Toward ethical review of health system transformations.
(57/153)
Efforts to transform health systems constitute social experiments on a population. Like clinical research, they deploy measures that are unproven in the context of the reform, and they often impose significant risks on some people in order to achieve a social goal: the improvement of health delivery. The rationale for proactively evaluating clinical experimentation on human subjects also applies to these social experiments. We used the "benchmarks of fairness" methodology to illustrate the elements such an evidence-based review should encompass, leaving open the question of who should perform it. The review must include the ethical objectives of reform, namely, an integrated approach to equity, accountability, and efficiency; the fit between measures taken and these objectives; and the governance of the reform. (+info)
Exploring the mission of primary care.
(58/153)
OBJECTIVE: This paper's objective was to examine the mission statements of the sponsoring boards and professional organizations of the primary care specialties. METHODS: Mission statements were obtained from the Web sites of the specialty boards and academies for each of the four primary care specialties of pediatrics, obstetrics-gynecology, general internal medicine, and family medicine. The mission statements were analyzed by two investigators, and the components of each mission statement were identified and categorized. RESULTS: There were 29 distinct characteristics defined among all the mission statements. Three of the four primary care specialty organizations listed 10 components, while the American Academy of Pediatrics contained the fewest, with three components. The most commonly named characteristics were commitment to public health and education along with assuring high-quality standards. There was little overlap among the mission statements. Several qualities listed by the Institute of Medicine were not included in the mission statements and three-patient trust, integration of services, and personalized treatment-were missing from all sources. CONCLUSIONS: The mission statements of the primary care specialties vary widely in their values and goals. The findings here provide a perspective that may help focus collaboration and contribute to the discussion surrounding primary care. (+info)
Assessing the reliability and credibility of industry science and scientists.
(59/153)
The chemical industry extensively researches and tests its products to implement product stewardship commitments and to ensure compliance with governmental requirements. In this commentary we argue that a wide variety of mechanisms enable policymakers and the public to assure themselves that studies performed or funded by industry are identified as such, meet high scientific standards, and are not suppressed when their findings are adverse to industry's interests. The more a given study follows these practices and standards, the more confidence one can place in it. No federal laws, rules, or policies express a presumption that scientific work should be ignored or given lesser weight because of the source of its funding. To the contrary, Congress has consistently mandated that agencies allow interested or affected parties to provide information to them and fairly consider that information. All participants in scientific review panels should disclose sources of potential biases and conflicts of interest. The former should be considered in seeking a balanced panel rather than being used as a basis for disqualification. Conflicts of interest generally do require disqualification, except where outweighed by the need for a person's services. Within these constraints, chemical industry scientists can serve important and legitimate functions on scientific advisory panels and should not be unjustifiably prevented from contributing to their work. (+info)
Physician health and wellness.
(60/153)
BACKGROUND: Impaired physician health can have a direct impact on patient health care and safety. In the past, problems of alcoholism and substance abuse among physicians have received more attention than other conditions-usually in the form of discipline. While patient safety is paramount, the medical profession may be more successful in achieving the required standards by fostering a culture committed to health and wellness as well as supporting impaired physicians. OBJECTIVE: To develop ethical guidelines regarding physician health and wellness. METHODS: The American Medical Association's (AMA's) Council on Ethical and Judicial Affairs developed recommendations based on the AMA's Code of Medical Ethics, an analysis of relevant Medline-indexed articles, and comments from experts. The report's recommendations were adopted as policy of the Association in December 2003. RESULTS: Individually, physicians can promote their personal health and wellness through healthy living habits, including having a personal physician. The medical profession can foster health and wellness if its members are taught to identify colleagues in need of assistance and initiate appropriate methods of intervention, including referrals to physician health programs. CONCLUSIONS: Physicians whose health or wellness is compromised should seek appropriate help and engage in honest self-assessment of their ability to practice. The medical profession should provide an environment that helps to maintain and restore health and wellness. Physicians need to ensure that impaired colleagues promptly modify or cease practice until they can resume professional patient care. In addition, physicians may be required to report impaired colleagues who continue to practice despite reasonable offers of assistance. (+info)
The aftermath of scientific fraud.
(61/153)
Scientists who have come face to face with scientific misconduct consider its consequences years later. (+info)
On pandemics and the duty to care: whose duty? who cares?
(62/153)
BACKGROUND: As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs - both in clinical care and in public health - were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. DISCUSSION: In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. SUMMARY: An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (+info)
Reasons scientists avoid thinking about ethics.
(63/153)
Science is a powerful force for change in modern society. As the professionals at its helm, scientists have a unique responsibility to shepherd that change with thoughtful advocacy of their research and careful ethical scrutiny of their own behavior. (+info)
Virulent epidemics and scope of healthcare workers' duty of care.
(64/153)
The phrase "duty of care" is, at best, too vague and, at worst, ethically dangerous. The nature and scope of the duty need to be determined, and conflicting duties must be recognized and acknowledged. Duty of care is neither fixed nor absolute but heavily dependent on context. The normal risk level of the working environment, the healthcare worker's specialty, the likely harm and benefits of treatment, and the competing obligations deriving from the worker's multiple roles will all influence the limits of the duty of care. As experts anticipate the arrival of an avian influenza pandemic in humans, discussion of this matter is urgently needed. (+info)