Health Policy Ethics Research Articles

Scoping the literature on patient travel abroad for cancer screening, diagnosis and treatment.

The incidence of cancer is on the rise globally. Under particular circumstances, patients are willing to travel abroad for healthcare treatments. We know relatively little however about patients travelling overseas for cancer-related screening, diagnosis and treatment. Where do patients go, for what treatments, what are their motivations, decision-making processes and treatment experiences? What do we know about patient safety and risk, and outcomes? More broadly, what are the ethical and legal implications? This review presents the first published assessment of what we term 'transnational oncology treatment', defined as patients travelling overseas or across borders for cancer screening, diagnosis and treatment. The review undertakes detailed search and retrieval of the literature, using an accepted scoping review method. We present a narrative review of existing knowledge and themes, identifying coverage and gaps. There is a five-fold agenda for future investigation: trajectories and itineraries; in depth focus on treatment decisions, experiences and outcomes; locating patient travel within wider health system analysis; exploration of professional perspectives and coordination; and situating travel within the context of health trade. Such an agenda is multidisciplinary and wide-ranging, encompassing epidemiology, health economics, health policy ethics, health politics, health management, and health policy.

Identifying and Classifying Tools for Health Policy Ethics Review: A Systematic Search and Review.

Ethical review and analysis of health policy may help to ensure policies address the needs of society and align with relevant values and principles. Indeed, researchers and bioethicists have recognized the need for ethical frameworks specifically for public health applications. The objective of this research was to compile structured tools for ethical review of (drafted or existing) health policy and to analyze these tools for their scope and philosophical underpinnings. A systematic search and review of academic and grey literature was conducted to compile existing tools designed for health policy ethics review. The search yielded 13 health policy ethical review tools. Qualitative content analysis revealed that all of the tools were influenced by multiple ethical values and that a majority were influenced by more than one ethical theory. The most common values were non-maleficence and beneficence (92.3%). The most common influencing ethical theory was the Principles Approach (92.3%). The structure of the tools demonstrates a heterogeneity of methodology designs to approach policy ethics review. This research offers a unique contribution to the bioethics field that provides a useful resource and understanding of the current ethical review tools for health policy.

Moving from clinical to pragmatic equipoise in health policy and systems research.

Health policy and systems research refers to the research conducted on the formulation, impact, organisation and functioning of health policies, and how to optimise the functioning of health systems and policies towards achieving health for all. There is emerging scholarship on the ethics of conducting such health policy and systems research. Ethics of health policy and systems research, though similar to the ethics of traditional clinical research in many ways, has several important distinctions. In traditional clinical research on human participants, where two treatments or interventions are compared, clinical equipoise is an important ethical consideration. This refers to the genuine uncertainty among professional peers on whether one of the interventions is better than the other. This uncertainty is in the biomedical efficacy of the intervention. Unless such equipoise exists, clinical research is said to be unethical from the benefit-risk balance and justice perspectives. In health policy and systems research, the question of clinical equipoise is often not relevant. This article will describe the condition of clinical equipoise in health policy and systems research, its applications and challenges.

The ethical challenges of health policies in Benin

Over the past two decades, new challenges in public health have sparked renewed interest in health policy ethics in the world. But in Africa in general and Benin in particular, public health ethics as an approach of intervention, remains embryonic. By aiming the well-being of the population, the health policy in Benin is implicitly ethics. But it is too focused on medical logic and operates at the expense of ethics-oriented approach, clearly expressed in terms of strategies assessed by an independent body before, during and after their implementation, based on the relevance, the efficiency, the equity, the transparency, the social justice... In a context of lack of access to information sources or credible knowledge, health policies recipients do not seem able to exercise their autonomy.

Ethics of health policy and systems research: a scoping review of the literature.

Health policy and systems research (HPSR) is increasingly funded and undertaken as part of health system strengthening efforts worldwide. HPSR ethics is also a relatively new and emerging field, with numerous normative and descriptive questions that have largely not been considered. Normative questions include what ethical principles and values should guide HPSR. Descriptive questions include what ethical concerns arise when conducting HPSR. A small but growing body of scholarly work characterizes the various ethics issues inherent in HPSR. Towards informing the future development of ethics guidance for HPSR, a scoping review was undertaken to: (1) identify the range of ethics issues relevant to the conduct of HPSR-with a deliberate (though not exclusive) focus on low- and middle-income country settings and (2) describe existing guidance on key ethics issues relevant to HPSR. Using the Cochrane methods as a basis, the review identified formal and informal literature on HPSR ethics by searching the following databases: PubMed's Medline, Embase, Global Health, Scopus, WHO Global Health Regional Libraries, LILACs, OpenDOAR and Bielefeld Academic Search Engine. In total, 11062 documents were identified from the formal (10519) and informal (543) literature. One hundred and seven of these documents (formal 99 and informal 8) met at least one inclusion criterion and underwent thematic analysis. Ethical issues in four main categories were identified: upholding autonomy, identifying and balancing risks and benefits, justice and determination of ethical review requirements. The review indicated that the ethical values behind HPSR place an emphasis on its contributing to the reduction of health disparities. Unsurprisingly then, numerous ethical concerns relating to justice arise in HPSR. However, the majority of existing guidance focuses on obtaining or waiving informed consent and, thus, appears to be insufficient for HPSR. A list of priority ethics issues in HPSR in need of guidance development is provided.

Research Involving Health Providers and Managers: Ethical Issues Faced by Researchers Conducting Diverse Health Policy and Systems Research in Kenya.

There is a growing interest in the ethics of Health Policy and Systems Research (HPSR), and especially in areas that have particular ethical salience across HPSR. Hyder et al (2014) provide an initial framework to consider this, and call for more conceptual and empirical work. In this paper, we respond by examining the ethical issues that arose for researchers over the course of conducting three HPSR studies in Kenya in which health managers and providers were key participants. All three studies involved qualitative work including observations and individual and group interviews. Many of the ethical dilemmas researchers faced only emerged over the course of the fieldwork, or on completion, and were related to interactions and relationships between individuals operating at different levels or positions in health/research systems. The dilemmas reveal significant ethical challenges for these forms of HPSR, and show that potential ‘solutions’ to dilemmas often lead to new issues and complications. Our experiences support the value of research ethics frameworks, and suggest that these can be enriched by incorporating careful consideration of context embedded social relations into research planning and conduct. Many of these essential relational elements of ethical practice, and of producing quality data, are given stronger emphasis in social science research ethics than in epidemiological, clinical or biomedical research ethics, and are particularly relevant where health systems are understood as social and political constructs. We conclude with practical and research implications.

Notes on Contributors

Previous article FreeNotes on ContributorsPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreScott Anderson is assistant professor of philosophy at the University of British Columbia. His main areas of study are coercion, social power, ethics, sex, and gender. He has previously published “Prostitution and Sexual Autonomy: Making Sense of the Prohibition of Prostitution” in Ethics. [email protected]Samuel Asarnow is assistant professor of philosophy at Macalester College. He works in ethics, action theory, and metaethics and is currently writing a series of papers on the idea of a reason for action. [email protected]Michael Bukoski is a PhD student in philosophy at the University of Arizona. His research focuses on the nature of normativity, especially attempts to explain normativity by appeal to what is constitutive of action or agency. He is also interested in the implications of moral uncertainty and in the basis of moral equality among persons. [email protected]Matthew Hammerton is a PhD student in philosophy at the Australian National University. His research is primarily focused on foundational issues in normative ethics and value theory. [email protected]Timo Jütten is a lecturer in philosophy at the University of Essex, UK. His research is in social and political philosophy. He has published papers on critical social theory and on the morality of markets. [email protected]Micah Lott is assistant professor in the department of philosophy at Boston College. He writes mostly about Neo-Aristotelianism in ethics and metaethics. His essays have appeared in Journal of Moral Philosophy, Social Theory and Practice, and Utilitas. [email protected]Abraham Sesshu Roth is an associate professor in the philosophy department at Ohio State University. He has taught at UCLA and at the University of Illinois at Chicago, and received his PhD from Princeton. He works mainly in the philosophy of action, focusing on issues concerning intentions, practical reasoning, reasons explanation, shared agency, and related issues in epistemology and moral psychology. He has published in Philosophical Review, Noûs, Philosophy and Phenomenological Research, and Philosophical Studies. [email protected]Andreas T. Schmidt is a postdoctoral research fellow at the University Center for Human Values and the Woodrow Wilson School of Public and International Affairs at Princeton University. His research interests include sociopolitical freedom, distributive justice, consequentialism, and the ethics of health policy. [email protected]Philip Swenson is currently a postdoc in the philosophy department at Rutgers University. Beginning in fall 2017, he will be an assistant professor of philosophy at the College of William & Mary. He works primarily on issues connected to free will and moral responsibility. [email protected]Patrick Todd is a faculty member (as a Chancellor’s Fellow) at the University of Edinburgh, and secretary of the Scots Philosophical Association. He works primarily in areas related to the problem of free will, especially metaphysics (the fixity of the past and the openness of the future), ethics (moral responsibility), and philosophy of religion (omniscience and freedom). [email protected] Previous article DetailsFiguresReferencesCited by Ethics Volume 127, Number 1October 2016 Article DOIhttps://doi.org/10.1086/687329 © 2016 by The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.

The Ethical Imperative to Move to a Seven-Day Care Model.

Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery.

Health policy, ethics, and the Kansas Legislative Health Academy.

We describe a unique program, the Kansas Legislative Health Academy, that brings together state legislators from across the political spectrum to build their capacity in advancing policies that can improve the health of Kansans. To that end, the academy helps legislators develop new skills to deliberate the ethics of health policy, use systems thinking to understand the long- and short-term effects of policy action and inaction, and engage in acts of civic leadership. The academy also seeks to foster an environment of respectful open dialogue and to build new cross-chamber and cross-party relationships. Among the most important outcomes cited by program participants is the value of sustained, personal interaction and problem solving with individuals holding differing political views.

Patient mobility in the global marketplace: a multidisciplinary perspective.

There is a growing global market in healthcare and patients. And while there is a small body of evidence emerging around this phenomenon commonly known as medical tourism there remain significant unanswered policy and research questions which need to be addressed. We outline some of the key issues set against the six key disciplinary preoccupations of the journal: epidemiology, health economics, health policy ethics, politics of health, health management, and health policy.

Professional Responsibility to and for Patients and the Ethics of Health Policy

Nancy Jecker (2013) mounts a sustained and formidable critique of Norman Daniels's prudential lifespan account (PLA) as a reliable basis for justice between age groups in the responsible allocation...

Health Policy and Ethics: A Catholic Contribution in a Pluralistic Society

Health policy generally seeks to improve the overall health of people in society. Since public health policy involves human values, decisions, and actions, it is inescapably ethical. In recent years there has been a growing awareness of the need for a systematic approach to the ethical analysis of public policy. Some government health-policy statements attempt to provide ethical frameworks. In our pluralistic societies, however, these tend to be pragmatic and lack a solid grounding in an adequate understanding of the human person. This could lead to justifying what is popular rather than what is ethical. This article attempts to show how a Catholic moral approach, which provides a solid foundation for ethics, can make a significant contribution to a discussion of health-policy ethics in a pluralistic society.

Contracts to devolve health services in fragile states and developing countries: do ethics matter?

Fragile states and developing countries increasingly contract out health services to non-state providers (NSPs) (such as non-governmental organisations, voluntary sector and private sector). The paper identifies ethical issues when contracts...

Representation or Reason: Consulting the Public on the Ethics of Health Policy

Consulting the public about the ethical approaches underlying health policies can seem an appealing means of addressing concerns about limited public participation in development of health policy. However ambiguity surrounds questions of whether, or how consultation can really contribute to more defensible decisions about ethical aspects of policy. This paper clarifies the role and limits of public consultation on ethics, beginning by separating different senses of defensibility in decisions on ethics. Defensibility of ethical decisions could be understood either in the sense of legitimacy in virtue of reflecting the opinions of the public whose interests are affected, or in the sense of being able to withstand and respond to challenges presented in ethical debate. The question then is whether there are forms of consultation which have the potential to realise more defensible decisions in either of these senses. Problems of adequately accounting for the views of those affected by policy decisions casts doubt on the plausibility of using consultation as a means of determining the opinions of the public. Consultation can have a role by bringing new ideas and challenges to debate, although it is uncertain whether this will increase the defensibility of any decision on ethics.

Universal Health Care, American Pragmatism and the Ethics of Health Policy: Questioning Political Efficacy

In this essay, I explore how thinking about the ethics of health policy is distinct from thinking either about ethics or about health policy. This is because a policy that seems ethically optimal may be pragmatically untenable, while a pragmatically tenable policy may be ethically problematic. If ought implies can, then some kind of pragmatic value seems required for any given policy choice to be relevant in policy discourse. I consider one particularly volatile and contentious health policy - universal health care - in light of the tension between ethics and American pragmatism, and conclude that justifying the policy on the basis of a theory of human needs is unlikely to be successful in policy discourse. Moreover, I challenge the common move from the existence of such needs to a theory of rights to such care. All this is not to assail a policy of universal health care per se, but simply to argue that, from a pragmatic (policy) perspective, grounding its justification in a theory of need may be unlikely to persuade stakeholders not already inclined to support such a policy.

Wanted: A New Ethics Field for Health Policy Analysis

Ethics guidance and ethical frameworks are becoming more explicit and prevalent in health policy proposals. However, little attention has been given to evaluating their roles and impacts in the policy arena. Before this can be investigated, fundamental questions must be asked about the nature of ethics in relation to policy, and about the nexus of the fields of applied ethical analysis and health policy analysis. This paper examines the interdisciplinary stretch between bioethics and health policy analysis. In particular, it highlights areas of scholarship where a health policy ethics specialization--as distinctive from bioethics--might develop to address health policy concerns. If policy and ethics both ask the same question, that question is: "What is the good, and how do we achieve (create, protect, cultivate) it?" To answer this question, the new field of "health policy ethics" requires development. First, we should develop a full set of ethical principles and complementary ethical theories germane to public policy per se. Second, we must understand better how explicit attention to ethical concerns affects policy dynamics. Third, we require new policy and ethical analytic approaches that contribute to constructive (not obstructive) policy making. Finally, we need indicators of robust, high quality ethical analysis for the purpose public policy making.

Advanced training in biomedical ethics: a curriculum in clinical specialty programmes.

Medical ethics play an essential role in the practice of medicine, in the care of individual patients, in the allocation of health care resources, and in the formulation of health care policy. A specific body of knowledge, 'biomedical ethics', has developed which applies ethical theory to biomedical practice. This has provided doctors with tools systematically to integrate rational ethical analysis into clinical decision-making. Training in the discipline of biomedical ethics is now required for all doctors in Canada. The goals, content areas, learning objectives, and learning methods considered appropriate for advanced training in this field for medical specialists are provided in this paper. Six topic areas are discussed: introduction to ethical theory, clinical ethics, professional ethics, ethics of human experimentation, ethics of health policy, and independent study. Ways this curriculum could be organized and evaluated are also offered.