Health care organization is entering a new age. Focus is increasingly shifting from individual health care institutions to interorganizational collaboration and health care networks. Much hope is set on such networks which have been argued to improve economic efficiency and quality of care. However, this does not automatically mean they are always ethically justified. A relevant question that remains is what ethical obligations or duties one can ascribe to these networks especially because (...) class='Hi'>networks involve many risks. Due to their often amorphous and complex structure, collective responsibility and accountability may increase while individual responsibility goes down. We argue that a business ethics approach to ethical obligations for health care networks, is problematic and we propose to opt for a patient perspective. Using the classic four principles of biomedical ethics it is possible to identify specific ethical duties. Based on the principle of justice, health care networks have an ethical duty to provide just and fair access for all patients and to be transparent to patients about how access is regulated. The principle of nonmaleficence implies an obligation to guarantee patient safety, whereas the principle of beneficence implies an obligation for health care networks to guarantee continuity of care in all its dimensions. Finally, the principle of autonomy is translated into a specific obligation to promote and respect patient choice. Networks that fail to meet any of these conditions are suspect and cannot be justified ethically. Faced with daunting challenges, the health care system is changing rapidly. Currently many hopes ride on integrated care and broad health care networks. Such networks are the topic of empirical debate, but more attention should be given to the ethical aspects. Health care networks raise new and pressing ethical issues and we are in need of a framework for assessing how and when such networks are justified. (shrink)

For at least the past several decades, medicine has been embroiled in a crisis concerning the nature of its professionalism. The fundamental questions that drive this ongoing crisis are primarily three. First, what is the nature of medical professionalism? Second, who are medical professionals? Third, what does medicine or these professionals profess or promise? In this paper, the professionalism crisis vis-à-vis these questions is examined and analyzed chiefly in terms of both Francis Peabody’s and Edmund Pellegrino’s writings. Based on their (...) writings, I introduce a conceptual framework for professionalism to address the crisis. In addition, I contend that to address the professionalism crisis adequately, medicine’s position within an evolving health care network must also be considered. To that end, I first discuss the genesis of the crisis in terms of the Flexner Report and especially Peabody’s response to it. Next, I explore how the crisis intensified during the twentieth century, particularly in terms of medicine’s ultimate scientification and eventual commercialization, and how Pellegrino reacted to this. I then propose a health care professionalism cycle and a care-competence cycle to provide a conceptual framework for addressing the crisis. I conclude that medicine’s position is no longer as the center of health care but rather as another node within a wider evolving health care network. And the resolution of medicine’s professionalism crisis depends on medicine’s positioning and defining itself in terms of the professionalism for each of the other professions within the health care network. (shrink)

The organisation of health care is rapidly changing. There is a trend to move away from individual health care institutions towards transmural integrated care and interorganizational collaboration in networks. However, within such collaboration and network there is often likely to be a pluralism of values as different health care institutions often have very different values. For this paper, we examine three different models of how we believe institutions can come to collaborate in networks, and (...) thus reap the potential benefits of such collaboration, despite having different moral beliefs or values. A first way is the pragmatic way in which the different health care institutions avoid ethical reflection and focus on solutions. A second possible route is that of consensus where health care institutions base their collaboration on values that they all share. The third, and final, approach is that of compromise. Although moral compromise is often seen in a negative light, we argue that in many cases compromise might be necessary and ethically justified. In a final section, we will shift our focus from discussing various theoretical methods to allow collaboration to the potential content of consensus or compromise. (shrink)

This positional paper explores the role of personal networks (family and friends) in caring for people with mental health problems. Since the eighties, major changes have been made in the organization and focus of professional mental healthcare. Correspondingly, new expectations and changes in the division of care responsibilities between people with mental health problems, their personal networks and their professional care providers were created. In this paper, I investigate how the transition in mental healthcare changed the (...) allocation of care responsibilities between personal networks, people with mental health problems and professional caregivers. I will consider why care responsibilities of personal networks have been taken for granted in these processes, and discuss whether personal networks should have a more prominent voice in the assignment of care responsibilities, and how this can be done. A theoretical framework of feminist care ethics inspired by scholars such as Margaret Urban Walker, Joan Tronto and Hilde Lindemann is used to reflect on the need for social inclusion. (shrink)

In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more (...) explicit what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

This study aims to describe social network and social participation and to assess associations with depressive symptoms in older persons with increased risk for dementia in Germany. We conducted a cross-sectional observational study in primary care patients (aged 60-77) as part of a multicenter cluster-randomized controlled trial (AgeWell.de). We present descriptive and multivariate analyses for social networks (Lubben Social Network Scale and subscales) and social participation (item list of social activities) and analyze associations of these variables with depressive (...) symptoms (Geriatric Depression Scale). Of 1030 included patients, 17.2% were at risk for social isolation (Lubben Social Network Scale < 12). Looking at the subscales, a reduced non-family network was found almost twice as often as a reduced family network. Patients with depressive symptoms had significantly smaller social networks than patients without depression (p < 0.001). They rather engaged in social activities of low involvement level or no weekly social activity at all (p < 0.001). The study shows associations of depressive symptoms with a decreased social network and less social participation in elderly participants. Sufficient non-family contacts and weekly social activities seem to play an important role in mental health and should be encouraged in elderly primary care patients. (shrink)

Internet companies place a high priority on the safety of their services and on their corporate social responsibility towards protection of all users, especially younger ones. However, such efforts are undermined by the large numbers of children who circumvent age restrictions and lie about their age to gain access to such platforms. This paper deals with the ethical issues that arise in this not-so-hypothetical situation. Who, for instance, bears responsibility for children’s welfare in this context? Are parents/carers ethically culpable in (...) failing to be sufficiently vigilant or even facilitating their children’s social media use? Do industry providers do enough to enforce their own regulations and remove those users they know to be underage? How far does a duty of care extend? Regulation of age restrictions has, it is argued, created unintended consequences that heighten online dangers for young people. While children are inevitably drawn to new online spaces for entertainment and fun, should their rights to participate in the social world around them be curtailed to ensure their best interests and those of the wider community? Such questions now pose significant practical and ethical dilemmas for policy makers and other stakeholders involved in internet governance. It especially highlights the question of responsibility for protection of minors online and calls into question whether the current model of shared responsibility is working. (shrink)

The medicalization of mental health remains a point of contention for bioethicists, especially as it concerns the epistemic capabilities of those diagnosed with an illness or disorder. Gosselin (2019) argues that biomedicalization commits epistemic injustices against these persons and consequently entraps them in a “cycle of vulnerability”; in response, she proposes principles of justice to defend them from such affronts. This paper builds off of her work and responds particularly to the demand for a “sociocentric view of the self as (...) essentially relational.” I present a theory of interdependent agency and affiliation that I contend conceptually bolsters her normative principles. I explain how an expanded use of relational epistemologies, united with a non-ideal theory of mental health, can enrich our hermeneutical resources with respect to those with mental illnesses/disorders. My account introduces normative considerations premised on interdependency, most notably from care theory. Concepts such as vulnerability, relational autonomy, attentiveness, and responsiveness ground a relationally-situated approach that (1) improves the epistemic positionalities of patients, (2) informs more suitable dynamics of care/treatment, and (3) unites groups of mutually interested actors against harm and injustice. I thus use a framework of care to promote affiliations of similarly disadvantaged persons under shared causes and initiatives. I refer to these assemblages as “caring affinity networks.”. (shrink)

This study investigates how social franchises extend health care in rural areas, thus addressing vast and persistent disparities in health care access. We conducted an inductive study of Unjani, a South African organization that extended primary health services to disadvantaged rural communities through a network of 135 health clinics. Our analysis focused on the process of impact intermediation—the propagation of impact across multiple layers of the franchise network, including franchisees and downstream beneficiaries. To facilitate impact intermediation, the franchisor (...) harmonized the mission of the franchisees with its own mission and integrated community impact among franchisees. Such coordination and monitoring activity exposed franchisees to intermediation problems in the form of mission conflict and impact divergence. Our analysis reveals how Unjani nurtured network stewardship that afforded the franchisee nurses with greater support, autonomy, and ownership, thus overcoming intermediation problems in their pursuit of shared communal responsibilities to extend health care to rural communities. (shrink)

Most animals have significant behavioral expertise built in without having to explicitly learn it all from scratch. This expertise is a product of evolution of the organism; it can be viewed as a very long term form of learning which provides a structured system within which individuals might learn more specialized skills or abilities. This paper suggests one possible mechanism for analagous robot evolution by describing a carefully designed series of networks, each one being a strict augmentation of the (...) previous one, which control a six legged walking machine capable of walking over rough terrain and following a person passively sensed in the infrared spectrum. As the completely decentralized networks are augmented. the robot’s performance and behavior repetoire demonstrably improve. The rationale for such demonstrations is that they may provide a hint as to the requirements for automatically building massive networks to carry out complex sensory-motor tasks. The experiments with an actual robot ensure that an essence of reality is maintained and that no critical disabling problems have been ignored. (shrink)

This article uses the work of Eva Feder Kittay and Maurice Merleau-Ponty to advocate for LGBT-inclusive intake questions across aging network services. I argue that care providers need to know their charge's sexual orientation and/or gender identity because caring touch is responsive, meaning that the care provider understands how her touch will be perceived and can change her actions accordingly. Information about a charge's sexual orientation and/or gender identity is one important way to furnish the care provider (...) with the information she needs to calibrate effectively the expressive impact of her touch. (shrink)

In 2016, the Atlanta Community Food Bank launched the Stabilizing Lives project to develop programs and policies that could better address clients’ needs as well as including clientele as part of the planning process. The ACFB partnered with a research team at the University of Georgia to conduct a participatory research project aimed at developing deeper insights into the factors contributing to both instability and stability in the lives of pantry clientele. This article describes the outcomes this research, offering both (...) a substantive contribution to scholarship on food insecurity and emergency food systems and a methodological innovation through a staged mixed-method participatory research project. Through use of a culture-centered approach, this project created discursive spaces within which to outline emergency food models that support informal networks of care. We used a range of methods, including photo elicitation, concept mapping, individual interviews, and focus groups, to facilitate conversation among agency staff, volunteers, and clientele about the effectiveness of current program models and potential new ideas. Specifically, we suggest that through such practices, food pantries and local agencies may help inform new program models that contribute to household stability, and push back against the sometimes alienating and atomizing paradigm found in current emergency food programs. (shrink)

This paper responds to arguments that polyamorous groups or care networks do not qualify for equal treatment with marriages. It refutes the points that polyamory is inherently hierarchical or unstable, that there are too few people in such arrangements to mount an argument for recognition, that polyamory harms children, and that there are insurmountable legal and practical hurdles to network marriage. Finally, it respond to the charge that extending recognition to polyamorists will devalue the recognition of same-sex marriage.

The policy of government procurement of elderly care services has the vulnerability characteristics that all complex systems have. To maintain the policy’s robustness, this paper studies the vulnerability of government procurement of elderly care services from the perspective of complex network. Case analysis and sample statistics are used to obtain the vulnerability influencing factors of the policy. Then, complex network diagram of vulnerability influencing factors is constructed through Pajek software. The compatibility coefficient is used to investigate the network’s (...) overall vulnerability from a macro perspective. From a micro perspective, a vulnerability index of the complex network is applied to measure each node’s vulnerability value, and the vulnerability priority of the nodes is established. Results show that government purchasing power and supervisory bodies’ diversity are at the first priority. The remaining vulnerability influencing factors are at the second and the third priority. (shrink)

Purpose: This study explores social networkers' interest in and attitudes toward personal genome testing (PGT), focusing on expectations related to the clinical integration of PGT results. Methods: An online survey of 1,087 social networking users was conducted to assess 1) use and interest in PGT; 2) attitudes toward PGT companies and test results; and 3) expectations for the clinical integration of PGT. Descriptive statistics were calculated to summarize respondents' characteristics and responses. Results: Six percent of respondents have used PGT, 64% (...) would consider using PGT, and 30% would not use PGT. Of those who would consider using PGT, 74% report they would use it to gain knowledge about disease in their family. 34% of all respondents consider the information obtained from PGT to be a medical diagnosis. 78% of those who would consider PGT would ask their physician for help interpreting test results, and 61% of all respondents believe physicians have a professional obligation to help individuals interpret PGT results. Conclusion: Respondents express interest in using PGT services, primarily for purposes related to their medical care and expect physicians to help interpret PGT results. Physicians should therefore be prepared for patient demands for information and counsel on the basis of PGT results. (shrink)

Background Migrant live-in care workers are a main pillar of long-term care in many countries, including Germany. Several studies examining their working and living conditions reveal serious problems. However, a key element of live-in arrangements, namely the relationship between the individuals involved, has not yet been systematically investigated from an ethical perspective. Aim Building on previous socioempirical work that explored and set out the meaning of “care networks”, we start from the premise that live-ins are embedded (...) in a network of relationships which are essential for their employment and living situation. Methods The theoretical analysis draws on a network approach that takes care–ethical considerations into account. Using Joan Tronto’s four care–ethical phases, existing dependencies are described and reflected upon using the corresponding four care–ethical dimensions. The central questions are how dependencies in the live-in arrangement can be characterised based on the existing body of empirical studies and with a focus on the elements of power, dependency and trust in the ethical reflection on care. Results Based on this analysis, it becomes apparent that the ambivalence resulting from the simultaneity of different forms of asymmetry and mutual dependence is omnipresent in live-in arrangements and gives rise to seemingly contradictory forms of relationships and emotions. Responsibilities are vague and are constantly renegotiated on the basis of implicit assumptions and problematic role expectations and are also assigned without negotiation. Conclusions In the future, it will not only be necessary to better understand and clarify responsibilities at the micro level of the individual care arrangement from the various positions and roles and with a view to the changing processes of caring for another, but also to address the pressing ethical questions and problems in live-in arrangements at the meso and macro levels—enriched by care–ethical perspectives. (shrink)

Bruno Latour is one of the founding figures in social network theory and a broadly influential systems thinker. Although his work has always been relational, little scholarship has engaged the relational morality, ontology, and epistemology of feminist care ethics with Latour’s actor–network theory. This article is intended as a translation and a prompt to spur further interactions. Latour’s recent publications, in particular, have focused on the new climate regime of the Anthropocene. Care theorists are just beginning to address (...) posthuman approaches to care. The argument here is that Latourian analysis is helpful for such explorations, given that caring for the earth and its inhabitants is the dire moral challenge of our time. The aim here is not to characterize Latour as a care theorist but rather as a provocative scholar who has much to say that is significant to care thinking. We begin with a brief introduction to Latour’s scholarship and lexicon, followed by a discussion of care theorist Puig de la Bellacasa’s work on Latour. We then explore recent work on care and the environment consistent with a Latourian approach. The conclusion reinforces the notion that valuing relationality across humans and non-human matter is essential to confronting the Anthropocene. (shrink)

Promoting clinicians’ knowledge sharing of appropriate health technology within the integrated care system is of great vitality in bridging the technological gap between member institutions. However, the role of social networks in knowledge sharing of health technology is still largely unknown. To address this issue, the study aims to clarify the influence of clinicians’ social networks on knowledge sharing of health technology within the ICS. A questionnaire survey was conducted among the clinicians in the Alliance of Liver (...) Disease Specialists in Fujian Province, China. Social network analysis was conducted using NetDraw and UCINET, and the quadratic assignment procedure multiple regression was used to analyze the influencing factors of knowledge sharing of health technology. The results showed that the ICS played an insufficient role in promoting overall knowledge sharing, especially inter-institutional knowledge sharing. Trust, emotional support, material support, and cognitive proximity positively influenced knowledge sharing of health technology, while the frequency of interaction and relationship importance had a negative impact on it. The finding extended the research scope of social network theory to the field of healthcare and will bridge the evidence gap in the influence of the clinicians’ social networks on their knowledge sharing within the ICS, providing new ideas to boost knowledge sharing and diffusion of appropriate health technology. (shrink)

Through in-depth interviews with 41 middle-class Puerto Rican transmigrants, this research examines how gender constrains global care work. Migration compromises embeddedness in care networks, concurrently heightening its meaning. Women felt these effects more acutely than men given their primary responsibility for reproductive work. Migrants engaged in emotion work to cope with constraints, strategically rearticulating care work; yet unsuccessful strategies resulted in further emotional dislocation, particularly for women. Migration led to a dichotomy in which professional success was (...) pitted against emotional fulfillment through care work. Gender, cultural, and geopolitical factors mediated this split, contributing to a permanently unsettled flow of migrants. (shrink)

The adverse effects of the Covid-19 pandemic have exposed the lack of multi-scalar community resilient strategies that catalyze the development of alternative coping mechanisms for future challenges. To address the immediate needs of vulnerable and marginalized groups, especially in times of crisis, as evidenced by the pandemic, micro-networks within communities have mitigated and reduced harm through self-devised ingenuity based on local ways of life. Socio-spatial micro-networks have the potential to empower communities to self-organize, engage, collaborate, co-design, co-build, and (...) connect with other communities to improve their resilience. This paper focuses on the impact of micro-networks of care, participatory action research, community health, solidarity and mutual aid in Nairobi (Kenya), comparing their resilience strategies, pre- and post Covid-19 pandemic era. Through analytical, empirical, and comparative studies, this paper envisions viable ways of augmenting and enhancing self-devised, self-sufficient, and resilient culture in marginalized communities in Africa and worldwide. -/- . (shrink)

After a short description of the major sociological theories based on the concept of risk (Douglas, Beck, Luhmann, Giddens) I propose to integrate the concept of risk with the concept of trust. On a less theoretical level I propose to consider governance as the institutional response to the growing complexity of the risk society. Above all, network governance – that is institutional steering based on a high community participation – seems to give good results in the field of health (...) class='Hi'>care policies, as has been shown in the Emilia-Romagna area (Italy). (shrink)

Quality care is more than a technical issue. It has a place among the core values of a company, and is thus an ethical issue as well as being a means and a benchmark for good management. The author is chairman of the Flemish Network for Business Ethics, Europastraat 31, 2850 Boom, Belgium. Tel: 00 31 3 844 00 89.

After a short description of the major sociological theories based on the concept of risk (Douglas, Beck, Luhmann, Giddens) I propose to integrate the concept of risk with the concept of trust. On a less theoretical level I propose to consider governance as the institutional response to the growing complexity of the risk society. Above all, network governance – that is institutional steering based on a high community participation – seems to give good results in the field of health (...) class='Hi'>care policies, as has been shown in the Emilia-Romagna area (Italy). (shrink)

This paper addresses early modern botanical nomenclature, the practices of identifying and publishing synonyms in particular, as a collaborative “information science”. Before Linnaean nomenclature became the lingua franca of botany, it was inevitable that, over time, the same plant was given several names by different people, which created confusion and made communication among botanists increasingly difficult. What names counted as synonyms and actually referred to the same plant had to be identified by meticulously comparing living and dried specimens of this (...) and similar plants as well as relevant illustrations und descriptions in the botanical literature. Identifying synonyms required and generated an ever-expanding mass of data, which was used continuously to adjust and rearrange plant names. Despite the greatest care, judgements on synonyms were not definitive, which meant that published lists of synonyms for individual species of plants were in a state of flux and had to be constantly updated, corrected, and rewritten. This required long-term international collaborations, the accumulated results of which were not published once but consecutively, in augmented and corrected editions of a book. As a result of this networked approach, synonyms are networked names that reflect the epistemic interconnectedness of the botanical community. These questions will be discussed with a focus on the Dutch botanist Johannes Burman, who placed synonyms at the centre of his work as posthumous editor—and co-author—of the botanical manuscripts that were left behind by other botanists. (shrink)

This paper addresses early modern botanical nomenclature, the practices of identifying and publishing synonyms in particular, as a collaborative “information science”. Before Linnaean nomenclature became the lingua franca of botany, it was inevitable that, over time, the same plant was given several names by different people, which created confusion and made communication among botanists increasingly difficult. What names counted as synonyms and actually referred to the same plant had to be identified by meticulously comparing living and dried specimens of this (...) and similar plants as well as relevant illustrations und descriptions in the botanical literature. Identifying synonyms required and generated an ever-expanding mass of data, which was used continuously to adjust and rearrange plant names. Despite the greatest care, judgements on synonyms were not definitive, which meant that published lists of synonyms for individual species of plants were in a state of flux and had to be constantly updated, corrected, and rewritten. This required long-term international collaborations, the accumulated results of which were not published once but consecutively, in augmented and corrected editions of a book. As a result of this networked approach, synonyms are networked names that reflect the epistemic interconnectedness of the botanical community. These questions will be discussed with a focus on the Dutch botanist Johannes Burman, who placed synonyms at the centre of his work as posthumous editor—and co-author—of the botanical manuscripts that were left behind by other botanists. (shrink)

The paper draws upon new conceptions of place, space, interaction and community in Geography and Media Studies to explore the possibilities of extending existing conceptions of care and caring from the context with which they are traditionally associated—face-to-face encounters within a shared physical locale. It proposes three structures of ‘caring at a distance’, all of which have a core element of mediated or distanciated interaction, and concludes that mass media and electronic networks play a significant role in extending (...) the scope of beneficence beyond our ‘nearest and dearest’ to embrace distant others. (shrink)

Diabetes is one of the most common diseases worldwide where a cure is not found for it yet. Annually it cost a lot of money to care for people with diabetes. Thus the most important issue is the prediction to be very accurate and to use a reliable method for that. One of these methods is using artificial intelligence systems and in particular is the use of Artificial Neural Networks (ANN). So in this paper, we used artificial neural (...) networks to predict whether a person is diabetic or not. The criterion was to minimize the error function in neural network training using a neural network model. After training the ANN model, the average error function of the neural network was equal to 0.01 and the accuracy of the prediction of whether a person is diabetics or not was 87.3%. (shrink)

How do we theorize the experiences of caregivers abused by their children with autism without intensifying stigma toward disability? Eva Kittay emphasizes examples of extreme vulnerability to overturn myths of independence, but she ignores the possibility that dependents with disabilities may be vulnerable and aggressive. Instead, her work over-emphasizes caregivers' capabilities and the constancy of disabled dependents' vulnerability. I turn to Judith Butler's ethics and her conception of the self as opaque to rethink care amid conflict. Person-centered planning approaches, (...) pioneered by disability rights activists, merge Butler's analysis of opacity with Kittay's work on embodied care, while also inviting a broader network of people to both interpret needs and change communities. By expanding our conceptions of dependency, feminist disability studies can continue the aim of both Kittay and Butler: to humanize unintelligible lives. (shrink)

In the scenario of growing polarization of promises and dangers that surround artificial intelligence (AI), how to introduce responsible AI and robotics in healthcare? In this paper, we develop an ethical–political approach to introduce democratic mechanisms to technological development, what we call “Caring in the In-Between”. Focusing on the multiple possibilities for action that emerge in the realm of uncertainty, we propose an ethical and responsible framework focused on care actions in between fears and hopes. Using the theoretical perspective (...) of Science and Technology Studies and empirical research, “Caring in the In-Between” is based on three movements: the first is a change of focus from the world of promises and dangers to the world of uncertainties; the second is a conceptual shift from assuming a relationship with robotics based on a Human–Robot Interaction to another focused on the network in which the robot is embedded (the “Robot Embedded in a Network”); and the last is an ethical shift from a general normative framework to a discussion on the context of use. Based on these suggestions, “Caring in the In-Between” implies institutional challenges, as well as new practices in healthcare systems. It is articulated around three simultaneous processes, each of them related to practical actions in the “in-between” dimensions considered: monitoring relations and caring processes, through public engagement and institutional changes; including concerns and priorities of stakeholders, with the organization of participatory processes and alternative forms of representation; and making fears and hopes commensurable, through the choice of progressive and reversible actions. (shrink)

The paper draws upon new conceptions of place, space, interaction and community in Geography and Media Studies to explore the possibilities of extending existing conceptions of care and caring from the context with which they are traditionally associated—face-to-face encounters within a shared physical locale. It proposes three structures of 'caring at a distance', all of which have a core element of mediated or distanciated interaction, and concludes that mass media and electronic networks play a significant role in extending (...) the scope of beneficence beyond our 'nearest and dearest' to embrace distant others. (shrink)

Managed Care Organizations (MCOs) are frequently criticized for their marketing mistakes. Often that criticism is leveled against an implicit benchmark of an ideal competitive market or an ideal system of government provision. But any accurate assessment in the choice of health care organizations always requires a comparative measure of error rates. These are high in the provision of health care, given the inherent uncertainties in both the cost and effectiveness of treatment. But the continuous and rapid evolution (...) of private health care mechanisms is, in the absence of regulation, more likely to secure access and contain costs than any system of government regulation. State regulation is subject to the risk of capture and to the sluggish and acquisitive behavior of state run monopolies. The proposed fixes for the MCOs (rights to specialists, access to physicians outside the network, guaranteed emergency room access) are likely, when imposed from without, to cost more than they are worth. The long-term risk is that markets will fail under regulation, paving the way for greater losses from massive government control of the health care delivery system. (shrink)

An increase in the number of older people with dementia is currently a trend around the world. In low and middle countries, effective public health services are not yet well‐developed, and family care‐givers may be overwhelmed by the requirements of care. This paper has two purposes: to share findings from an ethnographic study about family dementia care practices in Brazil and to draw attention to the significance of the materiality of care practices in the family context. (...) The study was conducted in Belo Horizonte, Brazil. We describe the care trajectory of one family and, analysing data using the insights of Actor Network Theory, show the significance of objects in a networked relation of care. In particular, we show how incontinence products such as adult diapers assume different positions in the network, acting as either mediator or intermediary of care in relation to other elements of the network composed of family members and their living situation, the person with dementia herself, the doctor, and Brazilian health policies. Although the diaper is often seen as an ordinary object for care providers, its participation in a care network shapes relations, activating conflict, financial constraint, and disciplining the body of the person with dementia. (shrink)

In Singh v. Blue Cross/Blue Shield of Massachusetts, Inc., the U.S. Court of Appeals for the First Circuit held that defendant Blue Cross/Blue Shield's peer review practices satisfied the immunity standard for professional review actions according to the Health Care Quality Improvement Act, and the First Circuit affirmed the U.S. District Court for the District of Massachusetts's grant of summary judgment in favor of the defendant.After Blue Cross/Blue Shield merged with Bay State Health Care, Blue Cross began to (...) offer “Bay State Health Care” to former Bay State subscribers. Blue Cross denied the plaintiff, Dr. Kunwar Singh, participation in the Bay State Healthcare Network due to poor utilization review. Singh sought reconsideration, and Blue Cross agreed to audit his practices before making a final decision. (shrink)

There are numerous challenges posed to Roman Catholic health care institutions by recent developments in health care delivery. Some are practical, involving the acceptable limits of accommodation to and collaboration with secular networks of health care delivery. Others, quite often implicated in the first set, are explicitly theological. What does it mean to be a distinctively Roman Catholic health care institution? What are the nature and the scope of Roman Catholic institutional identity? More broadly, what (...) is the moral relevance of themes in Roman Catholic social teaching to the provision of health care? This issue of Christian Bioethics addresses these questions with a spirited exchange among its authors. They offer noticeably different perspectives on the general cogency of Roman Catholic social teaching and different strategic recommendations for Roman Catholic institutions to maintain, or recover, their distinctive presence in health care delivery. (shrink)

This article examines how care functions as a critical feature in decolonial political theory and the politics of refusal. In recent years, political theorists have emphasized how refusal challenges the legitimacy of settler colonial government, asserts indigenous presence, and fuels decolonial politics. Care, I argue, plays a significant and under-examined role in the politics of refusal. I look, first, to the writings of William Apess to better examine the cruelty of settler colonial care and to highlight how (...) indigenous reworkings of care enact political presence and agency. I then examine how care has been taken up by contemporary indigenous activists in the Idle No More, Standing Rock, and Walking with Our Sisters movements. Care – expressed in online and on-the-ground grieving, social mobilization around environmental and health concerns, and teach-ins and healing practices – draws on affective intensities to build indigenous community, enact indigenous liberation, imagine and pursue radical alternatives, and create allied networks of support. In these examples, affective responses of joy, outrage, and mourning are not simply incidental accompaniments to the politics of refusal; they explain why refusal matters and how refusal in turn can challenge settler memory and pursue transformative decolonial politics. (shrink)

In the scenario of growing polarization of promises and dangers that surround artificial intelligence (AI), how to introduce responsible AI and robotics in healthcare? In this paper, we develop an ethical–political approach to introduce democratic mechanisms to technological development, what we call “Caring in the In-Between”. Focusing on the multiple possibilities for action that emerge in the realm of uncertainty, we propose an ethical and responsible framework focused on care actions in between fears and hopes. Using the theoretical perspective (...) of Science and Technology Studies and empirical research, “Caring in the In-Between” is based on three movements: the first is a change of focus from the world of promises and dangers to the world of uncertainties; the second is a conceptual shift from assuming a relationship with robotics based on a Human–Robot Interaction to another focused on the network in which the robot is embedded (the “Robot Embedded in a Network”); and the last is an ethical shift from a general normative framework to a discussion on the context of use. Based on these suggestions, “Caring in the In-Between” implies institutional challenges, as well as new practices in healthcare systems. It is articulated around three simultaneous processes, each of them related to practical actions in the “in-between” dimensions considered: monitoring relations and caring processes, through public engagement and institutional changes; including concerns and priorities of stakeholders, with the organization of participatory processes and alternative forms of representation; and making fears and hopes commensurable, through the choice of progressive and reversible actions. (shrink)

In Singh v. Blue Cross/Blue Shield of Massachusetts, Inc., the U.S. Court of Appeals for the First Circuit held that defendant Blue Cross/Blue Shield's peer review practices satisfied the immunity standard for professional review actions according to the Health Care Quality Improvement Act, and the First Circuit affirmed the U.S. District Court for the District of Massachusetts's grant of summary judgment in favor of the defendant.After Blue Cross/Blue Shield merged with Bay State Health Care, Blue Cross began to (...) offer “Bay State Health Care” to former Bay State subscribers. Blue Cross denied the plaintiff, Dr. Kunwar Singh, participation in the Bay State Healthcare Network due to poor utilization review. Singh sought reconsideration, and Blue Cross agreed to audit his practices before making a final decision. (shrink)