Journal of medical ethics
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Journal of medical ethics · Sep 2009
A note on Brock: prioritarianism, egalitarianism and the distribution of life years.
The moral philosopher Dan Brock has argued that equality of health outcomes "even if achievable" is problematic as a goal in its own right-because it is open to the levelling down objection. The levelling down objection to egalitarianism has received surprisingly little attention in the bioethics literature on distribution of health and healthcare and deserves more attention. This paper discusses and accepts an example given by Brock showing that prioritarianism and egalitarianism may judge distributions of health outcomes differently. ⋯ Levelling down is not an embarrassment for egalitarians if they adopt a pluralist theory that integrates fairness with goodness. Equality is not the only value egalitarians promote. But equality is so important that we should not reject it.
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Journal of medical ethics · Sep 2009
Nursing in asylum seeker detention in Australia: care, rights and witnessing.
The system of asylum seeker detention in Australia is one in which those seeking refuge are stripped of many of their rights, including the right to health. This presents serious ethical problems for healthcare providers working within this system. In this article we describe asylum seeker detention and analyse the role of nurses. We discuss how far an "ethics of care" and witnessing the suffering of asylum seekers can serve to improve their situation and improve ethical nursing practice.
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Journal of medical ethics · Aug 2009
Multicenter StudyThe principle of justice in patient priorities in the intensive care unit: the role of significant others.
Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. ⋯ The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers' professional and personal values, attitudes and interests.
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Journal of medical ethics · Aug 2009
Judgement of suffering in the case of a euthanasia request in The Netherlands.
In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. ⋯ When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient's suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia.
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This paper argues that the provider conscience regulation recently put into place in the USA is misguided. The rule is too broad in the scope of protection it affords, and its conception of what constitutes assistance in the performance of an objectionable procedure reveals that it is unworkable in practice. ⋯ Finally, the rule allows providers to refuse even to discuss "objectionable" options with patients and serves to protect discriminatory refusals of medical care. For all of these reasons, this regulation is unwise.