Online research in philosophy

Changes in modern societies originate the perception that ethical behaviour is essential in organization’s practices especially in the way they deal with aspects such as human rights. These issues are usually under the umbrella of the concept of social responsibility. Recently the Report of the International Bioethics Committee of UNESCO on Social Responsibility and Health has addressed this concept of social responsibility in the context of health care delivery suggesting a new paradigm in hospital governance. The objective of this paper (...) is to address the issue of corporate social responsibility in health care, namely in the hospital setting, emphasising the special governance arrangements of such complex organisations and to evaluate if new models of hospital management (entrepreneurism) will need robust mechanisms of corporate governance to fulfil its social responsiveness. The scope of this responsible behaviour requires hospitals to fulfil its social and market objectives, in accordance to the law and general ethical standards. Social responsibility includes aspects like abstention of harm to the environment or the protection of the interests of all the stakeholders enrolled in the deliverance of health care. In conclusion, adequate corporate governance and corporate strategy are the gold standard of social responsibility. In a competitive market hospital governance will be optimised if the organization culture is reframed to meet stakeholders’ demands for unequivocal assurances on ethical behaviour. Health care organizations should abide to this new governance approach that is to create organisation value through performance, conformance and responsibility. (shrink)

Explicit forms of rationing have already been implemented in some countries, and many of these prioritization systems resort to Norman Daniels’ “accountability for reasonableness” methodology. However, a question still remains: is “accountability for reasonableness” not only legitimate but also fair? The objective of this paper is to try to adjust “accountability for reasonableness” to the World Health Organization’s holistic view of health and propose an evolutionary perspective in relation to the “normal” functioning standard proposed by Norman Daniels. To accomplish this (...) purpose the authors depart from the “normal” functioning standard to a model that promotes effective opportunity for everyone in health care access, because even within the “normal” functioning criteria some treatments and medical interventions should have priority upon others. Equal opportunity function is a mathematical function that helps to hierarchize moral relevant necessities in health care according to this point of view. It is concluded, first, that accountability for reasonableness is an extremely valuable tool to address the issue of setting limits in health care; second, that what is called in this paper “equal opportunity function” might reflect how accountability for reasonableness results in fair limit-setting decisions; and third, that this methodology must be further specified to best achieve fair limit-setting decisions. Indeed, when resources are especially scarce the methodology suggested in this paper might allow not only prioritizing in an “all or nothing” basis but can contribute to a hierarchy system of priorities in health care. (shrink)

The lack of economic sustainability of most healthcare systems and a higher demand for quality and safety has contributed to the development of regulation as a decisive factor for modernisation, innovation and competitiveness in the health sector. The aim of this paper is to determine the importance of the principle of public accountability in healthcare regulation, stressing the fact that sunshine regulation—as a direct and transparent control over health activities—is vital for an effective regulatory activity, for an appropriate supervision of (...) the different agents, to avoid quality shading problems and for healthy competition in this sector. Methodologically, the authors depart from Kieran Walshe’s regulatory theory that foresees healthcare regulation as an instrument of performance improvement and they articulate this theory with the different regulatory strategies. The authors conclude that sunshine regulation takes on a special relevance as, by promoting publicity of the performance indicators, it contributes directly and indirectly to an overall improvement of the healthcare services, namely in countries were citizens are more critical with regard to the overall performance of the system. Indeed, sunshine regulation contributes to the achievement of high levels of transparency, which are fundamental to overcoming some of the market failures that are inevitable in the transformation of a vertical and integrated public system into a decentralised network where entrepreneurialism appears to be the predominant culture. (shrink)

O direito à proteçāo da saúde tende hoje a ser considerado como uma conquista civilizacional, o que faz com que a salvaguarda deste direito seja sobretudo uma responsabilidade da sociedade e das suas instituições democráticas. Tal como noutros países ocidentais, a existência em Portugal de um sistema público de proteçāo da saúde enquadra-se nesta dinâmica, sendo esse um factor decisivo para a melhoria sustentada dos indicadores de saúde da população portuguesa. Nessa medida, defende o autor do artigo, a política de (...) saúde deve sempre tentar conciliar os princípios da equidade e da solidariedade com a vontade social, democraticamente determinada, atribuindo um carácter operacional a critérios de justiça social, fundamentais para uma política de protecção da saúde atenta às necessidades básicas dos cidadãos. Por outro lado, reconhece-se também que, não obstante o contributo fundamental do Serviço Nacional de Saúde para a protecção da saúde dos portugueses, a gestão estatal dos serviços públicos se tem revelado pouco eficiente. Daí a necessidade de se promover uma nova cultura na saúde fundada na convergência de dois factores aparentemente irreconciliáveis: a qualidade na prestação de cuidados de saúde e a optimização da utilização dos recursos disponíveis. Para isso, porém, é necessário perceber que a saúde e a sua protecgao são um bem económico altamente dispendioso e não "gratuito", ainda que frequentemente o seja no momento da utilização dos serviços. Daí se deriva também, segundo o autor, a necessidade de se promover a eficiência do ponto de vista económico através da adequada gestão dos recursos financeiros e dos meios humanos e materiais. De facto, mais do que um direito constitucional, a protecção da saúde deve ser considerada como um dos grandes pilares de uma sociedade democrática e plural. /// All countries face the issue of choice in health care. It is one of the main problems of pluralistic societies. Allocation of healthcare resources is clearly associated with the concept of distributive justice. But does justice, in this context, imply the existence of a right to healthcare? And if it does, is it a fundamental right? Moreover, does such a right, if it exists, include all types of healthcare services or should it be limited to selected types only? Thus, choices must be made and priorities must always be set. In the Portuguese Constitutional Law the right to healthcare services is regarded as a fundamental one. But in most European countries the right to healthcare is a social right, politically and not ethically determined. Hence, this issue is one of distributive justice the aim of which is to ensure that everyone has access to necessary care based on the substantive ethical principles of equity and solidarity. The article proposes that resource allocation is paramount in public policy particularly in regard to healthcare. But whatever the healthcare financing model, the problem is that the efficiency of the system might be related to the degree of state intervention on the healthcare market. Moreover, the ethical principles involved in the debate are associated to an agreed definition of human dignity. This concept implies that no citizen should be excluded from the health system due to lack of financial resources. In fact, the full achievement of personal liberty implies equal access to certain basic goods, namely to the healthcare services deemed necessary. (shrink)

Evidence-Based Medicine (EBM) is defined as the conscious, and judicious use of current best evidence in making decisions about the care of individual patients. The greater the level of evidence the greater the grade of recommendation. This pioneering explicit concept of EBM is embedded in a particular view of medical practice namely the singular nature of the patient-physician relation and the commitment of the latter towards a specific goal: the treatment and the well being of his or her client. Nevertheless, (...) in many European countries as well as the United States, this integration of the best evidence from systematic research with clinical expertise and patient values appears to be re-interpreted in light of the scarcity of healthcare resources. The purpose of this paper is double. First, to claim that from an ethical perspective EBM should be a guideline to clinical practice; and second, that in specific circumstances EBM might be a useful tool in macro-allocation of healthcare resources. Methodologically the author follows Norman Daniels' theory of democratic accountability to justify this assumption. That is, choices in healthcare must be accountable by democratic procedures. This perspective of distributive justice is responsible for the scope and limits of healthcare services. It follows that particular entitlements to healthcare — namely expensive innovative treatments and medicines —may be fairly restricted as long as this decision is socially and democratically accountable and imposed by financial restrictions of the system. In conclusion, the implementation of EBM, as long as it limits the access to drugs and treatments of unproven scientific results is in accordance with this perspective. The use of EBM is regarded as an instrument to facilitate the access of all citizens to a reasonable level of healthcare and to promote the efficiency of the system. (shrink)

Introduction: All countries face theissue of choice in healthcare. Allocation ofhealthcare resources is clearly associated withthe concept of distributive justice and to theexistence of a right to healthcare.Nevertheless, there is still the question ofwhether this right should include all types ofhealthcare services or if it should be limitedto selected types. It follows that choices mustbe made, priorities must be set and thatefficiency of healthcare services should bemaximum.

In congenitally or prelingually deaf childrencochlear implantation is open to seriousethical challenge. The ethical dimension ofthis technology is closely related to both asocial standard of quality of life and to theuncertainty of the overall results of cochlearimplantation. Uncertainty with regards theacquisition of oral communicative skills.However, in the western world, available datasuggest that deafness is associated with thelowest educational level and the lowest familyincome. Notwithstanding the existence of aDeaf-World, deafness should be considered as ahandicap. Therefore, society should provide themeans for the (...) fulfilment of a deaf child'sspecific needs.For the time being there is no definitiveanswer with regard the best way to rehabilitatea particular deaf child. Therefore,communitarian values may be acceptable. If thedeaf child parents' decide not to implant,their decision should be respected. Guardiansare entitled to determine which standard ofbest interest to use in a specificcircumstance. They are the proper judges ofwhat (re)habilitation process is best for theirdeaf child. However, most deaf children areborn to two hearing parents. Probably, theywill not be acculturated in the Deaf-World. Itfollows that cochlear implantation is awelcomed (re)habilitation technology.If auditory (re)habilitation will in the futureprovide the necessary communicative skills, inparticular oral language acquisition, customs,values and attitudes of the hearing worldshould be regarded as necessary to accomplish adeaf child's right to an open future. Ifcochlear implantation technology will provideall deaf children with the capacity to developacceptable oral communicative skills –whatever the hearing status of the family andthe cultural environment – then auditory(re)habilitation will be an ethical imperative. (shrink)