Promoting social responsibility amongst health care users: medical tourists’ perspectives on an information sheet regarding ethical concerns in medical tourism

Background

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism.

Results

According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants’ desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision.

Conclusions

The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry.

     

“Advice to the medical students in my service”: the rediscovery of a golden book by Jean Hamburger,father of nephrology and of medical humanities

Jean Hamburger (1909–1992) is considered the founder of the concept of medical intensive care (réanimation médicale) and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world (with short-term success), in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix Balzac and the Cino del Duca prize (1979), awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a “golden” book, “Conseils aux étudiants en medicine de mon service” (“Advice to the Medical Students in my Service”), the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options (1963). The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice.     

The moral psychology of rationing among physicians: the role of harm and fairness intuitions in physician objections to cost-effectiveness and cost-containment

Introduction

Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.

Methods

We mailed an 8-page survey to a random sample of 2000 practicing U.S. physicians. The survey included the MFQ30 and items assessing agreement/disagreement with cost-containment and degree of objection to using cost-effectiveness data to guide care. We used t-tests for pairwise subscale mean comparisons and logistic regression to assess associations with agreement with cost-containment and objection to using cost-effectiveness analysis to guide care.

Results

1032 of 1895 physicians (54%) responded. Most (67%) supported cost-containment, while 54% expressed a strong or moderate objection to the use of cost-effectiveness data in clinical decisions. Physicians who strongly objected to the use of cost-effectiveness data had similar scores in all five of the foundations (all p-values?>?0.05). Agreement with cost-containment was associated with higher mean “harm” (3.6) and “fairness” (3.5) intuitions compared to “in-group” (2.8), “authority” (3.0), and “purity” (2.4) (p?<?0.05). In multivariate models adjusted for age, sex, region, and specialty, both “harm” and “fairness” were significantly associated with judgments about cost-containment (OR?=?1.2 [1.0-1.5]; OR?=?1.7 [1.4-2.1], respectively) but were not associated with degree of objection to cost-effectiveness (OR?=?1.2 [1.0-1.4]; OR?=?0.9 [0.7-1.0]).

Conclusions

Moral intuitions shed light on variation in physician judgments about cost issues in health care.

     

Neuroethics,confidentiality, and a cultural imperative in early onset Alzheimer disease: a case study with a First Nation population

The meaningful consideration of cultural practices, values and beliefs is a necessary component in the effective translation of advancements in neuroscience to clinical practice and public discourse. Society’s immense investment in biomedical science and technology, in conjunction with an increasingly diverse socio-cultural landscape, necessitates the study of how potential discoveries in neurodegenerative diseases such as Alzheimer disease are perceived and utilized across cultures. Building on the work of neuroscientists, ethicists and philosophers, we argue that the growing field of neuroethics provides a pragmatic and constructive pathway to guide advancements in neuroscience in a manner that is culturally nuanced and relevant. Here we review a case study of one issue in culturally oriented neuroscience research where it is evident that traditional research ethics must be broadened and the values and needs of diverse populations considered for meaningful and relevant research practices. A global approach to neuroethics has the potential to furnish critical engagement with cultural considerations of advancements in neuroscience.     

The place of words and numbers in psychiatric research

In recent decades, there has been widespread debate in the human and social sciences regarding the compatibility and the relative merits of quantitative and qualitative approaches in research. In psychiatry, depending on disciplines and traditions, objects of study can be represented either in words or using two types of mathematization. In the latter case, the use of mathematics in psychiatry is most often only local, as opposed to global as in the case of classical mechanics. Relationships between these objects of study can in turn be explored in three different ways: 1/ by a hermeneutic process, 2/ using statistics, the most frequent method in psychiatric research today, 3/ using equations, i.e. using mathematical relationships that are formal and deterministic. The 3 ways of representing entities (with language, locally with mathematics or globally with mathematics) and the 3 ways of expressing the relationships between entities (using hermeneutics, statistics or equations) can be combined in a cross-tabulation, and nearly all nine combinations can be described using examples. A typology of this nature may be useful in assessing which epistemological perspectives are currently dominant in a constantly evolving field such as psychiatry, and which other perspectives still need to be developed. It also contributes to undermining the overly simplistic and counterproductive beliefs that accompany the assumption of a Manichean “quantitative/qualitative” dichotomy. Systematic examination of this set of typologies could be useful in indicating new directions for future research beyond the quantitative/qualitative divide.     

Task dependent modulation of exogenous attention: Effects of target duration and intervening events

Inhibition of return (IOR) consists of slower reaction times in response to stimuli appearing at previously attended or inspected locations. The exact mechanisms underlying the effect have not yet been determined. In the present work, we manipulated two variables, target duration and intervening event (fixation cue between cue and target), through which we modulated the IOR effect as a function of task. When the target was presented until response, the presence of an intervening event made the cueing effect more negative in all tasks, although facilitation in the absence of an intervening event was only observed in discrimination and go–no-go tasks. When the target duration was 50 ms, the effect of the intervening event on cueing was also only observed for the discrimination and go–no-go tasks. Target duration had no effect at all in the discrimination task. Possible mechanisms for these modulations (detection cost and spatial selection benefit, both of which are based on cue–target integration processes) are discussed.     

False memories for script actions in a mugging account

Abstract

A number of cross-language priming experiments are reported that evaluate whether word meanings in the first and second language are represented in common or separate systems. A masked priming procedure was used on the assumption that when prime awareness is limited, any priming effects directly reveal the underlying structure of the semantic system. Primes were presented in the subjects' first language, while targets were in their second language. Priming effects were obtained for word pairs that were semantically highly similar but not translation equivalents, for example fence-haie (= hedge in French), suggesting that words in the two languages share common elements of semantic code. Priming was also obtained between translation equivalents which, in conjunction with the results for semantically similar pairs, is most naturally interpreted in terms of partially shared semantic representations. However, no masked priming effects were obtained between associated pairs of relatively low semantic similarity, for example shoe-pied (= foot in French), whereas such pairs did produce an effect when primes were unmasked. The results are discussed in terms of limitations on the semantic activation produced by masked words, and the role of collocational relationships in priming between associated words in the same language.     

Biasing decision making by means of retrieval practice

Decision making requires the recruitment of several cognitive processes. So far, however, few studies have dealt with the role of inhibitory control in this domain. In this study, we aim to examine this issue in a memory-based decision task by using an adaptation of the retrieval practice paradigm (Anderson, Bjork, & Bjork, 1994 Anderson, M. C., Bjork, R. A. and Bjork, E. L. 1994. Remembering can cause forgetting: Retrieval dynamics in long-term memory. Journal of Experimental Psychology: Learning, Memory, and Cognition, 20: 1063–1087. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). The retrieval-induced forgetting found through this task is normally explained in terms of inhibition. Specifically, we analyse how retrieval practice may affect what alternatives are selected as well as the choice probability and attribute recall. Our data show a relation between the recall impairment of the attributes due to retrieval practice and biased decisions.     

Peripheral spatial cues modulate spatial congruency effects: Analysing the “locus” of the cueing modulation

The spatial Stroop effect (slower left/right responses to left/right pointing arrows when they appear at spatially incongruent than at congruent locations) has often been used to examine the processing of irrelevant spatial information. We present data from two experiments in which the magnitude of such location-based interference is drastically reduced when the location of the arrow is precued by a spatial noninformative cue. The main aim of the present study was to clarify whether such modulation takes place at perceptual or at response-related stages of processing. First, we manipulated the spatial compatibility between the direction of the arrow and the location of the response so that each subject would respond with spatially compatible vs. incompatible key presses for each half of the experiment. We found that such manipulation did not have any effect on the standard reduction of the congruency effect by peripheral cues. In a second experiment, subjects made left/right key presses to directional arrows pointing bottom/up, which could appear equally often at left/right/bottom/up locations. In cued trials, we found a reduction of the congruency effect on the vertical axis (stimulus location-direction congruency), whereas congruency was unaffected by cueing in targets presented on the horizontal axis (stimulus-response location congruency). According to these results, we conclude that spatial noninformative cues modulate spatial Stroop interference by reducing the conflict between stimulus dimensions at perceptual- rather than motor-related stages of processing.