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At least 1,099 records · Page 61Linked to original sources
PubMed1990

Negotiating criteria and setting limits: the case of AIDS.

The classification of clinical problems, such as AIDS, requires choices. Choices are made on epistemic (i.e., knowledge-based) and non-epistemic (i.e., action-based) grounds. That is, the ways in which we classify clinical problems, such as AIDS, involve a balancing of different understandings of clinical reality and of clinical values among participants of the clinical community. On this view, the interplay between epistemic and non-epistemic interests occurs within the embrace of particular clinical contexts. The ways in which we classify AIDS is the topic of this paper. We consider the extent to which we construct clinical reality; we examine a suggested classification of AIDS; and we conclude suggesting that the choice regarding how to classify AIDS is the result of negotiation among participants in the clinical community.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Ethics, AIDS, and community responsibility.

In the discussion of the responsibilities of society to the HIV infected and uninfected, a serious question seems to have been left out of the picture: To what extent are people who are not infected, have no special relationship to the infected and have no professional responsibilities for the care of AIDS patients under an obligation to come to the aid of people with the HIV? In this paper, I shall examine our responsibilities, as members of society, for the welfare of others to whom we may or may not have a special relationship. I shall argue that those responsibilities flow from the conditions that structure our transactions with others; conditions that make such transactions possible.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Violating confidentiality to warn of a risk of HIV infection: ethical work in progress.

The old literature on whether medical confidentiality may be breached to warn a spouse of a risk of contracting syphilis from his/her partner - a deep and rich literature - has become relevant once again in the context of HIV infection and AIDS. This paper examines the reasoning and method employed in: the Catholic approach centered around the patient's (property) right to the secret; a (generic) model of justice, utilizing minimal principles of non-aggression and restitution; and an approach involving the elimination of unstable alternatives: the view that public health officials, but not the spouse, may/must be notified; and, that maintaining that the physician is at liberty to disclose but is not obliged to do so. The theory and method behind confidentiality turns out to be deeper than you might have anticipated.

Casuistry↗
PubMed1991

An outcomes model of medical decision making.

In the traditional 'fix-it' model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available interventions are only partially effective, a broader vision of the health care endeavor is needed. What matters to the patient, and what should matter to the practitioner, is the patient's future possibilities. More specifically, what is important is the character of the alternative futures that the patient could have and choosing among them so as to achieve the best future possible, with the ranking of outcomes determined by the patient's preferences. This paper describes the fix-it model, presents and defends the outcomes-based model, and demonstrates that the latter is useful in developing normative conceptions of informed consent and decision making and in establishing a basis for societal involvement in the decision making process. Finally, several shortcomings of the model will be acknowledged.

Attitude of Health Personnel↗
PubMed1989

Just health care (I): Is beneficence enough?

Few in our society believe that access to health care should be determined primarily by ability to pay. We believe instead that society has an obligation to assure access to adequate health care for all. This is the view explicitly endorsed in the President's Commission Report Securing Access to Health Care. But there is an important moral ambiguity here, for this obligation may be construed as being either beneficence-based or justice-based. A beneficence-based construal would yield a much weaker obligation with respect to the distribution of health care. In the first section of this paper I argue that the President's Commission is committed only to this weaker construal of this obligation. In the second section I argue that such a beneficence-based obligation is really rooted in a libertarian conception of justice, similar to that recently articulated by Engelhardt, and that this conception is seriously flawed when it comes to effecting a just distribution of health care.

Advisory Committees↗
PubMed1993

On the nature and ethics of health promotion. An attempt at a systematic analysis.

This paper attempts to analyse the notion of health promotion and related conceptual issues within an action-theoretical framework. The purpose is both theoretical and ethical. The paper provides a taxonomy as well as a system for classifying various types of health promotion. This system is inspired by Professor G H von Wright's theory of action explanation. The theoretical framework is used in the ethical part of the paper where some major ethical dilemmas in health promotion are analysed. Particular attention is paid to the use of manipulation and force in health promotion. An attempt is made to define when such measures are justified in various health enhancing contexts.

Behavior Control↗
PubMed1983

Justice and health for all.

The ethical aspects of the distribution of resources for health care at the macro level deserve more study than they hitherto received. The socio-medical and economic policy implications of four distribution principles are reviewed: the utilitarian, the egalitarian, the equal access and the libertarian. Policy in welfare states is primarily based on the equal access principle. Economic factors have led to policy proposals in libertarian and utilitarian directions; competition, cost-sharing, cost-effectiveness and individual responsibility are central to the discussion. The authors conclude that it remains to be seen whether these alternatives produce the results expected. They recommend more comprehensive examination of the practical and political feasibilities of a more egalitarian policy.

Delivery of Health Care↗
PubMed1983

Justice and the justification of a social policy: the distribution of primary care physicians.

A just distribution of primary care physicians in the United States would be one based on patient need. Given the nature of primary care and the distribution of need for primary care, such a principle would yield a pattern of roughly equal distribution of primary care physicians. A justified policy of distribution must take into account not only considerations of justice but other moral, political and economic considerations. It is argued that in the case of primary care physicians a policy of egalitarian distribution is justified. Methods for implementing such a policy are considered. It is argued that a workable policy must include some restriction on physicians' choice of practice location. A method of implementation is suggested.

Government Regulation↗
PubMed1989

Justice across the generations.

The title, 'justice across the generations', is reminiscent of expressions such as 'hands across the seas'. The latter is, of course, impossible in reality, but it symbolizes friendship between persons in far-flung lands. Is 'justice across the generations', likewise, no more than a hopeful metaphor, or is there, or at least should there be, some concrete reality to it? If so, what is, or should be, the substance of that reality? This text consists of some free association reflections, principally in the context of health care and mainly in the form of questions, on the concepts proclaimed in the title, namely, justice, across and generations, and what relevance these might have for our present and future societies.

Age Factors↗