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PubMedDate not supplied

Insulating ethical policymaking from politics: three views.

Above politics and beyond the law. That is what those in the field of health care ethics expect of their field, at least in the United States. We differentiate between what the law allows and what ethics expects, and we go to great lengths to champion the protection of ethical decision making from political influence and to preserve individual autonomy, personal integrity, and self-determination in the face of social pressure. We like the "supreme court" model as a structure to ensure autonomous decision making when it comes to ethical situations and deliberations. This view is consistent across organizational levels--from individual membership groups, to national commissions, to international bodies, but it is not easy to achieve, as the following articles show.

American Medical Association↗
PubMed1995

Is this legal? A non-profit primer on lobbying and political activities.

Lobbying by tax-exempt entities is permissible, but regulated by the Internal Revenue Code. Tax-exempt entities that lobby should not be confused with political activity by tax-exempt entities. Although a public charity may not involve itself in political campaign activities in any way, a public charity may engage in a certain level of lobbying activities. Consider three hypothetical situations involving CEOs of health care providers.

Charities↗
PubMedDate not supplied

How to become politically savvy.

On the political frontier, unprecedented changes are sweeping across the country. In this industry, health care financing and Medicare funding are at the vanguard of political change. CEOs can choose to shape the policies of the future or watch from the sidelines at their own peril.

Chief Executive Officers, Hospital↗
PubMedDate not supplied

The politics of fund raising through grantsmanship in the human services.

Funds for human service programs and services are declining, and selection criteria for funds are becoming more objective. These conditions are creating an imbalance in the system which will result in a significant change in human service funding and delivery. The climate is ripe for increased competition among those who obtain funds for human services. This article attempts to define how that competition will ultimately generate a spirit of cooperation among the survivors. To reach that point, however, grantsmen/providers, to be competitive, will need to sharpen their technical writing skills and their political skills, that is, they need to become more shrewd, prudent, and diplomatic. This article suggests some methods for improving technical grant-writing skills and developing political skills among grant writers.

Financial Management↗
PubMed1988

Hospital planners as political activists.

Faced with increasing financial pressures under the state's all-payer prospective pricing system, the New Jersey Hospital Assn. launched a broad-based political action campaign last year to bring relief to its beleaguered hospital members. The New Jersey experience makes a compelling case for hospitals or hospitals group elsewhere to formulate political action plans.

Communication↗
PubMed1989

Speaking up for nurses. Concerted political action garners some relief for personnel shortage.

To better understand public opinion and encourage trustee and community support concerning the nursing shortage in central New Jersey, a major medical center surveyed 400 household heads in a two-county area with a population of approximately 1 million. The findings suggested that an effective political action plan requiring trustee, hospital, and community involvement could be developed. The survey revealed that 75 percent of the respondents knew about the area nursing shortage, 82 percent believed the shortage was genuine, 67 percent believed it was serious, 86 percent believed it would adversely affect the quality of healthcare, and the majority was willing to take some political action to relieve the shortage. The New Jersey Hospital Association ran a campaign to explain the impact of the nursing shortage and other problems hospitals were facing. This effort suggested hospitals encourage their trustees, employees, and medical staffs to write the governor and key state officials. Hospital administrators, association representatives, and nursing groups lobbied state legislators and attended Hospital Rate Setting Commission hearings. As a result, hospitals received a temporary increase in their reimbursement rates in 1988 specifically intended to raise nursing salaries. In addition, the New Jersey Department of Health promised to reevaluate the cost components on which the state's diagnosis-related group system is based.

Adult↗
PubMed2000

Posttraumatic stress disorder following political imprisonment: the role of mental defeat, alienation, and perceived permanent change.

An interview study of 81 former political prisoners investigated whether posttraumatic stress disorder (PTSD) is related to the way individuals process the prison experience. In contrast to participants without PTSD, those with chronic or remitted PTSD were more likely to perceive mental defeat and an overall feeling of alienation from other people. Chronic PTSD was also related to perceived negative and permanent change in their personalities or life aspirations. The groups did not differ in their attempts to gain control during imprisonment. Evidence for a relationship between political commitment and PTSD was mixed. The results suggest that mental defeat, alienation, and permanent change are related to PTSD after interpersonal trauma and may need to be addressed in treatment.

Adolescent↗
PubMed2000

Human cost of political violence.

OBJECTIVE: To evaluate the cost of political violence in terms of human life and its influence on social, psychological and financial aspects of community. DESIGN: Retrospective study conducted from 1987 to 1989. SETTING: Department of Accident and Emergency, Jinnah Postgraduate Medical Centre, Karachi. SAMPLE SIZE: Nine hundred and fifty four victims including two hundred and fifty seven dead. RESULTS: The mean age of the victims was 27.29 +/- 9.46 years with a male to female ratio of 33:1. All ethnic groups suffered to some extent. No case of violence on religious differences was reported during this period. Firearms were frequently used. Most of the deaths (92.2%) occurred due to firearm injuries. Landhi, Korangi, Malir and Shah Faisal Colony were the worst affected areas. There was however no significant difference between them. The projected loss of life for the dead was approximately 3.15 million days. The same was difficult to assess for the injured because of multifactorial reasons. Six thousand four hundred and ninety two close family members suffered from Psychological and Physical Trauma. The number of distant members affected psychologically was estimated to be 0.566 million. Schooling of approximately five thousand four hundred thirty seven children of the victims suffered. CONCLUSION: Political violence has significant short and long term effects on the society in terms of physical and psychological trauma, financial losses, poor schooling and health, biased pattern of child development, migration of families and further division of society into identifiable communities which may prolong the conflict.

Adolescent↗
PubMed1999

Federalist flirtations: the politics and execution of health services decentralization for the uninsured population in Mexico, 1985-1995.

Around the world health services delivery systems are undergoing decentralization, responding to pressure to increase equity, efficiency, participation, intersectoral collaboration and accountability. This study examines the Mexican health decentralization efforts of the past decade to discern the motivations for the reform, the context for its implementation, the politics of its downfall, and the reform's impact at subnational levels of government. Sparked by economic crisis and pressure from international creditors for fiscal reform; demands for greater democracy, equity, and quality; and technocratic impulses to rationalize health services delivery, the decentralization reform could not overcome the authoritarian centralism of the federal government and its corporatist clients. In the end, even in the most technically capable states, the reform was unable to overcome political obstacles to decentralizing fiscal power, redistributing resources in an equitable fashion, and eliminating the inefficiencies of separate but unequal health systems for social security recipients and the uninsured population.

Delivery of Health Care↗
PubMed2000

Terrorist on trial: the context of political crime.

When political terrorists stand trial for their violent acts, the political context inevitably plays a major role. This article describes the trial of an Abu Nidal terrorist tried in federal court for skyjacking an Egyptian airliner. The defense portrayed the traumas of the Palestinian people and of the defendant at the hands of the Israelis, offering a not guilty by reason of insanity defense on the basis of posttraumatic stress disorder. Making sense to the jury of how a sane individual could carry out a violent act in which more than 50 innocent men, women, and children died was the task of the author, who served as expert for the U.S. Department of Justice. The paper describes how the subject was socialized to violence in the refugee camps, where he was inspired to be a soldier in the revolution in order to reclaim his family lands. Nationalist-separatist terrorism is particularly intractable because of the generational transmission of hatred and revenge.

Adult↗
PubMedDate not supplied

Making a play in the policy and politics arena: nursing and the national election.

With health care surfacing in political campaigns across the country and referencing virtually every one of the policy topics discussed here, nurses have an important opportunity to share their views regarding both policy substance as well as engage in the political arena. For those nurses not yet ready to run for elective office, participating in grassroots efforts of campaigns, on advisory panels, and making financial contributions to preferred candidates are important opportunities not to be missed. Given the interest in and challenges ahead associated with health care broadly and nursing specifically, there is a great deal at stake.

Health Care Costs↗
PubMed1995

[Medicine as ars in the Roman world. Its advance from sacral to secular approach, its trading and public diffusion: socio-political considerations and their legal consequences].

The close linkage between empiric knowledge and its magic religious background in the archaic period appears clearly as a main feature characterizing the medical ars at its beginning, at least till it advances to a full secular approach during the fifth and fourth century B.C. The medical knowledge, which had been a privileged inheritance of the ruling class underwent a rapid transformation with the rise of the Roman Empire and its hegemonic politics that reached its climax during the Punic wars. As it was spread to all social classes it achieved an ever increasing importance leading to its specialisation and trading. This socio-political change had repercussions on the legal field: indeed conventiones concerning medical service came into effect. As far as action was concerned, doctors were permitted to avail themselves of the cognitio extra ordinem in order to get the rewards they were entitled to. The application of the legal tool cognition was however a device embedded in a set of other remedies aiming at granting rewards and incentives i.e. privilegia and salarium. Their development over the period of the Roman Empire was linked with a growing monopoly run by the supreme authority.

Commerce↗
PubMed2001

[Drug politics in the USA].

About 40 million Americans over 65 years of age are enrolled in the Medicare programme. However, this programme (with some exceptions approved by the Congress) does not provide prescription drug coverage for the outpatients. Furthermore, the recent rate of drug expenditure increase has been twice higher compared to overall health care expenditures. Even though the Medicare beneficiaries are offered various forms of supplemental prescription drug coverage, there exist attempts to reform this national programme. Several such proposals, however, failed during the last 15 years (US Congress). A recent two-stage strategy for a comprehensive Medicare reform was proposed by president Bush jr. It would solve the prescription drug coverage (even without the Medicare beneficiary enrollment in supplemental private programmes) through direct support to federal states in the first stage; in the second stage, a comprehensive Medicare reform would take place and the prescription drug coverage would be subsidized in proportion to the annual income of the beneficiaries. The required cost of this reform would be about 160 thousand million $ over a decade. This plan brought about opposing proposals both from the Democrats and Republicans in the Congress. The fate of the reform will depend on the representation of the two political parties both in the House of Representatives and the Senate as well as on the political power of influential groups.

Humans↗
PubMedDate not supplied

[A feeling of coherence and delayed sequelae of post-traumatic stress in persons persecuted for political reasons in Poland in the years 1944-56].

The paper presents the results of research of 100 persons persecuted for political reasons in Poland in the years 1944-56. The research aims to study the relations between the level of Sense of Coherence and delayed effects of post-traumatic stress disorder in personal functioning (which is manifested by anxiety, depression, lack of meaning of life, and low well-being), and in interpersonal functioning. Introduction of this article presents the problems connected with delayed effects of post-traumatic stress disorder, and the general principle of Antonovsky's salutogenic concept also characterizes the sense of coherence category (SOC). SOC is a generalized, long-lasting feeling of confidence that the world is comprehensible (internal and external environments are structured, predictable, and explicable). People with a high level of SOC see their life as having some purpose and that their life is worthy of personal investments, and see themselves as having the personal resources to cope with the difficulties. The data was collected with using: The Sense of Coherence Questionnaire, PTSD-Interview, Beck Depression Inventory, State-Trait Anxiety Inventory, Purpose in Life Test, The Psychological General Well-Being (PGWB) Index, and The Scale of Interpersonal Relationships. The results indicate that the strength of the sense of coherence is negatively correlated with level of anxiety, depression, enmity syndrome, and positive with meaning of life, psychological well-being, and pro-social relationships. The research confirmed the important role of a sense of coherence (SOC) in modifying experience of delayed consequences of post-traumatic stress in victims of political persecution.

Adult↗
PubMed2000

Politics, public policy, and healthcare.

In many cases, justice is the ethical principle that drives decisions around politics, public policy, and healthcare. This article presents the ethical principle of justice as it relates to the equitable distribution of healthcare goods and services. The impact of politics, especially in a presidential election year, is discussed as it relates to agendas and alternatives for healthcare policy formation--specifically, as it directly and indirectly influences wound care and wound care delivery. Opportunities for wound care clinicians are presented.

Delivery of Health Care↗
PubMed2002

Politics, operant conditioning, Galileo, and the American Psychological Association's response to Rind et al. (1998).

The controversy surrounding B. Rind, P. Tromovitch, and R. Bauserman (1998) provides valuable lessons into scientific independence, politics, and organizational decision making. In an unprecedented action, the U.S. Congress officially condemned findings of Rind et al. Meanwhile, the American Psychological Association took similarly unprecedented measures in an effort to assuage its Congressional critics. This article, written from the perspective of a psychologist serving in Congress, discusses the various political and organizational dynamics that developed during the controversy. Understanding and learning from this incident can help psychologists and their professional associations better prepare for and respond to potential controversies arising from research or other publications.

Decision Making↗
PubMed2002

[The experience in emergency medical care in Lagos (Nigeria): cost-benefit analysis ... politics?].

In both the South and North, meeting the demand for health care services is a major issue in establishing political stability for sustainable development. Neither the need for emergency medicine nor the emergency need for medical care can escape this reality. At first glance, "bringing medical care outside hospitals ... to the bottom of the tree" by implementing an advanced rescue system would seem to overstep the usual goal of providing basic health services and capabilities in a developing country. However, the operational, tactical and strategic implications of a "French style SAMU" medical controlled system may contribute to the fair and equitable distribution of emergency health care resources during critical situations in a given environment. In this respect, such system cannot only become a measurable component in responding to increasingly intolerable health disasters, but also an institutional tool for health resources management in any insecure environment, where access to medical facilities usually involves a number of economic, structural, and ethical obstacles. In France, the effectiveness of such a system is still under evaluation with good results in terms of overall health performance for the year 2000. In 1997 the Nigerian authorities with the support of the French Embassy began a novel experience by setting up a state run SAMU services in Lagos. The purpose of this prospective approach was to answer the question "what emergency care system, for what environment?" with an ultimate goal: developing a sustainable service, not only in terms of medical and economic factors, but also ethical and political considerations.

Delivery of Health Care↗