Health care analysis : HCA : journal of health philosophy and policy
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Bengt Brülde in his article "The Goals of Medicine. Towards a Unified Theory" has proposed a normative theory of the goals of medicine within which the concept of quality of life plays a crucial role. ⋯ I do this mainly in two respects. (1) Following the nomenclature in a previously published article (Nordenfelt, 1998) I propose a systematic conceptual framework for all varieties of health enhancement and distinguish different notions of medicine within this framework. A consequence of this analysis is, for instance, that the means and also the immediate goals of medicine in its broadest sense are more diversified than the means and immediate goals of medicine in its narrowest sense. (2) From this position I expand the topic further by comparing medicine and health enhancement with social welfare and try to trace the basic features between--as well as the common properties of--these different enterprises.
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This paper presents a reading of the transcripts of interviews with NHS Trust Chief Executives. Using a poststructuralist understanding of the interviews, it privileges a reading that (ironically) represents these Chief Executives as heroes. ⋯ One way in which these stories can be understood to have significance is that they (misleadingly but powerfully) portray management as obvious and necessary by evocatively drawing on a myth of ancient origin. The piece concludes with some reflections on the ontological implications of the analysis and reflexive comments on the production of truth as a problem.
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In the practice of medicine there has long been a conflict between patient management and respect for patient autonomy. In recent years this conflict has taken on a new form as patient management has increasingly been shifted from physicians to insurers, employers, and health care bureaucracies. The consequence has been a diminishment of both physician and patient autonomy and a parallel diminishment of medical record confidentiality. ⋯ The traditional criterion for overriding the consent requirement has been that without the override some harm would directly result. This rule is now challenged by the claim that patients have a duty to make their records available for a wide range of research and public health purposes. The longstanding tension between physician responsibility for patient welfare and respect for patient autonomy is being replaced by a debatable requirement that both physician and patient autonomy be subordinated to the goals of data collection and analysis.