Social science & medicine
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Social science & medicine · Dec 2013
Bioethics and religious bodies: refusal of blood transfusions in Germany.
The refusal of medical treatment is a recurrent topic in bioethical debates and Jehovah's Witnesses often constitute an exemplary case in this regard. The refusal of a potentially life-saving blood transfusion is a controversial choice that challenges the basic medical principle of acting in patients' best interests and often leads physicians to adopt paternalistic attitudes toward patients who refuse transfusion. However, neither existing bioethical nor historical and social sciences scholarship sufficiently addresses experiences of rank-and-file Witnesses in their dealings with the health care system. ⋯ It shows how bioethical challenges are solved in practice by some German physicians and what they perceive to be the main goal of biomedicine: promoting the health or broadly understood well-being of patients. I argue that two different understandings of the concept of autonomy are at work here: autonomy based on reason and autonomy based on choice. The first is privileged by German physicians in line with a Kantian philosophical tradition and constitutional law; the second, paradoxically, is utilized by Jehovah's Witnesses in their version of the Anglo-Saxon Millian approach.
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Social science & medicine · Dec 2013
Village characteristics and health of rural Chinese older adults: examining the CHARLS Pilot Study of a rich and poor province.
Community (or village) characteristics have received growing attention as researchers have sought factors affecting health. This study examines the association between a variety of environmental, economic, and social village characteristics and health of Chinese older rural adults with health measured in terms of physical limitations. The Chinese Health and Retirement Longitudinal Survey (CHARLS) Pilot Study data were used. ⋯ At the village-level, decreased risk of limitations was associated with a continuous supply of electricity, not using coal in the household, the existence of a sewage system, low cost of electricity, and village wealth. Decreased risk of physical limitations was also associated with various characteristics of China's New Cooperative Medical Scheme (NCMS), an insurance program for rural older adults. Policy implications for improved health of rural older adults include: (1) continued use of China's NCMS, (2) establishment of village sewage systems, (3) ending the use of coal in the home, and (4) increased educational opportunities focused on health.
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Social science & medicine · Dec 2013
India's "tryst" with universal health coverage: reflections on ethnography in Indian health policymaking.
In 2011, India stood at the crossroads of potentially major health reform. A High Level Expert Group (HLEG) on universal health coverage (UHC), convened by the Indian Planning Commission, proposed major changes in the structure and functioning of the country's health system. ⋯ It theorizes that international discourses have been (re)appropriated in the Indian case by recourse to both experience and evidence, resulting in a plurality of concepts that could be prioritized for Indian health reform. This articulation involved HLEG members exerting para-ethnographic labour and paying close attention to context, suggesting that ethnographic sensibilities can reside within the interactive and knowledge production practices among experts oriented toward policy change.