Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according to the Vancouver (...) Protocol. Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress. (shrink)

Patient participation is one of the most prevalent focus areas in the Danish healthcare debate. Patient participation is generally presented as a fundamental democratic right, and is stated in an objective language with legal requirements for healthcare professionals to ensure that patients systematically participate in their own courses of care and treatment. In the research literature, it is not clear what is meant by ‘patient participation’, and several discourses on patient participation exist side by side. This study explores (...) how discourses of patient participation unfold and are at play in the articulations in official legal and political documents and patient records relating to a Danish psychiatric context. The documents and patient records have been analyzed using a Fairclough‐inspired critical discourse approach which is concerned with how power is exercised through language. The research findings show that patient participation within Danish psychiatric healthcare is governed within a neoliberal discourse where underlying discourses; discourse of biomedicine, paternalism, management, evidence and ethics of care are embedded, and a discourse that seems to ascribe stigmatizing traits to mentally ill patients. (shrink)

RésuméIntroductionLa motivation est. un thème crucial et répandu en médecine. Que. ce soit pour un scénario clinique ou chirurgical, l’acceptation de prendre une pilule ou de se rendre à une consultation est. essentielle au succès du traitement médical. La “décennie du cerveau” a fourni aux praticiens des données neuroscientifiques substantielles sur le comportement humain, a aidé à expliquer pourquoi les gens font ce qu’ils font et a créé le concept de “cerveau motivé”. Les résultats de la psychologie empirique ont stratifié (...) la motivation en étapes de changement, qui sont devenues plus complexes au fil des décennies. Cette recherche vise à améliorer la compréhension de la façon dont les gens prennent des décisions concernant leur santé et comment mieux comprendre les stratégies et les techniques pour les aider à résoudre les problèmes d’ambivalence de manière efficace et ciblée.MéthodesNous établissons un dialogue avec la phénoménologie de la volonté de Ricoeur afin de comprendre le sens de ces découvertes scientifiques. À partir de la phénoménologie husserlienne, Paul Ricoeur a développé sa pensée en s’éloignant de l’idéalisme transcendantal en émancipant les structures intentionnelles de la volonté du domaine de la perception. Résultats: En introduisant les concepts de volontaire et d’involontaire, Ricoeur s’est. écarté du dualisme cartésien, qui fait du corps un corps d’objet, cible de vicissitudes naturelles. Le nouveau dualisme entre volontaire et involontaire est. traité par référence à ce que Ricoeur a appelé le mystère central de l’existence incarnée, qui considère l’homme “double dans l’humanité, simple dans lavitalité”. Cette dualité permet de considérer le cerveau comme l’organe naturel du comportement dans le corps humain et d’utiliser la psychologie empirique comme moyen d’échapper aux subjectivations superficielles des concepts.ConclusionLa simplicité (ou unité) d’existence invite la médecine à repenser certaines de ses hypothèses philosophiques, de telle sorte que les patients puissent être considérés comme des sujets autonomes avec des projets de vie d’auteur. L’anthropologie ricourienne a un impact éthique profond sur la manière dont la médecine devrait utiliser la technologie, ce qui découle de résultats de psychologie empirique. L’utilisation de ces nouvelles connaissances doit également faire l’objet d’une inspection minutieuse, car elle modifie le rôle social de la science médicale. (shrink)

This theoretical paper explores the application of Hegelian inferentialism combined with contemporary quantitative methods to enhance decision-making in healthcare leadership. It proposes a novel conceptual framework that integrates Hegel’s inferentialism with Bayesian analysis and epistemic justice indices to offer a new approach for understanding complex decision processes in healthcare settings. The paper develops theoretical constructs such as the Decision Quality Index (DQI) and the Epistemic Justice Quotient (EJQ), which aim to quantitatively assess leadership effectiveness and ethical considerations in (...) decision-making processes. The discussion includes mathematical proofs for these proposed indices and examines the potential practical implications of this integrated approach, emphasizing its theoretical potential to improve healthcare leadership through more inclusive and evidence-based practices. This work provides a conceptual foundation for future empirical research in healthcare leadership and decision-making. (shrink)

In writing this paper I am reminded of a conference that I once attended. On that panel, the Jewish scholar spoke first. he began, and he gave a wonderful talk full of references to the legal rulings and stories of the Jewish tradition. Then the Catholic priest spoke. he began, and he gave a wonderful talk carefully attentive to the moral tradition of the Catholic Church. Finally, a Protestant spoke. he began, I didn't know whether to laugh or cry, but (...) now I find myself in a similar situation. (shrink)

Many ethical theorists believe that a given distribution of healthcare is morally justified only if (1) it is cost-effective and (2) it does not discriminate against older adults and disabled people. However, if (3) cost-effectiveness involves maximizing the number of quality-adjusted life-years (QALYs) added by a given unit of healthcare resource, or cost, it seems the pursuit of cost-effectiveness will inevitably discriminate against older adults and disabled patients. I show why this trilemma is harder to escape than some (...) theorists think. We cannot avoid it by using age- or disability-weighted QALY scores, for example. I then explain why there is no sense of “discrimination” on which discrimination isbothunjust, and thus something healthcare rationing must avoid,andsomething cost-effective healthcare rationing inevitably involves. I go on to argue that many of the reasons we have for not favoring rationing that maximizes QALYs outside the healthcare context apply in healthcare as well. Thus, claim (1) above is dubious. (shrink)

This article is concerned with "all-or-nothing" approaches to female genital cosmetic surgeries, those that overemphasize either women's autonomy to defend total accessibility or the oppressive social context affecting women to defend the total banning of the procedures. By contrast, the author takes both phenomena into consideration. The author argues identifying patterns of false consciousness and weighing those against harm done to a patient provides a moral basis for a doctor to possibly deny their consent at face value. This also requires (...) a shift in understanding the doctor–patient relationship as a first step toward a feminist model for women's healthcare. (shrink)

The UK Supreme Court’s recent judgement inMcCulloch v Forth Valley Health Boardclarifies the standard for the identification of ‘reasonable’ alternative medical treatments. The required standard is that of a reasonable doctor: treatments that would be accepted as proper by a responsible body of medical opinion. Accordingly, the assessment of consent involves a two-stage test: first, a ‘reasonable doctor’ test for identifying alternative treatments; followed by a ‘reasonable person in the patient’s position’ test for identifying the material risks of these reasonable (...) alternative treatments. The separation of consent into two stages is consistent with not only a certain conception of freedom but also a nuanced construct of respect for autonomy that has a normative base. Furthermore, reliance on a reasonable doctor in the first stage is in keeping with a sociological account of medical professionalism, which posits that only doctors, and none others, can determine what is a proper treatment. Yet, reliance on a reasonable doctor permits a plurality of standards for reasonableness, because differences in opinion among doctors are pervasive. The reasons for some differences might be acceptable as unavoidable imperfections in medical decision-making to a reasonable person. But reasons for other differences might be objectionable; and the resultant inequalities in medical treatments would be considered unfair. One solution is to make the plurality of reasonable alternatives available to the patient, but this would introduce practical uncertainty and it is rejected by the Court. The Court’s approach may be pragmatic; however, it seems to allow avoidable injustice in healthcare. (shrink)

The hypothesis that administering a diagnostic test to an asymptomatic population can detect a relevant proportion of prevalent cases in an early phase and therefore improve the chances of curing disease dates back to the sixties and has been tested and applied mainly to neoplastic diseases. Meanwhile, the practice of screening has benefitted from the progress of diagnostic technology and from the development, particularly in Europe, of efficient national health systems.Half a century later, two Swedish researchers, Niklas Juth and Christian (...) Munthe, undertake the task of reexamining various aspects of screening practices in light of the ethical justification of this secondary prevention tool. Their analysis encompasses all public health actions in which the personal benefit is contrasted with collective health considerations. Screening generates such doubts and conflicts, which are inherently ethical.The publication could be split in two parts. The first is a long section, mainly infor .. (shrink)

I work at a large urban medical center. Our hospital has over 1,200 beds and was built in 1805 to take care of the poor. Our patients are still poor, but now so are the hospital and the doctors. Russian doctors are paid about one-third of what truck drivers are paid. The government historically allocates no more than 3% of the budget to medicine because this is not a means of production, like manufacturing.

This collection of essays, brings together essays from leading figures in the field of medical law and ethics. The compilation of articles undertaken by Prof. Sheila A.M. McLean, University of Glasgow, UK, address the key issues currently challenging scholars in the field.

Currently held conceptions of autonomy that inform biomedicine are inadequate and oppressive. Liberal notions of individualism are anti-humanist and constitute pernicious socialization, which leads to internalized oppression and dehumanization, especially among already oppressed groups. Women in recovery from addiction and other mental illnesses are especially affected by anti-humanist conceptions of autonomy. I argue that these women need to receive treatment that supports autonomy through supplementing psychiatric and rehabilitative therapy with humanistic education and group therapy. Treatment must encourage the construction of (...) healthy social interaction that augments a sense of supported autonomy. (shrink)

It is such a treat and a privilege to have been at the “Defining Health Law for the Future” symposium and to have met Charity’s family. She was dear to me.

Democratic societies that separate church and state face major challenges in accommodating religious convictions. This applies especially to determining healthcare policies. Building on our prior work on the demands and limits of religious accommodation in democratic societies, we propose a set of ethical standards that can guide societies in meeting this challenge. In applying and defending these standards, we explore three topics: vaccine resistance, abortion, and concerns about rights to healthcare. We clarify these and other issues of religious (...) accommodation and propose ethical standards for approaching these and other problems. (shrink)

Healthcare professionals currently lack guidance for their use of AI. This means they currently lack clear counsel to aid their navigation of the problematic novel issues that will arise from their use of these systems. This pilot study gathered and analysed cross-sectional attitudinal and qualitative data to address the question: what should be in professional ethical guidance (PEG) to support healthcare practitioners in their use of AI? Our survey asked respondents (n = 42) to review 6 themes and (...) 15 items of guidance content for our proposed PEG-AI. The attitudinal data are presented as simple numerical analysis and the accompanying qualitative data were subjected to conventional content analysis; the findings of which are presented in this report. The study data allowed us to identify further items that could be added to the PEG-AI and to test the survey instrument for content and face validity prior to wider deployment. Subject to further funding, we plan to take this work further to a wider study involving the next iteration of this survey, interviews with interested parties regarding PEG-AI, and an iterative Delphi process (comprising an initial co-creation workshop followed by iterative consensus building) to enable experts to reach consensus regarding recommendations for the content of PEG for AI use in healthcare. We aim for this work to inform the healthcare regulators as they develop regulatory strategies in this area. (shrink)

Clinical medicine is an inexact science. In situations of uncertainty, we often ask an experienced colleague for a second opinion. But what if one could effectively call upon the experience of thou...

Background: Young next of kin to patients with mental health problems are faced with many challenges. It is important to focus on the special needs of children and adolescents as next of kin to ensure their welfare and prevent harm. Research questions: We aimed to investigate young next of kin’s need for information and involvement, to examine the ways they cope with situations involving coercion related to the treatment of their relative, and to identify ethical challenges. Research design: We conducted (...) a qualitative study based on semi-structured, individual interviews. Participants and research context: Seven young next of kin aged 14–22 years participated in the study. The informants were recruited from a regional hospital trust in Norway. Ethical considerations: The study was approved by the National Data Protection Official for Research and based upon informed consent and confidentiality. Findings: The adolescents wanted more information and described a need for increased interaction with their sick relative at the hospital. They struggled to keep their relationship with their relative intact, and they described communication problems in the family. Coercive treatment was perceived in a negative way. Discussion: The study finds that there are ethical challenges at stake for young next of kin and their families other than those that are often emphasized by traditional healthcare, which often focuses on the individual patient’s rights. These challenges are related to the young next of kin’s needs for interconnectedness and for the preservation of relationships as well as challenges related to family communication and the need for information. Conclusion: The study finds a need for more family-oriented perspectives in both mental healthcare practices and healthcare ethics. (shrink)

Here we respond to Shaw et al., and show why the application of Conscientious Objection cannot be dismissed from cases of organ donation, where the donor is presumed to be dead.

_In the pursuit of health and well-being, healthcare innovation shines as a beacon of hope, promising treatments for once-unconquerable ailments and improved quality of life. However, the chasm between the brilliance of innovation and the reality of patient access poses a complex economic challenge. This article delves into the intricate relationships between healthcare innovation, economic forces, and equitable access, analyzing the factors that drive innovation, the barriers to widespread adoption, and the potential policy remedies to bridge the chasm. (...) By navigating the labyrinth of costs, incentives, and ethical considerations, we can chart a course towards a healthcare system where innovation flourishes for the benefit of all, not just the privileged few._. (shrink)

Over the last 50 years, there has been significant development of qualitative research and related methods in healthcare. Theoretical frameworks support researchers in selecting appropriate research approaches, procedures and analytical tools. However, the implications of the choice of theory are sparsely elucidated. Based on a text excerpt from a public debate article, the study aimed to show how different theory‐inspired analytical perspectives produced varied understandings of the same text. The study presented three subanalyses inspired by Bourdieu's sociological theory, Lazarus (...) and Folkman's psychological theory and utilitarian ethics, respectively. The analyses showed that by using different theoretical analytical perspectives in inductive processes, an immediate interpretation of the text was not obvious. It became possible to spot the underlying meta‐theoretical assumptions, as the interpretations were not taken for granted or indisputable. Our analyses suggest that different theoretical lenses lead to different interpretations of the same empirical material, recognising the existence of multiple truths or realities. Thus, utilising a theoretical perspective in inductive analyses can enhance transparency and rigour because the analytical optics are made explicit to the reader. This allows the reader to follow the analysis processes and comprehend from which theoretical starting point a truth arises. (shrink)

Background: The ability to consent promotes children’s access to health services. Healthcare providers should assess and arrive at a clinical judgement about the child’s maturity and mental capacity to obtain valid consent. Research objective: The objective of the study was to determine practices employed by South African healthcare providers to obtain consent for treatment from children. Research design: A qualitative, explorative, descriptive research design was used and the study was contextual. Participants and research context: In all, 24 (...) class='Hi'>healthcare providers (professional nurses and medical practitioners) were purposively sampled from a hospital and primary health clinics. Semi-structured interviews were used. Ethical consideration: Ethical approval was obtained from the Institutional Review Board and gatekeepers. Written informed consent was obtained from each participant. Findings: Healthcare providers’ current practices in obtaining consent from children revealed inconsistency in implementation as well as the yardstick used to determine children’s mental capacity. Building trust with children, sharing information and assessment were interlinked in obtaining consent. Discussion: The inconsistent practice has implications for children’s access to healthcare services. Conclusion: Inconsistent practices in the implementation of consent laws have the potential to violate children’s rights to bodily and psychological integrity, access to health services and having their opinions heard and be taken into consideration. Through uncovering the current perceptions and practices and a literature review, guidelines intended for use by the Department of Health could be developed. (shrink)

This article aimed to explore issues of concern related to quarantine, its social consequences and influences, challenging its effects on human behavioral expressions during social isolation. The advent of the coronavirus disease 2019 (COVID-19) pandemic impacted human lives in multifarious ways, threatening the meaning of normalcy. Quarantine, lockdown, isolation, and other terms reflecting conditions limiting human freedoms have become synonymous in importance to safety, security, and survival. To understand human defiance in the face of maintaining limited mobility during the COVID-19 (...) pandemic, reimagining situations of “unfreedoms” is explained as thinking of changes to inspire and improve the meaning of living lives meaningfully. During the pandemic, issues regarding healthcare practices and social behaviors focused much attention on interactive challenges that enhance ways to mitigate the spread of contagious diseases. Illuminating these issues, discussing concerns and highlighting recommendations to engage in alternative approaches and practices, heightens the declaration of efficiency of quarantine outcomes and effectiveness. Implications are proposed with the hope that they may lead the way forward in exercising contemporary healthcare practices. (shrink)