Introduction: Previous studies have measured individuals’ willingness to share personal information stored in an electronic health record (EHR) with healthcare providers. But none have measured preferences when patients’ choices determine access by healthcare providers. -/- Methods: Patients were given the ability to control the access of doctors, nurses or other staff in a primary care clinic to personal information stored in an EHR. Patients could restrict access to all personal data or to specific types of sensitive information, and could restrict (...) access for a specific time period. Patients also completed a survey regarding their understanding and opinions regarding the process. -/- Results: Of 139 eligible patients who were approached, 105 (75.5%) were enrolled and preferences were collected from 105 of them (100%). Sixty patients (57%) did not restrict access by any providers. Of the 45 patients (43%) who chose to limit the access of at least 1 provider, 36 restricted access only to all personal information in the EHR, while 9 restricted access of some providers to a subset of the their personal information. Thirty-four (32.3%) patients blocked access to all personal information by all doctors, nurses, and/or other staff; 26 (24.8%) blocked access by all doctors and/or nurses, and 5 (4.8%) denied access to alldoctors, nurses, and staff. -/- Conclusions: A significant minority of patients chose to restrict access by their primary care providers to personal information contained in an EHR, and few chose to restrict access to specific types of information. More research is needed to identify patient goals and understanding when facing decisions of this sort, and to identify the impact of educating patients regarding information contained in the EHR and its use in clinical care. (shrink)
Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)
The objective of this study was to take a closer look at defense-related expenses for medical malpractice cases over time. We conducted a retrospective review of medical malpractice claims reported to the Physician Insurers Association of America's Data Sharing Project with a closing date between January 1, 1985 and December 31, 2008. On average a medical malpractice claim costs more than $27,000 to defend. Claims that go to trial are much more costly to defend than are those that are dropped, (...) withdrawn, or dismissed. However, since the overwhelming majority of claims are dropped, withdrawn, or dismissed, the total amount spent to defend them surpasses that spent on claims that go to trial. Defense attorney expenses account for the majority of defense-related expenses (74%), while expert witness expenses and other expenses split the remaining 26%. A strong association was also found between the average indemnity payment and the amount it costs to defend individual claims by specialty. Our study found that defense-related expenses for medical malpractice claims are not an insignificant cost. As state and federal governments debate how to repair the malpractice system, addressing the high cost of defending claims should not be ignored. (shrink)
The lattice of r.e. equivalence relations has not been carefully examined even though r.e. equivalence relations have proved useful in logic. A maximal r.e. equivalence relation has the expected lattice theoretic definition. It is proved that, in every pair of r.e. nonrecursive Turing degrees, there exist maximal r.e. equivalence relations which intersect trivially. This is, so far, unique among r.e. submodel lattices.
Humanism built Western civilization as we know it today. Its achievements include the liberation of the individual, democracy, universal rights, and widespread prosperity and comfort. Its ambassadors are the heroes of modern culture—Erasmus, Holbein, Shakespeare, Velázquez, Descartes, Kant, Freud. Those who sought to contain humanism’s pride within a frame of higher truth—Luther, Calvin, Poussin, Kierkegaard—could barely interrupt its torrential progress. Those who sought to reform humanism’s tenets from within—Marx, Darwin, and Nietzsche—were tested by the success of their own prophecies. So (...) runs the approved view. It is not shared by John Carroll. Instead, Carroll articulates a disruptive and compelling alternative narrative of the course of Western civilization since the Renaissance and the Reformation contrived to unleash reason, will, and a superhuman man on the world. The West’s five-hundred-year experiment with humanism has failed, he maintains in this bracing study of humanism’s rise to preeminence and its headlong tumble into contradiction, because humans ultimately need some kind of contact with a higher, or metaphysical, order beyond the confines of their time-bound, mundane selves. And if this wasn’t entirely clear before September 11, 2001, Carroll concludes, it surely is now. His provocative and brilliant arguments will challenge received wisdom on every side. (shrink)
Pack includes 2 titles from the popular Blackwell Philosophy Anthologies Series: _ _ Philosophy of Literature_: Contemporary and Classic Readings_ _Edited by Eileen John and Dominic McIver Lopes ISBN: 9781405112086 _ Philosophy of Film and Motion Pictures_: An Anthology _Edited by No ë l Carroll and Jinhee Choi ISBN: 9781405120272.
In this article we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (...) (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research. (shrink)
This study examined the emergence of corporate social responsibility (CSR) as a public issue over 25 years using a content analysis of two national news- papers and seven regional, geographically-dispersed newspapers in the U.S. The present study adopted a comprehensive definition encompassing all four CSR dimensions: economic, ethical, legal, and philanthropic. This study examined newspaper editorials, letters to the editor, op-ed columns, news analyses, and guest columns for three aspects: media attention, media prominence, and media valence. Results showed an increase (...) in the number of opinion pieces covering CSR issues over the 25-year period. The prominence of each of the four CSR dimensions varied over time. Each of the four CSR dimensions had its moment of media prominence when it was more important than the other dimensions. The most prevalent valence of the opinion pieces was negative; the volume of negative pieces increased over the 25 years, whereas the number of opinions with positive, neutral, and mixed tones showed little change over time. The study concludes by tracing the implications of the role of the news media for business ethics research. (shrink)
Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)
American health policy today faces dual problems of too little health coverage at too high a cost. The mix of public and private financing leaves about one seventh of the population without any insurance coverage. At the same time, the coverage Americans do have costs an ever-larger share of our country's productive capacity. This "paradox of excess and deprivation" results from the incremental approach the U.S. has taken to promoting incompatible policy goals of increasing health insurance coverage and medical quality (...) while trying to control costs, without squarely confronting tradeoffs. This essay examines the record of incremental developments and draws lessons for current efforts at reform. (shrink)
The effect of lactation on menstrual cycles, ovulation and conception was studied in a group of non-contracepting Amerindian Mopan Mayan women. Anthropological observations of relevant events were made over a 21-month period. Blood samples were assayed to determine the plasma concentrations of prolactin, luteinising hormone, follicle stimulating hormone, human chorionic gonadotrophin, placental lactogen, oestrogen, progesterone and cortisol. The data show that: frequent and prolonged breast-feeding was associated with a marked increase in plasma prolactin concentrations to levels similar to those in (...) lactating Gaing but higher than those in lactating Scottish women; ovulatory menstrual cycles and pregnancy occurred during frequent lactation; in lactating menstruating women there was an inverse correlation between fat weight and months post-partum. These data suggest that other factors as well as suckling account for the effects of lactation on fecundity. (shrink)
In this paper, we examined how companies are employing new media to engage in dialogue with their stakeholders about corporate social responsibility -related matters. Through a qualitative theory-building study conducted in three stages over a period of 2 years, we discovered that corporations with reputations for CSR have built virtual spaces for dialogue about CSR, but that these spaces remain empty of dialogue. Our theory-building model highlights how the mix of four dialogue processes may allow companies to create open dialogue (...) about CSR initiatives and avoid leaving these spaces empty. Contributions for CSR studies are discussed. (shrink)