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PubMed2005

Can drug patents be morally justified?

This paper offers a few elements of an answer to the question to what extent drug patents can be morally justified. Justifications based on natural rights, distributive justice and utilitarian arguments are discussed and criticized. The author recognizes the potential of the patents to benefit society but argues that the system is currently evolving in the wrong direction, particularly in the field of drugs. More than a third of the world's population has no access to essential drugs. The working of the patent system is an important determinant of access to drugs. This paper argues that drug patents are not easily justified and that the 'architecture' of the patent system should be rethought in view of its mission of benefiting society.

Human Rights↗
PubMed1985

Social uses of illness at the workplace: sick leave and moral evaluation.

From interviews with 25 white-collar employees in France, the processes are analysed through which fellow workers and superiors morally evaluate persons who are ill. The differences between this lay interpretation and the medical one are highlighted along with the criteria (the 'sick leave' and 'morbidity' scales) used to form judgments. A person's illness can be used as a pretext to justify measures that are related to other aspects of his life at the workplace. These uses of illness lead us to raise new questions about the legitimation of symptoms by the physician. They also throw light upon the pervasive means of social control that lie outside medical institutions.

Absenteeism↗
PubMed1986

Divided loyalties for physicians: social context and moral problems.

An examination of the notion of divided loyalties dilemmas in medicine, situated within their social contexts, yields insight into the contemporary social and moral position of medicine in the United States. In a review of the literature, the author identifies four concepts important to gaining an understanding of the position that divided loyalties play in medicine and the physician-patient relationship. After describing some of the situations in which these dilemmas affect physicians' responses to patients' health care needs, interests, and choices, the author argues that divided loyalties dilemmas are not rare, and will probably increase with the changes in U.S. medicine. Candor and awareness of the importance of the public belief in physician loyalty are seen as necessary in preventing these changes from becoming destructive of the physician-patient relationship.

Behavior Control↗
PubMed1987

Moral and social aspects of AIDS: a medical students' project.

The rising number of cases of AIDS in Great Britain has important implications for all those who work in the health services. A group of pre-clinical students at the Royal Free Hospital School of Medicine, London, undertook a project in which they explored some of the sociological and epidemiological aspects of AIDS. Particular attention was paid to any stigma that may surround the disease. The moral definition of the disease pervaded all areas of enquiry during the project. It is suggested that sound management of AIDS patients and those who are HIV antibody positive, will require both health care staff and students to carefully consider their own beliefs regarding the disease and those most at risk.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Moral competence and character strengths among adolescents: the development and validation of the Values in Action Inventory of Strengths for Youth.

Moral competence among adolescents can be approached in terms of good character. Character is a multidimensional construct comprised of a family of positive traits manifest in an individual's thoughts, emotions and behaviours. The Values in Action Inventory for Youth (VIA-Youth) is a self-report questionnaire suitable for adolescents that measures 24 widely valued strength of character. Data from several samples bearing on the internal consistency, stability, and validity of the VIA-Youth are described, along with what is known about the prevalence and demographic correlates of the character strengths it measures. Exploratory factor analysis revealed an interpretable four-factor structure of the VIA-Youth subscales: temperance strengths (e.g., prudence, self-regulation), intellectual strengths (e.g., love of learning, curiosity), theological strengths (e.g., hope, religiousness, love), and other-directed (interpersonal) strengths (e.g., kindness, modesty). The uses of the VIA-Youth in research and practise are discussed along with directions for future research.

Adolescent↗
PubMed2005

From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine--Part I: conceptual, moral, and legal foundations.

Respect for patient privacy and confidentiality is an ancient and a contemporary professional responsibility of physicians. Carrying out this responsibility may be more challenging and more important in the emergency department than in many other clinical settings. Part I of this 2-part article outlines the basic concepts of privacy and confidentiality, reviews the moral and legal foundations and limits of these concepts, and highlights the new federal privacy regulations implemented under the Health Insurance Portability and Accountability Act of 1996. Part II of the article examines specific privacy and confidentiality issues commonly encountered in the ED.

Codes of Ethics↗
PubMed2005

Identification, situational constraint, and social cognition: studies in the attribution of moral responsibility.

In three experiments we studied lay observers' attributions of responsibility for an antisocial act (homicide). We systematically varied both the degree to which the action was coerced by external circumstances and the degree to which the actor endorsed and accepted ownership of the act, a psychological state that philosophers have termed "identification." Our findings with respect to identification were highly consistent. The more an actor was identified with an action, the more likely observers were to assign responsibility to the actor, even when the action was performed under constraints so powerful that no other behavioral option was available. Our findings indicate that social cognition involving assignment of responsibility for an action is a more complex process than previous research has indicated. It would appear that laypersons' judgments of moral responsibility may, in some circumstances, accord with philosophical views in which freedom and determinism are regarded to be compatible.

Adult↗
PubMed2006

Moral hazard or realised access to care? Empirical observations in Hong Kong.

We examined for the presence of moral hazard among those covered by medical benefits or insurance schemes, whether provided for by employers or privately purchased and stratified by health care provider sector in Hong Kong. Data for this study were derived from the 2002 Thematic Household Survey, covering 24,610 non-institutional residents aged 15 and over, representing 5,353,666 persons after applying population weights. Zero-inflated Poisson or negative binomial models were constructed to examine the association between predisposing, need and enabling factors with inpatient and outpatient utilisation patterns as per Andersen's health behavioural framework. Individuals with insurance or medical benefits were more likely to have been ever admitted in the previous year but did not incur more bed-days. Similarly, those who were covered by insurance or medical benefits had a higher probability of ever visiting a doctor in the previous month but not consuming more episodes. These findings were consistent across the public and private sectors. We propose that our observations mostly reflected realised access that met genuine health need rather than inappropriate overuse of services. A supply-driven public sector and high out-of-pocket co-payments for private services likely explained these findings.

Adolescent↗
PubMed2005

Is moral hazard good for the environment? Revenue insurance and chemical input use.

Using farm level data we evaluate the input use and environmental effects of revenue insurance. A priori, the moral hazard effect on input use is indeterminate. This paper empirically assesses the input use impact of the increasingly popular, and federally subsidized, risk management instrument of revenue insurance and the extent to which its effects on input use may differ from those of the older yield based instruments. We conclude that among winter wheat farmers, those who purchase revenue insurance tend to spend less on fertilizers but do not appreciably alter pesticide expenditures. Thus, any improved environmental outcomes due to crop insurance are likely due to reduced fertilizer not pesticide use. When the environmental indicators included indicated a potential environmental fragility (i.e. high erosion, pesticide leaching or pesticide runoff potential), the input use equation suggested that fertilizer expenditures decreased. Revenue insurance undoubtedly further reduces fertilizer applications on these fields as well, but the marginal environmental benefit of revenue insurance is lessened because the reduction, where it matters most, accrues on land on which fertilizer use has already been curtailed to some degree.

Agriculture↗
PubMed2004

Internalized stigma predicts erosion of morale among psychiatric outpatients.

Stigma in society causes harm to people with severe mental illness (SMI) and internalized stigma represents its psychological point of impact. We evaluated the extent of internalized stigma in a sample of outpatients with SMI, using the Internalized Stigma of Mental Illness (ISMI) Scale, developed with consumer input. About a third of the sample reported high levels of internalized stigma. We tested whether internalized stigma predicted increased depressive symptoms and reduced self-esteem at 4-month follow-up, controlling for baseline levels. Depression was predicted by Alienation, Stereotype Endorsement, Social Withdrawal Scales and total ISMI score. Reduced self-esteem was predicted by Alienation. ISMI results were stronger than those for the widely used Devaluation-Discrimination Scale. The finding that alienation further reduces morale speaks to the difficulty of pulling oneself out of this type of vicious cycle without assistance.

Ambulatory Care↗
PubMed1999

Seizures induced by frustration and despair due to unresolved moral and political issues: a rare case of reflex epilepsy.

We present a case of reflex-induced simple partial seizures, triggered by feelings of frustration, anger and despair. Such emotions were provoked by pondering over complex national and international, political and moral issues. The present case may suggest that activation of right temporal networks may mediate negative and adverse emotions induced by preoccupation with agitating, controversial issues.

Aged↗
PubMed2003

Ethics: "life before birth" and moral complexity in maternal-fetal surgery for spina bifida.

This article considers the ethical significance of a moral belief common among pregnant women (and their partners) who seek open uterine repair for fetal spina, namely that their fetuses are already "babies." The need to recognize and interact sensitively with a pregnant woman's vulnerability to her own beliefs and concerns regarding potential disabilities, the fetal intervention, and its potential outcome is emphasized. Such recognition and explicit discussions are ethically important for informed consent and to safeguard against the judgments, enthusiasms, and biases of surgeons and other team members.

Bioethical Issues↗
PubMed2004

Moral imagination in tissue engineering research on animal models.

Animal experimentation is an integrated part of tissue engineering research. This paper investigates what scientists conducting such experimentation should reasonably take into consideration from an ethical point of view. It is argued that scientists should use their moral imagination in making fundamental ethical choices, in reflecting on legal regulation, in taking public opinion seriously, and in balancing human benefit and animal harm as expected outcomes of the experiments.

Animal Experimentation↗
PubMed1988

Psychiatric, legal, and moral issues of herpes simplex infections.

When patients first realize that they have genital herpes, they are likely to have a series of psychiatric reactions that include (1) denial, (2) a belief that there is a cure, (3) realization that they do have herpes, (4) loneliness, (5) anger toward their sexual partners, (6) fear of sexual deprivation, and (7) development of a poor self-image. One of the best coping mechanisms is to develop a social support system. Despite many concerns about sexual activities, the patient's work performance often goes on as before. By 1985, law suits by patients against those who allegedly gave them herpes had not resulted in awards at the Appeals Court level and one malpractice suit against physicians was not awarded. Genital infections in children must be regarded as potential child abuse by physicians. Morally, it is right for an infected person to disclose the existence of herpes to a potential partner but this is not always done for fear of compromising a relationship in its early phases. Because one's original infection may be asymptomatic, relating the time of acquisition of an infection to an act of infidelity cannot be judged solely on the basis of the time of the herpetic breakout.

Child↗
PubMed2003

The moral relevance of personal characteristics in setting health care priorities.

This paper discusses the moral relevance of accounting for various personal characteristics when prioritising between groups of patients. After a review of the results from empirical studies, we discuss the ethical reasons which might explain-and justify-the views expressed in these studies. The paper develops a general framework based upon the causes of ill health and the consequences of treatment. It then turns to the question of the extent to which a personal characteristic-and the eventual underlying ethical justification of its relevance-could have any relationships to these causes and consequences. We attempt to disentangle those characteristics that may reflect a potentially relevant justification from those which violate widely accepted principles of social justice.

Attitude to Health↗
PubMed2004

Predictive genetic test decisions for Huntington's disease: context, appraisal and new moral imperatives.

Predictive testing is one of the new genetic technologies which, in conjunction with developing fields such as pharmacogenomics, promises many benefits for preventive and population health. Understanding how individuals appraise and make genetic test decisions is increasingly relevant as the technology expands. "Lay" understandings of genetic risk and test decision-making, located within holistic life frameworks including family or kin relationships, may vary considerably from clinical representations of these phenomena. The predictive test for Huntington's disease (HD), whilst specific to a single-gene, serious, mature-onset but currently untreatable disorder, is regarded as a model in this context. This paper reports upon a qualitative Australian study which investigated predictive test decision-making by individuals at risk for HD, the contexts of their decisions and the appraisals which underpinned them. In-depth interviews were conducted in Australia with 16 individuals at 50% risk for HD, with variation across testing decisions, gender, age and selected characteristics. Findings suggested predictive testing was regarded as a significant life decision with important implications for self and others, while the right "not to know" genetic status was staunchly and unanimously defended. Multiple contexts of reference were identified within which test decisions were located, including intra- and inter-personal frameworks, family history and experience of HD, and temporality. Participants used two main criteria in appraising test options: perceived value of, or need for the test information, for self and/or significant others, and degree to which such information could be tolerated and managed, short and long-term, by self and/or others. Selected moral and ethical considerations involved in decision-making are examined, as well as the clinical and socio-political contexts in which predictive testing is located. The paper argues that psychosocial vulnerabilities generated by the availability of testing technologies and exacerbated by policy imperatives towards individual responsibility and self-governance should be addressed at broader societal levels.

Adult↗
PubMed1999

Norms and prenorms on prenatal diagnosis: new ways to deal with morality in counseling.

This paper consists of two parts. In the first part, we report the results of an empirical study on Dutch women's decisions about prenatal diagnosis. We were interested in the norms these women used as guidance. One clear norm was found that was shared by everyone: everybody should decide for herself. Despite this clear norm, almost all women expressed difficulty with the choice, often regretted the fact that they had to make it and sometimes even expressed disgust about having to choose. These findings indicate that the choice is often experienced as a burden, which we think should be taken more seriously. In the second part of the paper, we present a way to do so. The core of our proposal is to pay more attention in counseling to the moral character of choices about prenatal diagnosis. We discuss difficulties and possibilities in that direction.

Abortion, Therapeutic↗
PubMed2002

Living at the sharp end: moral obligations of nurses in reporting and disclosing errors in health care.

Nurses are mandated to keep patients safe. When that safety is threatened by a nursing error, the nurse as a moral agent has the obligation to report and disclose the error to the appropriate people honestly and fully. Telling the truth should be a closely held value by all nurses. Nurses must continue to act as advocates for their patients while recognizing their own human frailties. Human errors are inevitable in the practice of nursing. They cannot completely be eradicated, although they can be reduced. Nursing's ethical imperative is to exhaust our efforts in correcting the processes and situations that lead to error.

Disclosure↗