Measured fairness, situated justice: feminist reflections on health care rationing

Bioethical discussion of justice in health care has been much enlivened in recent years by new developments in the theory of rationing and by the emergence of a strong communitarian voice. Unfortunately, these developments have not enjoyed much in the way of close engagement with feminist-inspired reflections on power, privilege, and justice. I hope here to promote interchange between "mainstream" treatments of justice in health care and feminist thought.     

Double agency and the ethics of rationing health care: a response to Marcia Angell

The arguments against doctors as "double agents" that are presented by Marcia Angell in the preceding article do not defeat the core justification for rationing some relatively high-expense, low-benefit care, and they do not enable us to conclude that clinicians should be barred from any active, substantive role in decisions to limit that care. They do, however, reveal several important conditions that need to govern cost-conscious medial practice in order to preserve an ethic of fidelity to patients: insurers' profits and providers' incomes must be fair, providers must inform patients of any economic reasons that lead to the foregoing of care, and "direct incentive" arrangements must not be used to contain costs.     

Jewish and Roman Catholic approaches to access to health care and rationing

In addressing issues of access to health care and rationing, Jewish and Roman Catholic writers identify similar guiding values and specific concerns. Moral thinkers in each tradition tend to support the guarantee of universal access to at least a basic level of health care for all members of society, based on such values as human dignity, justice, and healing. Catholic writers are more likely to frame their arguments in terms of the common good and to be more accepting of rationing that denies beneficial and needed health care to some persons. Jewish writers are more likely to consider individual responsibility for illness in allocation decisions and to accept differences in health care that different members of society receive. The article considers the relevance of both shared and complementary perspectives for deliberations in nations such as the United States.     

Ethics and public health emergencies: rationing vaccines

There are three broad ethical issues related to handling public health emergencies. They are the three R's-rationing, restrictions and responsibilities. Recently, a severe shortage of annual influenza vaccine in the US, combined with the threat of pandemic flu, has provided an opportunity for policy makers to think about rationing in very concrete terms. Some lessons from annual flu vaccination likely will apply to pandemic vaccine distribution, but many preparatory decisions must be based on very rough estimates. What ethical principles should guide rationing decisions, what data should inform these decisions, how to revise decisions as new data emerge, and how to implement rationing decisions on the ground are all important considerations. In addition, ethicists might be able to help policy makers think through the importance of international cooperation in surmounting global rationing dilemmas and to accept the inevitable responsibilities of government in making and implementing rationing decisions.     

An ethical dilemma: Information control in cancer care

Cancer is a group of diseases that are complicated by various treatment choices available. Information exchange between a patient and physician is critical in helping people to understand what is happening to them and what options for therapy are recommended and available. When information is not exchanged, information control by one or both of the participants occurs. Information needs to be taken into account by both health care professional and patients in making decisions during the crucial phases of care. The phases of care presented are a diagnosis, treatment, the decision, and a recurrence. Factors that influence effective information exchange among patient-provider systems are discussed.     

Counselling psychology in primary health care: A review

This paper reviews the development of counselling psychology within the field of primary health care. Issues discussed include liaison between counselling psychologists and other professionals, evaluation of treatment in primary care, family therapy in general practice and general practitioners’ skills in counselling. The need for training and evaluation of counselling are discussed and suggestions are made for further research.     

The dilemma of conscience in Christian belief: A pastoral perspective

This article describes the crisis of integrity experienced by a trinitarian Christian attempting to take seriously the results of current Jesus scholarship. It explores a number of traditional methods for reconciling the Jesus of history with the Christ of faith, and proposes a different paradigm, based on the structure of kairos time and the psychological dynamics of friendship.     

The give-or-take-some dilemma: An empirical investigation of a hybrid social dilemma

We describe and empirically investigate a hybrid social dilemma that merges give-some and take-some dilemmas by allowing individuals to choose to either give or to take resources from a shared resource pool. Study 1 finds that (a) group size increases the inequality among group members and the likelihood of creating the public good, while reducing the amount of wasted resources; (b) larger bonuses increase provision rates; and (c) asymmetry in the wealth distribution of the group members induces higher levels of inequality of the final outcomes. Following the logic of appropriateness, players with high (low) endowments were more likely to give toward (take from) the shared resource. Study 2 finds that the tendency of the players with high (low) endowments to give (take) is amplified as the difference between endowment levels increased, and the players’ behavior is correlated with, and predictable from, independent judgments of what is perceived as appropriate.     

Evaluating health care work settings: A holistic conceptual framework

Abstract

After offering a systems perspective that considers a diversity of job-related and personal factors, we discuss the determinants and impacts of health care work climates and how staff morale and performance can influence the treatment milieu and quality of patient care. We also describe the physical features, organizational structure and policies, and suprapersonal and task factors that help to shape health care work climates. We then review research on the connections between work climate and staff morale and performance, the interplay of work climate factors, and the role of personal factors in these relationships. Finally, we orovide some ideas about how to improve health care work settings and focus on some promising new research directions.