed the transformation of the relationship between consciousness, embodiment, and human engagement with the material world, increasingly subsumed into raw material for transformation through industrialized labour into the commodity form.

 

Biomedical packages: Adjusting drugs, bodies, and environment in a phase III clinical trial

Charlotte Brives

Clinical trials are a fundamental stage in a drug’s biography for they provide the standard by which a molecule’s therapeutic status is determined.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Singapore Case Notes: In the Community, Who is Ethics Education For?

For previous posts on the Singapore Casebook project, a collaboration among the Centre for Biomedical Ethics at the National University of Singapore, The Hastings Center, and the Ethox Centre at the University of Oxford, see here and here .The first edition of this public, web-based casebook, “Making Difficult Decisions with Patients and Families,” was published in 2014. The second edition, “Care Transitions in Aging Societies,” will be published in 2017.

In February, our team held six workshops with Singaporean health care professionals to discuss the cases we’d developed, based on discussions during earlier visits, to illustrate common ethical challenges in the care of aging, often frail or chronically ill people in Singapore. Piloting workshops is always exciting, because we get to see what real people make of our fictional characters and situations. Do they seem “realistic” as well as “typical”?

One case is structured as a dialogue between an elderly woman determined to live independently despite deteriorating health and a case worker who is trying to figure out whether he should support his client’s choices or try to change her behavior. This case prompted participants in several workshops to ask the same question: What language are these people speaking? The characters’ names were Chinese – but would a young case worker speak the same dialect as a client who is 50 or 60 years his senior? Or should we imagine that the elderly woman had attended English schools as a child and was accustomed to speaking British-influenced English? Or did they both speak Singlish? Would the case worker call his client “ah po” (Grandma)?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The FDA Should Have No Role in Setting Prices for Off-Patent Pharmaceuticals

An article that appeared in the Journal of the American Medical Association
on January 4, 2016, written by Johns Hopkins Institute of the History of
Medicine and Bloomberg School of Public Health professors Jeremy A. Green,
Gerard Anderson, and Joshua M. Sharfstein recommended that the Food and Drug
Administration (FDA) act to improve access to approved generic drugs that are
becoming scarce because of a lack of competition. It’s surprising that respected historians and health policy educators believe
that the FDA should have any such governmental role. As highly regarded as they
are, the authors appear neither to fully understand FDA and drug regulation
history or health care delivery competition oversight. The FDA has never had
statutory authority to regulate drug prices, period. And, they rightly
shouldn’t have.

The
FDA exists to protect the public safety, health, and welfare by assuring that
drugs marketed in the US are safe and effective. The reasonableness of the
prices for these drug products is of no concern to the FDA as a regulatory
body. In the general scheme of federal oversight, fair business and trade
practices are the responsibility of the Federal Trade Commission (FTC) and the
Civil and Criminal Divisions of the Department of Justice. These governmental
authorities are responsible for the enforcement of the anti-competition and
antitrust laws. The FDA has enough to do already; drug pricing should be left
in the regulatory hands that are charged with this duty without involving the
FDA. There’s no real value of involving the FDA here, except perhaps to muddle
the waters more.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Health Law Events at AALS 2016

Next week, the 110th AALS Annual Meeting starts in New York.  I have collected those events at the meeting that relate to health law.

Thursday (Jan. 7) – 1:30 to 3:15P
Hilton, Gramercy West, 2nd Floor
Aging and the Law
Challenging Assumptions About Caregiving
In this session, a diverse group of legal scholars will help reimagine how the law might support both older adults and care providers by challenging common assumptions about caregiving relationships. Specifically, participants will challenge assumptions about the identity of caregivers, the scope of caretaking responsibilities, compensation for care providers, and the impact of traditional approaches to caring for older adults. Topics of discussion will include: (1) the role and legal treatment of non-family care providers, especially in relation to care for LGBT elders, (2) the “taboo” needs of care recipients including needs related to sexual intimacy; (3) the “myth” that surrogate decision-making and guardianship protects older adults; and (4) the Medicaid program’s hidden penalties for those who employ family members as care providers.
Speaker: Alexander A Boni-Saenz, Chicago-Kent College of Law, Illinois Institute of Technology
Moderator: Roberta K. Flowers, Stetson University College of Law
Speaker: Kristin B. Glen, City University of New York School of Law
Speaker: Nancy J. Knauer, Temple University, James E. Beasley School of Law
Speaker: Nina A. Kohn, Syracuse University College of Law
Thursday (Jan. 7) – 3:30 to 4:45P
Hilton, Nassau West, 2nd Floor
Law, Medicine and Health Care
Works-In-Progress for New Law School Teachers
Contracting for Results in Health Care?
Wendy Netter Epstein
Tackling the Social Determinants of Health: A Central Role for Providers
Jessica Mantel
Elizabeth Y.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Be Brave: From Contemplation to Action in Canadian Health Care

Marika Warren and Kirstin Borgerson discuss a key obstacle to improving the Canadian health care system.

__________________________________________

In late June, André Picard gave a presentation entitled “Inequality: Bad for our Health, Bad for Business” at the North End Community Health Centre’s first annual Advocacy Breakfast. As the public health reporter for the Globe and Mail, Picard is particularly skilled at bringing research data and patient narratives together. Some of the arguments he advanced are familiar, such as the economic argument for universal health care (we all benefit from having a healthy workforce). Others are less familiar and deserve more attention than they’ve received; we trace one such argument from his presentation and add our reflections on it below.

Picard identified a tendency for Canadians to feel relieved (and, frequently, morally superior) for having avoided the inequitable and inefficient American health care system, without acknowledging that our system lags behind many other health systems in the industrialized world on measures of quality, access, efficiency, healthy lives, and equity. What this persistent comparison does is entrench a complacency about the status quo in health care and encourage a tendency to think that the way to improve our system is to pump more money or health providers into it. But we don’t (merely) need more of the same in Canadian health care; we need thoughtful and strategic changes aimed at improving equity, access, and quality of care along with concrete recognition that most determinants of health have very little to do with health care (for example, the North End Community Health Centre is currently targeting child literacy in its activities).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.