How physician executives and clinicians perceive ethical issues in Saudi Arabian hospitals.
OBJECTIVES: To compare the perceptions of physician executives and clinicians regarding ethical issues in Saudi Arabian hospitals and the attributes that might lead to the existence of these ethical issues. DESIGN: Self-completion questionnaire administered from February to July 1997. SETTING: Different health regions in the Kingdom of Saudi Arabia. PARTICIPANTS: Random sample of 457 physicians (317 clinicians and 140 physician executives) from several hospitals in various regions across the kingdom. RESULTS: There were statistically significant differences in the perceptions of physician executives and clinicians regarding the existence of various ethical issues in their hospitals. The vast majority of physician executives did not perceive that seven of the eight issues addressed by the study were ethical concerns in their hospitals. However, the majority of the clinicians perceived that six of the same eight issues were ethical considerations in their hospitals. Statistically significant differences in the perceptions of physician executives and clinicians were observed in only three out of eight attributes that might possibly lead to the existence of ethical issues. The most significant attribute that was perceived to result in ethical issues was that of hospitals having a multinational staff. CONCLUSION: The study calls for the formulation of a code of ethics that will address specifically the physicians who work in the kingdom of Saudi Arabia. As a more immediate initiative, it is recommended that seminars and workshops be conducted to provide physicians with an opportunity to discuss the ethical dilemmas they face in their medical practice. (+info)
To give or sell human gametes--the interplay between pragmatics, policy and ethics.
The ever-growing acceptance and use of assisted human reproduction techniques has caused demand for "donated" sperm and eggs to outstrip supply. Medical professionals and others argue that monetary reward is the only way to recruit sufficient numbers of "donors". Is this a clash between pragmatics and policy/ethics? Where monetary payments are the norm, alternative recruitment strategies used successfully elsewhere may not have been considered, nor the negative consequences of commercialism on all participants thought through. Considerations leading some countries to ban the buying and selling of sperm, eggs and embryos are outlined and a case made that the collective welfare of all involved parties be the primary consideration in this, at times heated, debate. (+info)
'If you pay, we'll operate immediately'.
OBJECTIVES: To study the attitudes of health care staff in four postcommunist countries towards taking gifts from their clients--and their confessed experience of actually taking such gifts. DESIGN: Survey questionnaire administered to officials including health care staff, supplemented by focus-group discussions with the general public. SETTING: Ukraine, Bulgaria, Slovakia and the Czech Republic. PARTICIPANTS: A quota sample of 1,307 officials including 292 health care staff, supplemented by stratified national random samples of 4,778 ordinary members of the public and in-depth interviews or focus-group discussions involving another 323. MAIN MEASUREMENTS: Explicit justifications and willingness to accept offers, reported frequency of offers, and personal confessions to accepting "money and expensive presents" as well as smaller gifts. RESULTS: Health care staff were far more inclined than the average official or public servant to accept "money or an expensive present" if offered, far more inclined to justify asking clients for "extra payments", and far more inclined to confess that they had actually taken gifts from clients recently. Judged by their own confessions, hospital doctors were only rivalled by traffic police and customs officials for taking money or expensive gifts from their clients. CONCLUSIONS: Poor pay does not explain why doctors so often took large gifts from their clients. Moral self justification, opportunity, and bargaining power are much more effective explanations. (+info)
Mectizan Donation Program: evaluation of a public-private partnership.
The Mectizan Donation Program (MDP) has been perceived as a highly effective public health programme, and as a possible model for addressing future problems in international health. This evaluation examines how the MDP partnership has been functioning from the perspectives of partner organizations. The results of a survey of 25 partners show that the perceived benefits far outweigh the problems, and that the direct costs to the organizations have been minimal. The partnership is rated highly on many aspects of governance and management, with relatively few problems identified. A factor analysis demonstrated that a wide range of factors have influenced the partners' perceptions. The benefits with the largest weights appear to be those related to external perceptions of the organization, and those indicating that the organization feels that its opinions will matter and lead to action in the partnership. The biggest factors influencing the positive perceptions on the governance and management of the MDP partnership appear to be the involvement of senior leaders from different organizations, and being able to agree on priorities. The MDP has been able to involve a large and heterogeneous number of partner organizations through relatively informal mechanisms that rely on goodwill and reciprocity. The survey results show how there was a strong alignment of the MDP with the interests of the various partners, and that a manageable number of problems were addressed and services provided. While having long-term goals, the MDP and the onchocerciasis control programmes have been effective at demonstrating the effectiveness of the approach through regular, professional, and outcome-oriented evaluations. Although the MDP is considered to be central to concerns of national officials, this feature is not rated as high as public perceptions, the internal characteristics of the partnership, or its accomplishments. Similarly, the need to secure resources is not viewed as a major determinant of the partnership's success, perhaps because resources were readily available through Merck and the partner organizations and programmes. These findings, along with the strategic and operational success of the MDP confirm the view that this type of public-private partnership should be pursued vigorously in other areas of public health. Other potential partnerships would do well to examine the characteristics of the MDP partnership, with careful attention to the features of its governance and the management, including a strong alignment of interests with partners, balancing a long-term vision with clarity of roles and intensive management of coordination, and professional and results-oriented accountability. (+info)
Economic evaluation of Mectizan distribution.
The distribution of ivermectin has dramatically altered the nature of onchocerciasis control. Existing economic analyses of ivermectin distribution programmes show that these programmes have a highly beneficial impact. Most analyses have estimated the economic benefits in terms of increased labour productivity as a result of reductions in blindness, and in terms of additional land-availability because of a reduced transmission of the parasite. Economic evaluations of the Onchocerciasis Control Program (OPC) in West Africa have calculated a net present value - equivalent discounted benefits minus discounted costs - of $485 million for the programme over a 39-year period, using a conservative 10% rate to discount future health and productivity gains. The net present value for the African Program for Onchocerciasis Control (APOC) is calculated at 88 million US dollars over a 21-year time period, also using a 10% discount rate. Cost-effectiveness analyses of ivermectin distribution have found a cost of 14-30 US dollars per disability-adjusted life-year prevented - estimates comparable with other priority disease control programmes. However, the economic success of ivermectin distribution is sensitive to the fact that the drug itself has been donated free of charge. The market value of Merck's donations to the APOC for just 1 year considerably outweighs the benefits calculated for both the OPC and the APOC over the life of these projects. Pending the development of an effective macrofilaricide, the distribution of ivermectin will remain a public health priority into the foreseeable future. (+info)
Impact of a financial incentive on case and control participation in a telephone interview.
The authors investigated the effect of a 5.00 dollars incentive on participation in a telephone interview among cases and controls in an ongoing study of colorectal cancer. Cases and matched community controls were sent a letter introducing the study. One week later, a nurse called to invite the person to participate in a 30-minute telephone interview. After 1 year of data collection (which began in June 2001), the authors began enclosing a 5.00 dollars bill in the initial letter as an incentive. Incentives were mailed to all potential controls. The authors randomized 50% of a subset of cases to receive the incentive. In the year prior to institution of the incentive, 44.2% of 851 controls participated in the interview, as compared with 56.2% of 1,043 controls in the year after the incentive was instituted (p < 0.001). Among cases randomized to receive the incentive (n = 199), 63.8% participated as compared with 68.4% in the nonincentive group (n = 193) (p > 0.05). Among cases aged 60-69 years, the response rate in the incentive group was reduced by 17% (p = 0.03). Thus, among controls, a small monetary incentive appears to promote a feeling of goodwill toward the research. It does not seem to have an equivalent effect among cases, and in the worst case it may insult or annoy some cases who may otherwise have participated. (+info)
Household disbandment in later life.
OBJECTIVE: This study described activities that older people undertake to reduce the volume of their possessions in the course of a residential move to smaller quarters, a process with practical, cognitive, emotional, and social dimensions. METHODS: Qualitative interviews were conducted with members of 30 households who had moved in the prior year. The disbandment period, typically lasting about 2 months, was a particular focus of the interview. RESULT: The interviews suggested nine reasons why people had accumulated and kept things, which now became problematic for the impending move. The initial steps of disbandment entailed decisions about major furniture and meaningful gifts to family and friends, followed by evaluation of the remaining belongings for retention, sale, further gifts, donation, or discard. Things not divested by one means were reassigned to another strategy. People took pleasure in dispositions that saw their things used, cared for, and valued as they had done, thus fulfilling a responsibility to their belongings. DISCUSSION: Disbandment is an acute episode of a more general, lifelong process of possession management. It is an encounter with things that are meaningful to the self, but as it unfolds, it also makes new meaning for things. (+info)
An invasion of cheats; the evolution of worthless nuptial gifts.
Nuptial gifts are food items or inedible tokens that are transferred to females during courtship or copulation . Tokens are of no direct value to females, and it is unknown why females require such worthless gifts as a precondition of mating. One hypothesis is that token giving arose in species that gave nutritious gifts and males exploited female preferences for nutritional gifts by substituting more easily obtainable but worthless items. An invasion of such behavior would require that females accept the substitute gift and copulate for a period of time similar to that with genuine gifts. We show that both these prerequisites are met in the dance fly Rhamphomyia sulcata, in which females normally accept a nutritious gift. We removed the gift from copulating pairs and replaced it with either a large or small prey item or inedible token. We found that although pairs copulated longest with a large genuine gift, the tokens resulted in copula durations equivalent to those with a small genuine gift. We also observed that males that returned to the lek with tokens re-paired successfully. These findings suggest that female behavior in genuine gift-giving species is susceptible to the invasion of male cheating on reproductive investment. (+info)