Over the past few years, intercultural health has become an emerging issue in health policy. Intercultural health is an approach in health that aims at reducing the gap between indigenous and western health systems, on the basis of mutual respect and equal recognition of these knowledge systems. This article questions the applicability of such a concept in the context of Chile. Here, conflicting interests between the Mapuche and the Chilean state are related to (...) aspects of economic development, modernity processes, integration, intercultural relations, and indigenous rights and are deeply reflected also in projects for an intercultural health system. By analysing the experience of the intercultural practice of Makewe Hospital, this article argues that effective and equitable intercultural health practices will not take place unless there will be an integral valorisation of the Mapuche culture from a broader perspective. (shrink)

Este artículo tiene como objetivo sistematizar los avances del enfoque narrativo en bioética con el fin de proponer una fundamentación de las prácticas de salud intercultural que facilite su complementariedad con el conjunto del sistema sanitario. Para ello revisará críticamente los fundamentos de la bioética narrativa y su vinculación con las corrientes hermenéuticas en las éticas aplicadas y con el movimiento de la medicina narrativa. A la vez relacionará el enfoque narrativo con el paradigma intercultural en salud, en (...) orden a evaluar sus capacidades de complementación y articulación con la sabiduría ancestral mapuche, desde su raigambre y especificidad. Finalmente informará sobre las posibilidades de desarrollo de una bioética narrativa en clave intercultural, adecuada a las prácticas en el ámbito sanitario que se basan en el acervo de la sabiduría ancestral mapuche. This article aims to systematize the progress of the narrative approach in bioethics in order to propose a groundwork for intercultural health practices. Seeks propose a basis for intercultural health practices that facilitate the complementarity of the health system through the recovery of ancestral Mapuche Worldview, their roots and specificity. It will critically review the basics of narrative bioethics and its relationship with the hermeneutical currents in applied ethics and the movement of Narrative Medicine. At the same time relates the narrative approach to the intercultural paradigm in health, in order to assess its capabilities complementation and articulation. And finally it will report on the possibilities of developing an intercultural key Narrative Bioethics appropriate to the intercultural practices in health care based on the acquis of the Mapuche Ancestral Wisdom. (shrink)

Concerns about intercultural communication practices in child and family health were raised during a South Australian ethnographic study. The family partnership model was observed as a universal pedagogic tool introduced into the host organisation in 2003. It has a role in shaping and reshaping cultural production within child health practice. In this study, we draw on insights from postcolonial feminist scholarship together with three‐body analysis to critique the theoretical canons of care that inform intercultural communication (...) in the child and family health setting.We contend that although the family partnership model may be very useful, its intended universal application is problematic in the context of multiculture. Issues of race, gender and class were seemingly unattended when using a communication approach based in historical scientific rationalism. Liberal interpretations of discourses of equity and empathy arising out of contemporary models of communication were often adopted by child and family health nurses and protected them from seeing the inherent binaries that constrain practice. Insights from postcolonial feminist thinking enabled us to recognise the problems of applying theory to practice in a linear fashion. We demonstrate the use of three‐body analysis as a deconstruction strategy to refigure how theory might be understood and worked with in the multiculture that is Australia. (shrink)

This study presents a first assessment of the challenges faced by Dutch health care providers dealing with the increasing cultural diversity in Dutch society. Qualitative interviews with 24 Dutch caregivers and policy-makers point to a number of important difficulties encountered when confronted with the growing diversity of patient populations. The study focuses explicitly on the challenges health care providers perceive in their direct interactions with patients. On the basis of the observations of the 24 respondents five strategies were (...) formulated to improve the delivery of care in a multicultural environment. Their findings were further evaluated by confronting the empirical data with care-ethical notions (attentiveness, responsibility, competence, and responsiveness) and intercultural communication-theory. (shrink)

This study presents a first assessment of the challenges faced by Dutch health care providers dealing with the increasing cultural diversity in Dutch society. Qualitative interviews with 24 Dutch caregivers and policy-makers point to a number of important difficulties encountered when confronted with the growing diversity of patient populations. The study focuses explicitly on the challenges health care providers perceive in their direct interactions with patients. On the basis of the observations of the 24 respondents five strategies were (...) formulated to improve the delivery of care in a multicultural environment. Their findings were further evaluated by confronting the empirical data with care-ethical notions (attentiveness, responsibility, competence, and responsiveness) and intercultural communication-theory. (shrink)

Over the last two decades or so, the need to decolonise bioethics and make it inclusive, equitable and accommodative of voices from the traditionally marginalised global South has received increasing attention in academic scholarship. The recent publication by Pratt and de Vries offers a very comprehensive critical analysis and thoughtful overview of the issue, using global health ethics as its starting point.1 I fundamentally agree with their characterisation of the issue as an ‘epistemic justice’ problem. I further find their (...) recommended conceptual and practical ideas for measuring epistemic injustice and ethical responsibilities to promote epistemic justice very thoughtful and insightful. However, I find their responses to possible objections to their arguments a bit hasty and unclear, especially the idea that ‘greater epistemic justice calls for global health ethics to advance a transcultural framework of ethical values and principles’ (p. 7). They look ambiguous on their position on the fundamental global bioethical question regarding the possibility of an intercultural ethical framework. I think the question of whether there are global ethical values and principles that are commonly shared among human beings in the global world is a fair and legitimate issue that deserves deep attention and a persuasive answer by those who call for more inclusive and equitable global bioethics. I attempt to flesh out this issue in a bit more detail to further enrich the discussion. Pratt …. (shrink)

– This paper aims to examine the present status of the research field intercultural information ethics including the foundational debate as well as specific issues., – A critical overview of the recent literature of the field is given., – The present IIE debate focuses on a narrow view of the field leaving aside comparative studies with non‐digital media as well as with other epochs and cultures. There is an emphasis on the question of privacy but other issues such as (...) online communities, governmentality, gender issues, mobile phones, health care and the digital divide are on the agenda., – The paper addresses basic issues of IIE that may open new vistas for research and practice in this field. (shrink)

The metaphor of host and guest has value for exploring the practice and role identity of nurses on inpatient mental health units. Two complementary texts, one from the ancient Zen record of Lin‐chi, and the other from the contemporary hermeneutic philosopher Richard Kearney, are used to elaborate meanings of host and guest that can be applied to the situation of mental health nurses. In a doctoral study with a hermeneutic design, I addressed the topic of nurse–patient relationship using (...) an interpretive framework that included sources from Buddhist thought. The positions of host and guest emerged from interviews with nurses as one interpretive theme to open up new understanding of the topic. The two texts, originally distant in era and culture, both employ the host and guest metaphor. They are applied to extracts from interviews to open up discussions of hierarchy, status, patients' perspectives, otherness and resistances as features of nurses' complex experience. These provide insights into understanding practice and suggest implications for how institutional environments shape practice. An intercultural reading of texts can provide a source of new understanding of nurse–patient relationships. (shrink)

Based on an empirical study regarding ethical challenges within intercultural health care, the focus of this article is upon autonomy and disclosure, discussed in light of philosophy and anthropology. What are the consequences for patients if the patients’ right to be autonomous and to participate in treatment and care decisions by health care workers is interpreted as an obligation to participate? To force a person to make independent choices who is socio-culturally unprepared to do so, may violate (...) his/her integrity. This may in turn jeopardise the respect, integrity and human worth the principle of autonomy was meant to ensure, and if so, may damage any relationship of trust that may exist between patient and health care worker. There is necessarily a link between autonomy and disclosure. Western disclosure practices may make the relationship between patients and health care workers difficult -- even distrustful. To confront a patient with a very serious diagnosis may be seen not only as a tactless action, but also an unforgivable one. Hence, among many ethnic groups it is a family member’s duty to shield patients from bad or disquieting news, e.g., a cancer diagnosis. If a family member is used to interpret in such situations, will the information given equal the information communicated by that interpreter? Even though respect for a person’s autonomy is part of the respect for a person, one’s respect for the person in question should not depend on his/her ability or aptitude to act autonomously. (shrink)

English translation by Glenn H. Shepard Jr. Revision by Matthew MeyerThis article reports on the recent “International Congress of Traditional Medicine, Interculturality, and Mental Health” held by the Takiwasi Center in Tarapoto in the Peruvian Amazon. The event united 218 researchers and indigenous and religious representatives from 22 countries to present results of scientific discussions and engage in political and ethical debates surrounding the increasingly globalized, transnational, and biomedicalized reach of indigenous medical practices, especially ayahuasca-based therapy and religious (...) practice. The author interviewed several key researchers and representatives present at the event, and presents several important controversies in the field of ayahuasca and traditional medicine. She also reports on the colorful and eclectic nonacademic sessions at the event which included Inca chiropractics, ayahuasca sessions, and various forms of indigenous medicine. The text also reflects on the tragic events that unfolded in nearby Bagua, Peru, on the evening of the meeting, bringing a special urgency to the event's focus on indigenous cultural heritage. (shrink)

The exportation of Western biomedicine throughout the world has not resulted in a systematic homogenization of scientific ideology but rather in the proliferation of many forms and practices of biomedicine. Similarly, in the last decade, bioethics has become increasingly an international enterprise. Although there may be consensus regarding the inherent value of ethical discourse as it relates to health and medical care, there are disagreements about the nature and parameters of medical morality. This lack of consensus exists because (...) our beliefs about morality are culturally constituted, embedded in social, religious, and political ideologies that influence particular individuals and communities at specific historical moments. (shrink)

The exportation of Western biomedicine throughout the world has not resulted in a systematic homogenization of scientific ideology but rather in the proliferation of many forms and practices of biomedicine. Similarly, in the last decade, bioethics has become increasingly an international enterprise. Although there may be consensus regarding the inherent value of ethical discourse as it relates to health and medical care, there are disagreements about the nature and parameters of medical morality. This lack of consensus exists because (...) our beliefs about morality are culturally constituted, embedded in social, religious, and political ideologies that influence particular individuals and communities at specific historical moments. (shrink)

Workplace politeness concerns the structural, interactional and individual level. Using the example of mobbing, it is illustrated how small acts of impoliteness can lead to the destruction a person psychologically and physically. Particularly, so-called downward mobbing is an increasing problem worldwide; most of the cases are orchestrated by superiors, the people subordinates depend on the most. Data clearly illustrate the social toxin created by up to 45 seemingly small actions in five areas of work life. These actions result in (...) class='Hi'>health hazards and ultimately loss of jobs. By example of workplace harassment, it is illustrated how systematic acts of impoliteness are used to manipulate a person's emotion and identity, to ensure anxiety-born solidarity in others while abusing power, with high costs for the target, the organisation, and society. The discussion gives way to considerations about intercultural cooperation at the workplace, showing similarities between subtle devaluations in intercultural communication called microaggression and what has been discussed as mobbing. Overall, impoliteness is deconstructed as a sign of degrading social bonds, security and health, thereby raising awareness of the importance of intercultural interaction without microaggression. The practical value of linguistic impoliteness research and its connection to work psychology becomes apparent. (shrink)

Many people in the developing world access essential health services either partially or primarily through programs run by international non-governmental organizations (INGOs). Given that such programs are typically designed and run by Westerners, and funded by Western countries and their citizens, it is not surprising that such programs are regarded by many as vehicles for Western cultural imperialism. In this chapter, I consider this phenomenon as it emerges in the context of development and humanitarian aid programs, particularly those delivering (...) medical treatment, nutrition and access to clean water. I argue that in order to avoid contributing to cultural imperialism, INGOs have a duty to ensure that they do not offer services in a way that requires their beneficiaries to choose between accessing essential health services and violating or otherwise undermining traditional norms and practices which have significance for their beneficiaries. Following Onora O'Neill, I argue that offers requiring such a choice are effectively “unrefuseable” and so coercive. INGOs therefore, must avoid making such offers, and can accomplish this by means of an iterated process of reciprocal negotiation under conditions of equality, in which both the INGOs’ and the beneficiaries’ deep values and concerns play a role. In essence, I claim that employing such a process is a requirement of procedural justice, given the non-ideal conditions in which INGOs must operate. (shrink)

The fourteen authors in this collection used phenomenology and hermeneutics to conduct deep inquiry into perplexing and wondrous events in their work and personal lives. These seasoned scholar-practitioners gained remarkable insight into areas such as health care and illness, organ donation, intercultural communications, high-performance teams, artistic production, jazz improvisation, and the integration of Tai Chi into education. All authors were transformed by phenomenology's expanded ways of seeing and being.

Abstract:Representations of the space of the village, the wilderness, and the overlapping edge of the forest between them often play a critical role in intercultural collisions between the “developing” world's spaces and pressures from the ‘developed’ world's activities within them. These collisions include land grabs and resource extraction, conversion of forest or wilderness to mechanized agriculture, uneven legal disputes over what constitutes ownership and use, and conservation efforts to reduce climate change or restore genetic biodiversity in forests. This study (...) illuminates how the physical and perceptual spaces of village, wilderness, and forest change, resist change, and are forced to change in three key domains: health (traditional medicine), food security (hunting, farming, and resource extraction in general), and use-ownership (as indigenous knowledge, occupancy, and access to land-use generally). Findings from the study disclose a need to include time (as the pace of change) whenever changed perceptions of space are proposed or occur. Recommendations include applying the criterion to strive always for the least disruptive (short-term) procedures for addressing a problem such that those outcomes achieve the most sustainable impacts over the long-term. (shrink)

The fourteen authors in this collection used phenomenology and hermeneutics to conduct deep inquiry into perplexing and wondrous events in their work and personal lives. These seasoned scholar-practitioners gained remarkable insight into areas such as health care and illness, organ donation, intercultural communications, high-performance teams, artistic production, jazz improvisation, and the integration of Tai Chi into education. All authors were transformed by phenomenology's expanded ways of seeing and being.

Increasing privacy concerns are arising from expanding use of aggregated personal information in health practices. Conversely, in light of the promising benefits of data driven healthcare, privacy...

We are in the midst of a crisis of climate change and environmental degradation that will only get worse, unless significant changes are rapidly made. Globally, the healthcare sector causes a large share of our total environmental footprint: 4.4% of greenhouse gases. Sustainable healthcare has emerged as a way for healthcare sectors in high‐income countries to help mitigate climate change by reducing their emissions. Whether global health should be sustainable and what ethical grounds might exist to support such a (...) claim are not questions that have been investigated. The paper argues that global health practice—the delivery of health services to underserved populations in resource‐poor areas of the world—should be sustainable as a matter of climate justice and solidarity. Reducing climate change‐related risks and harms for the vulnerable is integral to the mission of global health and thus it is necessary to consider the climate impact of its practice. The field has a duty to provide sustainable health services that are responsive to climate change‐related changes in the local burden of disease and to build sustainable health system infrastructure. Specific responsibilities for global health funders, managers, and implementers to uphold the duty are proposed. To conclude, the paper considers what limits might be placed on the duty to deliver sustainable global healthcare. (shrink)

The concrete insertion of nurses into the context of an inquiry contributes to empirical evaluation research of health promotion programs. As interveners and concrete actors in social movements, nurses are in a privileged position to give realism to a local understanding of the political and cultural context of evaluative research. Drawing on the practice of empirical evaluation research, this paper seeks to generate new methodological approaches in a way that broadens nursing inquiries in community health nursing. It explores (...) new ways of thinking about epistemology and knowledge production in nursing practice. For 5 months an evaluative research project adopting a participatory‐action research approach was conducted with local community actors in an AIDS prevention project in Amazonas (Brazil) in a prostitution setting. An auto‐ethnographic journal was used as a reflective approach for the critical analysis of nursing research activities. This paper calls for a closer relationship between scientific research settings and the sociopolitical and the sociocultural aspects of nursing practice. It increases an incorporation of popular, social and professional experiential learning and skill acquisition in embedded knowledge production. (shrink)

This article, corresponding to a part of the restitution of a financed international research project between France, Brazil, Canada, Italy and Belgium, aims to offer a modelisation and qualitative evaluation of mediation care settings based on an original methodological tool that involves identifying the typical games at the foundations of creativity, following a multidisciplinary perspective. Therapeutic mediations are settings or devices organised around a “pliable medium”, often artistic, like painting, modeling, writing, ​and theatre, which are very widespread in institutional (...) class='Hi'>practices, both in France and abroad. The scientific objectives of this research consist in a multi-disciplinary exploration (anthropology, criminology, neuroscience, clinical psychology) of the process of creative symbolisation understood as a process of transformation involving play. According to this orientation, play can be defined as a psychic process whereby a subjective experience can be explored with pleasure, and consequently symbolised and appropriated. Our fundamental and original hypothesis is that play is at the source of the creative process, conceived as a work of metabolisation by the psyche of playful experiences during the different stages of life. The review of the understanding of play in psychoanalysis, anthropology, criminology and neuroscience emphasises the richness of this model and the importance of reflecting on the typical games in the field of psychic care. A clinical example of treatment in a pictorial therapeutic mediation setting of a child with psychotic disorders makes it possible to identify a number of typical games as well as the modalities of interpretation of the therapists through play. These multidisciplinary studies lead to the presentation of a general table of typical games, and these first results highlight the richness of identifying typical games in clinical settings. Ultimately, the multidisciplinary approach shows the interest of the model of play in the evaluation of therapeutic mediation settings, with a convergence of the different disciplines emphasising the pertinence of this model. The scientific impact of this research overlaps with its societal impact, through the development of innovative tools for evaluating therapeutic mediations, in order to take account of the evolution of the different forms of social expression of psychic suffering. (shrink)

What are the Differences between Public Health Practice and Research? This perplexing question constantly arises in the planning and performance of public health activities involving the acquisition and use of identifiable health information. Public health agencies collect and analyze significant identifiable health data from health care providers, insurers, other agencies, or individuals to perform an array of public health activities. These activities include surveillance, epidemiological investigations, and evaluation and monitoring. Few debate that these (...) essential public health activities, often specifically authorized by law, are classifiable as public health practice.Other public health activities in which identifiable health data are acquired or used, however, can resemble, include, or constitute human subjects research. “Human subjects research” is legally defined as “a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge” that involves living human subjects. (shrink)

Stigma can influence the prevention and identification of fetal alcohol spectrum disorder, a leading cause of developmental delay in North America. Understanding the effects of public health practices and policies on stigma is imperative. We reviewed social science and biomedical literatures to understand the nature of stigma in FASD and its relevance from an ethics standpoint in matters of health practices and policies. We propose a descriptive model of stigma in FASD and note current knowledge gaps; (...) discuss the ethical implications of stigma based on two distinct criteria ; and describe two cases and the concerns associated with inadvertent stigmatization by public health initiatives for FASD. We recommend further empirical and ethical analyses to examine whether public health policies and practices inadvertently stigmatize and impact the success of public health initiatives and programs for FASD. (shrink)

In the UK, higher education and health care providers share responsibility for educating the workforce. The challenges facing health practice also face health education and as educators we are implicated, by the way we design curricula and through students’ experiences and their stories.

This article examines the regulation of Latina youth sexualities in the context of sexual and reproductive health care provision. In-depth interviews with health care providers working in two Latino-serving community health centers are analyzed for how they interpret and respond to the sexual and reproductive practices of their low-income Latina teen patients. The author finds that providers emphasize teenage pregnancy as a social problem among this population to the exclusion of other dimensions of youth sexualities and (...) encourage Latina girls’ adherence to a life course trajectory that conforms to middle-class, heteronormative ideals as a solution to this problem. By relying on such understandings, providers construct meanings of sexual citizenship that require participation in bourgeois heteronormativity. These findings suggest that Latino-serving community health centers, their providers, and their teen patients could benefit from questioning the assumptions that inform providers’ appraisals of Latina youth and developing a more inclusive approach to Latina youth sexualities beyond a discourse of pregnancy prevention. Such efforts could allow community health centers to actively participate in disrupting the structural inequalities that shape their young patients’ lives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pains And Gains Of Rural Health Practice:Lessons Books Never TaughtSridevi Seetharam, Bindu Balasubramaniam, G. S. Kumar, and M. R. SeetharamHow The Journey BeganIn the early 1980s, as fresh graduates from Mysore Medical College in southern India, we were brimming with a zeal to "cure the sick" and "change the world." We had an ideal of evidence-based, rational, ethical and equitable health care and set out to serve (...) rural and under-served communities which included displaced forest-based tribes. In the initial years, with the naivety of the inexperienced, we believed that by correcting the dehydration of the doe-eyed six-year-old Mare and giving her a free course of antibiotics, we had made health care accessible to her. Much to our dismay, within a month, Mare was back in the outpatient clinic, with diarrhea all over again and looking thinner than ever. We realized that it was a losing battle to keep her healthy as long as she continued to drink water from the same contaminated stream, live in unhygienic surroundings, and eat only the paltry meals that her family could barely afford. We gradually began to connect these living examples to what our preventive medicine text books had stressed all along—there are many social determinants of health which, if left unaddressed, do not permit realization of the vision of health for all.Such instances continually pulled us out of the hospital building and into the villages and tribal hamlets. We discovered that our textbook of Preventive and Social Medicine (Park, 1986) (P&SM as we used to call it), was our most valuable possession. [End Page 106] We devoured the descriptions of national health programs, sanitation procedures, water treatment protocols, and maintenance of cold chain for vaccines with a completely new perspective. We discovered the Manual of Basic Techniques for a Health Laboratory, (World Health Organization, 1980) detailing how to set up a laboratory with low cost, reliable and simple methods. We learned to drive a jeep to haul supplies and patients. To step up the level of clinical care, some of us pursued post-graduate programs and equipped ourselves to provide more specialized care too. It has been over two decades since we embarked on this journey. We have encountered a variety of perplexing dilemmas with no clear solutions. We have sometimes been compelled to adopt health practices that were not really evidence-based, seemingly irrational, inequitable and even downright unethical. This narration describes only a few of our thousands of cases, and hopefully conveys our periods of self-doubt, despair and hope, as well as, the challenges we face to reconcile with the difficult choices we are forced to make every day.Unforeseen Challenges in Saving Mothers and ChildrenHigh maternal and child mortality rates have been one of the most disturbing aspects of the health care scenario in rural India. To ensure immunization of all children, health workers with vaccine carriers go from village to village and hamlet to hamlet to reach those infants that would have missed visits to the immunization clinics. Our grass-root workers facilitate these visits by identifying households with such children. Occasionally, they encounter families who spirit away the infant into the adjoining woods as soon as the health worker is seen approaching, and blandly proclaim that the child is not at home. Despite reassurance and counseling about the safety and necessity of the vaccine, their apprehensions and misconceptions are insurmountable. What is the extent of the responsibility of the health worker? Is it ethical to hunt down the child and force the administration of the vaccine in view of the public health gains, besides the child's welfare?A few months ago, a pre-term neonate was admitted to our hospital, but worsened and needed referral to a higher centre in the city. The family refused to go despite repeated persuasion and detailed explanation about the technical limitations of care at our centre. From the family's perspective, the variety of social, cultural, and monetary challenges they would face in the city were themselves limitations for care. We were compelled to retain the baby and continue giving the best care we could.Two... (shrink)

Standards for professional training and practice are defined by accrediting organisations or statutory bodies. These describe the arena in which the practitioner may speak with authority. The sphere of authorised practice is further delineated by the external resources available. Within this explicit framework, unconscious mental processes can affect the professional response in potentially adverse ways. This is particularly important in mental health practice. Professionals must be prepared to examine their own responses on this basis in order to enhance their (...) knowledge of the patient and minimise the possibilities of the patient becoming the victim of the professional's own psychopathology. The maintenance of such a position in an institution or organisation requires a similar process within its structure in order to provide the necessary setting and define the limits of good practice. In this paper, the field of adolescent mental health is specifically examined. (shrink)

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon (...) the following set of six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors’empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners. (shrink)

The discursive production of the ‘self in the context of mental health care has potential implications for how the subjects of intervention come to understand and experience themselves. Eating disorders provide an illustrative example of the ways in which conceptualizations of the self that structure mental health practices can be gendered, because they are mainly diagnosed in women and dominant explanations of their origins are feminized. This discourse analytic study examines the gendered nature of mental health (...) workers’ constructions of the eating-disordered self through the psychological construct of ‘identity’, examining the dominant discourses implicated in the feminization of deficient identity, and addressing the implications of this construction for mental health practice. (shrink)

Within an ethics framework, this article explores mental health practitioners' use of credentials that lack acceptable accreditation or authority. Increased competition among mental health care providers has elevated the importance of credentials for marketing professional services. Practitioners worried about economic survival, along with certain personality characteristics (e.g., sheer ego), are tempted to rely on credentials that lack proof of quality, thereby potentially jeopardizing professionalism. Specific assertions and recommendations are set forth in the interest of safe-guarding consumers and promoting (...) professionalism. (shrink)

Two areas of ethical conflict in intercultural nursing — who needs single rooms more, and how far should nurses go to comply with ethnic minority patients’ wishes? — are discussed from a utilitarian and common-sense morality point of view. These theories may mirror nurses’ way of thinking better than principled ethics, and both philosophies play a significant role in shaping nurses’ decision making. Questions concerning room allocation, noisy behaviour, and demands that nurses are unprepared or unequipped for may be (...) hard to cope with owing to physical restrictions and other patients’ needs. Unsolvable problems may cause stress and a bad conscience as no solution is ‘right’ for all the patients concerned. Nurses experience a moral state of disequilibrium, which occurs when they feel responsible for the outcomes of their actions in situations that have no clear-cut solution. (shrink)

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client? How can clinicians refuse costly gifts from clients without damaging the therapeutic relationship? Should a therapist disclose a client's suicidal intent to the authorities? In Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice, these and other real-life scenarios constitute a comprehensive and definitive ethics casebook for mental (...) class='Hi'>health professionals. Inspired by the many difficult situations they themselves have faced, an eminent group of accomplished mental health clinicians provide first-hand accounts of ethical problems that defy boilerplate solutions. Each chapter begins with a compelling and ethically complex case followed by an illustrative yet succinct analysis of the key ethical issues present and a personal reflection on the case itself, along with the process of ethical reasoning used to arrive at a final decision. Every case concludes with key recommendations for promoting ethical practice within an often challenging work setting. Highlighting the human aspect of ethics in mental health practice through the use of mesmerizing narratives while also provoking the reader to reflect upon what is the "right" thing to do, Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice offers trainees and seasoned professionals alike invaluable informative models for dealing with ethical dilemmas, as well as the inspiration to confront seemingly insurmountable clinical problems. (shrink)

What are the Differences between Public Health Practice and Research? This perplexing question constantly arises in the planning and performance of public health activities involving the acquisition and use of identifiable health information. Public health agencies collect and analyze significant identifiable health data from health care providers, insurers, other agencies, or individuals to perform an array of public health activities. These activities include surveillance, epidemiological investigations, and evaluation and monitoring. Few debate that these (...) essential public health activities, often specifically authorized by law, are classifiable as public health practice.Other public health activities in which identifiable health data are acquired or used, however, can resemble, include, or constitute human subjects research. “Human subjects research” is legally defined as “a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge” that involves living human subjects. (shrink)

Privacy must be protected for social reasons. That is what was argued in “Privacy and Health Practices in the Digital Age” (Pyrrho, Cambraia, and de Vasconcelos 2022). Versalovic, Goering, and Klei...

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the (...) field of public health ethics is developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

Attempts to think anew about philosophical questions from the perspective of breath and breathing. As a physiological or biological matter, breath is mostly considered to be mechanical and thoughtless. By expanding on the insights of many religions and therapeutic practices, which emphasize the cultivation of breath, the contributors argue that breath should be understood as fundamentally and comprehensively intertwined with human life and experience. Various dimensions of the respiratory world are referred to as “atmospheres” that encircle and connect human (...) existence, coexistence, and the world. Drawing from a number of traditions of breathing, including from Indian and East Asian religion and philosophy, the book considers breath in relation to ontological, hermeneutical, phenomenological, ethical, and aesthetic concerns in philosophy. The wide-ranging topics include poetry, theater, environmental issues and health, feminism, and media studies. “Atmospheres of Breathing, the first collection of its kind, explores an emerging ‘respiratory philosophy’ of great consequence for philosophy and other fields. Its rich and diverse essays, many written by the pioneers of this radically new direction, show the deep historical and intercultural roots of such a philosophy, ranging from treatments of forerunners like Zhuangzi and Heraclitus to contemporary theorists of breathing such as Abram and Kleinberg-Levin. Presented here is the vision of innovative ways in which philosophy, on its own or inspired by spiritual practices, can bring breathing into the center of its concern. This is a landmark book that scintillates with brilliant and original insights. If taken as seriously as it deserves, this book has the potential to revolutionize contemporary and future thought.” — Edward S. Casey, author of The World at a Glance and The World on Edge “Air, the misunderstood element, finds ways and means of advancing to places where no one reckons with its presence; and, more significantly, it makes space on its own strength for strange places where there were previously none.” — Peter Sloterdijk. (shrink)

Protecting the privacy of individually-identifiable health data and promoting the public’s health often seem at odds. Privacy advocates consistently seek to limit the acquisition, use, and disclosure of identifiable health information in governmental and private sector settings. Their concerns relate to misuses or wrongful disclosures of sensitive health data that can lead to discrimination and stigmatization against individuals. Public health practitioners, on the other hand, seek regular, ongoing access to and use of identifiable health (...) information to accomplish important public health objectives. The collection and use of identifiable health data by federal, tribal, state, and local health authorities support nearly all public health functions and goals.Identifiable health data are the lifeblood of public health practice. When aggregated, these data help authorities monitor the incidence, patterns, and trends of injury and disease in populations. Health data are acquired by public health authorities through testing, screening, and treatment programs. (shrink)

Should mental health insurance cover only disorders found in DSM‐IV, or should it be extended to treatment for ordinary shyness, unhappiness, and other responses to life's hard knocks?

This book draws on both the historical context & contemporary research evidence to present the roles of mental health social work, AMHP & BIA, within an ethical framework. Codes of practice & statutory legal requirements, such as the Mental Health Act, Mental Capacity Act & the Human Rights Act, are all considered.

It appears that there are two distinct practices within public health, namely health promotion and disease prevention, leading to different goals. But does the distinction hold? Can we promote health without preventing disease, and vice versa? The aim of the paper is to answer these questions. First, the central concepts are defined and the logical relations between them are spelt out. A preliminary conclusion is that there is a logical difference between health and disease, which (...) makes health promotion and disease prevention two distinct endeavours. However, since disease is defined in relation to health, as those kinds of internal processes and states that typically lead to ill health, the difference is smaller than it might appear. Second, in order to answer the practical question whether it is possible to promote health without preventing disease, and vice versa, several kinds of public health interventions are discussed. The conclusion is that while health promotion and disease prevention can be distinguished conceptually, they can hardly be distinguished in practice. Most general measures do both at the same time. (shrink)

The public expects members of the medical profession to conduct themselves according to the terms of the Hippocratic oath, yet few physicians and virtually no laypersons know what is in that oath. For the oath to reach beyond its symbolic importance, ethical conduct must be learned and practised. There are many texts on the practice of medicine, surgery and all of the related disciplines, yet one is hard pressed to find anything on ethical practice in any of them. Scholarly texts (...) on ethics tend to deal with the landmark issues and dilemmas that have occurred within particular jurisdictions or religions. This book is intended as a student-friendly text that seeks not to turn students into ethics scholars but to provide them with a practical guide to ethical conduct in everyday medical practice. and discussion are provided for each of the following areas: Ethical Practices in Health Care Law and Ethics Rights of Patients and Responsibilities of Health-Care Providers The Rights of Health-Care Professionals The Duty of Care Confidentiality Consent to Treatment Life and Death Research Ethics Ethics in Public Health Practice Ethical Practice in Everyday Health Care is useful, practical and student friendly. The exercises and discussions will stimulate thought about ethical conduct and help students to develop and translate ethical principles into their daily practice as health-care workers. Dr Walrond offers a ready and concise source of information for medical students on ethical issues. The text is simple, comprehensive and factual, addressing issues encountered in everyday medical practices. Case studies provide practical illustrations of complex ethical issues. (shrink)

The relevance of the study is the need to reform the educational environment based on the values of inclusion to ensure the accessibility of quality education for all people. The purpose of the study is to justify the need an inclusive culture formation as a culture of acceptance of diversity and mutual understanding. The research problem is the lack of development of an inclusive organizational culture is a barrier to ensuring the availability of quality education in a variety of (...) class='Hi'>health limitations and the educational needs of students. The study is based on the analysis of regulatory documents, comparison and generalization of the available approaches in international and Russian theory and practice on the inclusion values issue in the strategy of educational organizations and the formation of an inclusive organizational culture. Results: it was established that the inclusive agenda in education aggravates the problem of the formation of an inclusive organizational culture as a culture of accepting diversity as a value, advantage, significant educational, upbringing, developing resource; staged, the need for a proactive strategy of the formation of intercultural competencies are justified. -/- . (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:In Search of the Good: A Life in Bioethics by Daniel Callahan, and: Why the Church Needs Bioethics: A Guide to the Wise Engagement with Life’s Challenges ed. by John F. Kilner, and: Respecting Life: Theology and Bioethics by Neil MesserAndrea Vicini SJIn Search of the Good: A Life in Bioethics By Daniel Callahan (edited by Arthur Caplan) CAMBRIDGE, MA: MIT PRESS, 2012. XVII + 206 PP. $29.00Why (...) the Church Needs Bioethics: A Guide to the Wise Engagement with Life’s Challenges Edited by John F. Kilner GRAND RAPIDS: ZONDERVAN, 2011. 304 PP. $26.99Respecting Life: Theology and Bioethics By Neil Messer LONDON: SCM PRESS, 2011. XI + 236 PP. $36.20With their specific styles, targeted readerships, and overall goals, these three volumes provide diverse but synergic ways to articulate and expand bioethical reflection in today’s society. Daniel Callahan is undoubtedly one of the founders of the field of bioethics. In Search of the Good: A Life in Bioethics is a fascinating memoir where, in a very engaging and personal way, Callahan unveils his intellectual development, career, and major interests. At the same time, he provides a critical lens to examine the history of bioethics in the United States. It shows his “abiding fascination with the human nature, scope, and validity of ethics as part of human life, and a similar strong interest in the ways that the scientific knowledge of medicine influences how we think about our health and mortality and shapes the ways we live our lives” (xvi). In particular, he describes how his philosophical training, and philosophical mind, led him to address the burgeoning ethical questions in biology and medicine and, thereby, to contribute to the founding of today’s bioethics.By sharing his intellectual journey with great honesty and transparency, Callahan guides his readers from his initial philosophical questioning to the later critical developments that have shaped bioethics as a theoretical and practical discipline in the last forty years. The list of topics that he has studied is impressive—from birth control to heart transplants, from end-of-life issues to embryonic stem cell research, and from market-driven health care to medical rationing. Drawing on his time as editor of the famous liberal Catholic magazine Commonweal in the 1960s, Callahan narrates his 1969 founding of the Hastings Center in cooperation with the author and psychiatrist Willard Gaylin. He describes the [End Page 196] stages in the life of this first bioethics research institution in the world, focusing on the years of its success (1980–86) and then on the routinization of its charisma (1986–96). More recent years have seen Callahan questioning medical progress and stressing the urgency of critically examining the goals of today’s medicine, even including discussion topics that are often avoided.Bioethics scholars and students will enjoy In Search of the Good. They will be able to integrate their own historical study of this discipline with Callahan’s personal memoir, which gives a human face to issues and debates. Moreover, bioethicists will be stimulated to reassess their own intellectual engagement and reflect on the future developments of this interdisciplinary discipline whose “roots lie in the humanities” (167).John Kilner, director of bioethics programs and professor of bioethics and contemporary culture at Trinity Evangelical Divinity School, takes a broader approach in Why the Church Needs Bioethics. The volume includes contributions from an interdisciplinary group of thirty-one Christian leaders with diverse expertise, ranging from medicine, business, and law to biblical studies, theology, counseling, and intercultural and pastoral ministry. Nineteen leaders contributed essays, and twelve offered their critiques to earlier drafts. This collaborative effort is praiseworthy, but at the same time it leaves readers desiring more cohesive reflections and a synthetic theological voice.The volume considers three cases emblematic of major human quests: reproductive technologies for a better birth; enhancing drugs for a better life; and end-of-life care for a better death. Each case is discussed by experts from three different disciplines—biblical theology, practical theology, and other secular professions (business, law, or health care)—followed by a specifically bioethical essay. The volume ends with two conclusive contributions discussing how preaching and wisdom... (shrink)

John Coggon argues that the important question for analysts in the fields of public health law and ethics is 'what makes health public?' He offers a conceptual and analytic scrutiny of the salient issues raised by this question, outlines the concepts entailed in, or denoted by, the term 'public health' and argues why and how normative analyses in public health are inquiries in political theory. The arguments expose and explain the political claims inherent in key works (...) in public health ethics. Coggon then develops and defends a particular understanding of political liberalism, describing its implications for critical study of public health policies and practices. Covering important works from legal, moral, and political theory, public health, public health law and ethics, and bioethics, this is a foundational text for scholars, practitioners and policy bodies interested in freedoms, rights and responsibilities relating to health. (shrink)

The goal of improving public health involves the use of different tools, with the law being one way to influence the activities of institutions and individuals. Of the regulatory mechanisms afforded by law to achieve this end, criminal law remains a perennial mechanism to delimit the scope of individual and group conduct. However, criminal law may promote or hinder public health goals, and its use raises a number of complex questions that merit exploration. This examination of the interface (...) between criminal law and public health brings together international experts from a variety of disciplines, including law, criminology, public health, philosophy and health policy, in order to examine the theoretical and practical implications of using criminal law to improve public health. (shrink)

Same-sex practices are commonly medicalised in various global spaces. Some societies view same-sex practices as some form of disease that needs to be cured. In Africa, the influence of Christianity has prompted many communities to conclude that there are spiritual forces behind same-sex orientations and practices. Therefore, same-sex practices are demonised, and those identifying with these sexualities and gender identities are viewed as sick, or as having some form of mental illness. As a fast-growing and influential (...) movement in South Africa, Christianity plays a critical role in this narrative. Against this backdrop, this article examined how some Pentecostal pastors in South Africa use God-talk to propel the narrative that medicalises same-sex practices and how these pastors claim to have miraculous powers to heal these practices. Consequently, the gender and sexuality commonly accepted within African religiosity and spirituality are pushed to the peripheries. Therefore, it is argued in this article that the colonial-missionary discourses regarding African sexualities and genders are at play within the religious medicalisation of same-sex narratives. Thus, there is a need to problematise and transform this narrative. This act can contribute to delinking African genders and sexualities from Western repressions and subjugation agendas. The discussion moved from the premise of decoloniality while adopting a multidisciplinary approach that incorporated theology, gender and sexuality studies, psychology, health, and socio-political sciences. Again, the article used secondary literature analysis to examine this phenomenon and to gain a thorough understanding of how African Pentecostalism continues to use God-talk to medicalise same-sex practices in contemporary South Africa and the repercussions thereof.Contribution: The study contributed to the existing knowledge that addresses religious challenges faced by people identifying with non-normative sexualities and genders in Africa. This can contribute to the transformation of religious medicalisation of same-sex practices in South Africa, and elsewhere. (shrink)