There is very little literature on the actual decision-making frameworks used by general practitioners with respect to ethical issues and virtually none on the impact of personal experiences of illness on this. This study aimed to investigate what these frameworks might be and if and how they were altered by doctors’ own illness experience. Twenty general practitioners were recruited, 10 having had a previous serious medical illness and 10 having no such history. They participated in a semi-structured interview, including case (...) vignettes, recorded and analysed using qualitative thematic analysis. Being a patient themselves altered general practitioners’ decision-making by enhancing physician empathy, increasing ease at discussing difficult topics, having a greater willingness to support patient choice and a wider ability to provide a greater diversity of therapeutic strategies, with the role of empathy being the most noticeable difference between the groups. Doctors who had not had a severe personal illnes... (shrink)

This study examined the challenges for supervisors and managers of managing sick leave within a New Zealand university. We used a qualitative research design, interviewing 20 university staff across the academic and service divisions who had managerial roles. We applied Habermas’ distinctions of technical instrumental, practical relational, and emancipatory critical transformative interests, and his twofold distinction of system and lifeworld to our analysis. The primary findings suggest that while the technical instrumental discourses were dominant within the university bureaucracy, managers drew (...) upon practical relational and emancipatory critical transformative discourses to justify the considerable discretion they exercised in managing sick leave. Far from being incidental, these humanistic elements are as much a part of the bureaucracy as the rational elements and are fundamental to the system’s equilibrium. (shrink)

In the United States, disease screening is offered to the public as a consumer service. It has been proposed that the act of “consumption” is a manifestation of agency and that the decision to consume is an exercise of autonomy. The enthusiasm of the American public for disease screening and the expansion in the demand for all sorts of disease screening in recent years can be viewed as an expression of such autonomy. Here, we argue that the enthusiasm for disease (...) screening witnessed in the American public today may be more a reflection of the constraint on autonomy than its facilitation. It is our opinion that the articulation of socio-historical processes has contributed to a moral imperative which is reflected in the decision making of individuals around disease screening. We suggest medical and health professionals have a responsibility to facilitate the exercise of individual autonomy in health care decision making as an integral component of professional obligation. These professionals need to problematise healthcare activities that constrain individual autonomy. (shrink)