Toward critical research ethics: transforming ethical conduct in qualitative health care research

Based on research conducted with women injection drug users (WIDUs), I discuss the ethical conflicts that researchers and sub-contractors face in gaining access to the life narratives of WIDUs. Foremost among these is the potentially exploitative nature of the study participant-researcher relationship. I suggest that federal and institutional guidelines for human subject research must incorporate additional safeguards to protect study populations such as WIDUs. Moreover, the ethical concerns related to health care research should be addressed in guidelines for ethical conduct with human subjects, research ethics seminars, and required training programs for researchers and subcontractors separately.     

Ethics in American health 2: an ethical framework for health system reform

I argue that an ethical vision resting on explicitly articulated values and norms is critical to ensuring comprehensive health reform. Reform requires a consensus on the public good transcending self-interest and narrow agendas and underpinning collective action for universal coverage. In what I call shared health governance, individuals, providers, and institutions all have essential roles in achieving health goals and work together to create a positive environment for health. This ethical paradigm provides (1) reasoned consensus through a joint scientific and deliberative approach to judge the value of a health care intervention; (2) a method for achieving consensus that differs from aggregate tools such as a strict majority vote; (3) combined technical and ethical rationality for collective choice; (4) a joint clinical and economic approach combining efficiency with equity, but with economic solutions following and complementing clinical progress; and (5) protection for disabled individuals from discrimination.     

Toward an information system in the health field--the MONICA experience

Sans résumé     

我国流动人口公共卫生服务体系建设审视——基于卫生经济伦理视角

改革开放以来,越来越多的农村人口涌入城市,对发展城市经济、加快城市建设、改善城市环境、提高城市居民生活水平起到了积极作用。但是,由于流动人口文化程度整体较低,多集中在高危或低薪行业,缺乏基本的医疗保障和卫生保健意识,使得他们在严重威胁自身健康的同时,也影响到城市的公共卫生、经济与社会稳定。卫生经济伦理尤其重视公正、正义、公平在整个卫生服务和医疗保健中的实现,强调病人和公众享有医疗、保健、健康权利。因此,无论是从保护流动人口健康,促进城市公共卫生安全和和谐社会建设的角度,还是从卫生经济伦理的视角,我们都应重视流动人口的公共卫生服务体系建设。     

Toward a methodology for the ethical analysis of clinical practice

The scope of this essay is to introduce and explain the methodology underlying the Lanza Foundation Protocol for the analysis of clinical cases. The essay is divided in three parts. Part one examines the Protocol's methodology within the whole evolutionary framework of argumentation in bioethics. Particular attention is given to the most significant methodologies developed in European bioethics. Part two describes the system of argumentation which serves as a frame for both approaches, namely, the normative and the hermeneutical. Finally, the third part presents in an analytic fashion the operations which define the Protocol itself. The Protocol is the result of an interdisciplinary effort and it provides a detailed grid for analyzing and tackling the ethical components of clinical cases. The Protocol is primarily directed toward Ethics Committees in their consulting activity, yet it has been proven of considerable importance at an educational level also, particular in continuing education programs for health care professionals. This revised version was published online in July 2006 with corrections to the Cover Date.     

Toward a public mental health promotion and intervention system for youth

Substantial limitations exist at all levels of mental health care for youth in most communities in the United States. Particular gaps exist in the areas of prevention, mental health promotion, and early intervention programs. The national movement toward enhancing mental health programs for youth in schools offers an important opportunity to fill gaps in the prevention-services continuum toward the development of a Public Mental Health Promotion and Intervention System for Youth. A strategy--the Child and Adolescent Program Planning Schema (CAPPS)--is presented to analyze gaps in a community's system of mental health programs for youth, and to facilitate planning toward development of a full continuum of programs from broad, population-based prevention, and mental health promotion strategies to treatment of youth with more established problems.     

Literature review: Afghanistan women's health crisis, health service delivery, and ethical issues for international aid

The literature indicates that the health of women in Afghanistan is poor. In 1997 maternal mortality in Afghanistan was one of the worst in the world. Difficulties in establishing health services revolve around fundamentalist Islamic ideas and ongoing violence within Afghanistan. The literature holds advice on key behaviours for health professionals who may chose to work in Afghanistan. The literature also identifies the local level action that is occurring as the issue of women's health is recognised. Humanitarian assistance has been provided, with international aid agencies having to weigh the ethical responsibilities they hold and one agency tragically facing the violent loss of its own staff. Easy answers are not in the literature, merely an opportunity to understand, consider, and take action about what is facing women in Afghanistan and those who try to help.     

Toward standardization of health information

NCVHS has made recommendations to the DHHS to standardize 42 core health data elements, a number of which relate to medical conditions and services. The committee has asked the DHHS Data Council to actively promote, both within the department and externally, standardization of data elements and definitions where substantial consensus already exists. For those elements that have been recognized as significant core data elements, but for which there is not consensus on approach or definition, the NCVHS is recommending that the Data Council support the formation of a public-private working group to conduct further study and evaluation. This group, or a separate group, could also be the focus for evaluating additions to the list of core data elements and for setting up methods for testing and promulgating the final products. The coming 12-18 months will be exceedingly important for health data standardization efforts in the US as the DHHS responds to both the NCVHS recommendations and the legislation recently enacted by Congress.     

Mental health issues: ethical considerations

Employer-initiated psychiatric evaluations raise a number of ethical issues particular to mental health in the workplace. This article addresses the ethical concerns and potential legal implications of psychiatrist and employee role ambiguity (e.g., "mutual deception"); describes the elements common to psychiatric examinations in this setting; offers one way to provide information and documentation of a confidentiality waiver; reviews some differences between psychiatric and general medical IME evaluations; discusses interview and report record "ownership"; reviews dangerousness assessment strengths and limitations; and addresses treatment and restoration to fitness issues.     

Toward guidelines for the ethical reanalysis and reinterpretation of another's research

Reanalysis and reinterpretation occur when a person other than the original investigator obtains an epidemiologic data set and conducts analyses to evaluate the quality, reliability or validity of the dataset, methods, results or conclusions reported by the original investigator. We propose ethical guidelines with regard to the duty of original investigators to cooperate with competent impartial reanalysis and for the sponsors of reanalysis and reinterpretation and the epidemiologists who carry it out. The rights and interests of these parties and of the public interest need to be protected.     

Toward a high performance health system: the Commonwealth Fund's new commission

Continuing its historical role of bridging the worlds of health services research and health policy, the Commonwealth Fund recently established the Commission on a High Performance Health System to stimulate transformation at this critical juncture in U.S. health care. Double-digit increases in health insurance premiums, rising numbers of people without insurance, and unequal access to safe, effective care indicate the strong need for improved health system performance. Through coordinated program components focused on coverage, quality, and efficiency, the commission seeks to forge consensus on policy options and to spread innovation, making high-quality health care accessible and affordable for all Americans.