Health care analysis : HCA : journal of health philosophy and policy
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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.
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This paper challenges the view, commonly held in biolaw and bioethics, that there can be no proprietary rights in our own bodies or body parts. Whether the starting point is the post-intervention informed consent regime of Article 22 of the Convention of Human Rights and Biomedicine or the traditional (exclusionary) understanding of private property it is argued that property in our own bodies or body parts is presupposed. Although these arguments do not demonstrate that there is property of this kind (for that, a full-scale justification of the institution of private property would be required), they suggest nevertheless that the commonly held view has an immanent property logic that has not yet been drawn out or appreciated.
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Last year (1998) saw the celebration of the 50th Anniversary of the British National Health Service (NHS). One of the few completely nationalized systems of health care in the world, the NHS is seen by many as a moral beacon of what it means to provide equitable medical treatment to all citizens on the basis of need and need alone. However, others argue that it has failed to achieve the overall goals for which it was created. ⋯ Scarce resources are the key problem facing the NHS, making rationing inevitable and it is shown that this is not incompatible with the moral foundations of the service. However, there can be little doubt that the NHS is now becoming dangerously under-funded. The paper concludes with arguments about why this is so and what might be done about it.
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Historical Article
What is primary care? Developments in Britain since the 1960s.
Since 1994, health policy in the UK has focused explicitly on making the NHS 'primary care-led'. However, the meaning of primary is contested by different health professions and by policy-makers. This paper charts the major points of debate since the 1960s and suggests that there are limitations as to what general practice can be expected to deliver in respect of primary care.