Philosophy Of Health Care Research Articles

Naturopathic medicine and aboriginal health: an exploratory study at Anishnawbe Health Toronto.

To explore the experiences and perceptions of providing and receiving naturopathic care within the Aboriginal community served by community health centre Anishnawbe Health Toronto. This is an exploratory study using a descriptive qualitative approach to enable better understanding of the care provided to Aboriginal patients by naturopathic interns and clinician supervisors at Anishnawbe Health Toronto (AHT). We conducted semi-structured interviews with 3 naturopathic supervisors, 7 naturopathic interns, and 7 Aboriginal patients to gain an in-depth understanding of participants' experiences and perceptions of naturopathic medicine at AHT. We also conducted 3 confirmatory interviews with Naturopathic Doctors practicing in other Aboriginal communities. Naturopathic medicine is perceived to fit with health care philosophies in Aboriginal communities, as it emphasizes spiritual, mental and emotional aspects of health. Specifically, strengths of naturopathic medicine within the Aboriginal community relate to the philosophical suitability of naturopathic medicine, the ability to meet a wide range of health needs, the lack of power imbalance in the patient-practitioner relationship, and the cultural sensitivity of the practitioners. While AHT is highly regarded by patients and practitioners, certain limitations at the local setting regarding privacy and inter-professional communication were evident. Further, to facilitate trust, naturopathic interns require enhanced training in specific health issues that face the Aboriginal population to allow them to better engage with the culture and practices of the Aboriginal community. The naturopathic clinic at AHT contributes to positive patient outcomes and satisfaction and helps address unmet health needs in this population. Naturopathic medicine may be well suited to address Aboriginal health care needs through its holistic and respectful approach to care and a foundation of traditional knowledge and research evidence for treatment of a person's mind, body and spirit.

Naturopathic Medicine and Aboriginal Health: An Exploratory Study at Anishnawbe Health Toronto

Objective: To explore the experiences and perceptions of providing and receiving naturopathic care within the Aboriginal community served by community health centre Anishnawbe Health Toronto. Methods: This is an exploratory study using a descriptive qualitative approach to enable better understanding of the care provided to Aboriginal patients by naturopathic interns and clinician supervisors at Anishnawbe Health Toronto (AHT). We conducted semi-structured interviews with 3 naturopathic supervisors, 7 naturopathic interns, and 7 Aboriginal patients to gain an in-depth understanding of participants’ experiences and perceptions of naturopathic medicine at AHT. We also conducted 3 confirmatory interviews with Naturopathic Doctors practicing in other Aboriginal communities. Results: Naturopathic medicine is perceived to fit with health care philosophies in Aboriginal communities, as it emphasizes spiritual, mental and emotional aspects of health. Specifically, strengths of naturopathic medicine within the Aboriginal community relate to the philosophical suitability of naturopathic medicine, the ability to meet a wide range of health needs, the lack of power imbalance in the patient–practitioner relationship, and the cultural sensitivity of the practitioners. While AHT is highly regarded by patients and practitioners, certain limitations at the local setting regarding privacy and inter-professional communication were evident. Further, to facilitate trust, naturopathic interns require enhanced training in specific health issues that face the Aboriginal population to allow them to better engage with the culture and practices of the Aboriginal community. Conclusion: The naturopathic clinic at AHT contributes to positive patient outcomes and satisfaction and helps address unmet health needs in this population. Naturopathic medicine may be well suited to address Aboriginal health care needs through its holistic and respectful approach to care and a foundation of traditional knowledge and research evidence for treatment of a person’s mind, body and spirit. Key words: Naturopathy; Aboriginal health; First Nations health; community health centres; indigenous health services; complementary and alternative medicine

Models of health service delivery in remote or isolated areas of Queensland: a multiple case study

Objective: This paper reports on models of health service delivery in remote or isolated areas of Queensland. Background: There is little research that investigates current models of health service delivery in remote or isolated areas of Australia. Design: A multiple case study research design was employed that included interviews and focus groups. Setting: Three types of health care facilities in remote or isolated Queensland. Subjects: Thirty-five registered nurses. Results: Findings indicated that nurses and Indigenous health workers are predominantly resident and provide health services in this environment, while medical and allied health care services are usually provided by non‑resident visiting specialists. Conclusions: Findings suggest that meeting the needs of communities in remote and isolated areas of Queensland requires a change in the focus of health service delivery to accommodate a primary health care philosophy. The introduction of a new model of health service delivery is recommended; however this will only occur if resources are harnessed to prepare staff to reprioritise services offered. Implications for Health Service Management: Supporting community partnerships with shared responsibility between health service providers and community members for increasing primary care prevention practices is advocated.

Health promotion perceptions among community pharmacists in Nigeria

AbstractObjectiveTo explore the attitudes of Nigerian community pharmacists towards health promotion, to determine the importance pharmacists attach to health promotion behaviours and their perceived involvement in promoting them among their clients.MethodsWe conducted a cross-sectional survey of community pharmacists in two Nigerian cities. Attitudes toward health promotion were assessed using a 24-item instrument. The importance pharmacists attach to healthy behaviours as well as their perceived involvement was assessed using a 23-item standard instrument. Interval data on questionnaire items were gathered on a Likert-type scale, and the demographic characteristics of the respondents were also profiled. Principal factor analysis employed Varimax rotation with Kaiser normalisation. Associations between demographic profile and responses were evaluated using Student's t test and one-way ANOVA.ResultsAbout 84% of the respondents indicated a favourable attitude towards health promotion. Nearly all the respondents (98%) were interested in health promotion services, and 94% indicated willingness to devote extra time to talk to patients. A majority (93%) reported willingness to retrain on health promotion. Lack of health promotion policy for pharmacists, and negative attitude towards the utilisation of pharmacy technicians were potential barriers. Pharmacists that were studied attached very high importance to 12 of the 23 widely advocated health promotion behaviours, and felt they should be very involved in seven of them. Medication-related counselling, use of condoms, and maintenance of blood pressure were perceived to be top priorities. Rating attitudinal scores, importance of healthy behaviours, and level of involvement were 94.07 ± 20.77, 99.22 ± 21.78, and 93.33 ± 24.01 respectively (range 23 to 115; midpoint 69). Perceived involvement had moderate correlation with the importance attached, r = 0.6488 (P = 0.0008).ConclusionThere is an indication that the Nigerian community pharmacists in this survey perceived an extended role in health promotion, especially medication-related activities. This is consistent with the philosophy of primary healthcare and pharmaceutical care.

Conceptual analysis and empirical research in medical philosophy and medical ethics

One cannot think of medical practice and medical science without being aware of the phenomena of health and disease (or illness). Since time immemorial health and disease are essential concepts in the philosophy of medicine and health care. It is a long ongoing debate. The concepts of health and disease have been studied and analyzed for decades without reaching any consensus on their content. In the literature, it is argued that the concept of disease is complex, vague, slippery, indefinable, or even dead. In the first paper in this issue, Bjorn Hofmann argues that the arguments for the vagueness, complexity and indefinability of the concept of disease are not overly convincing and that the claim that the concept of disease can be abandoned altogether needs better arguments. His conclusion is that it appears at least as hard to show that disease is indefinable as it is to define it. Marianne Boenink also embarks on the philosophy of disease, especially on the relationship between the emergence of new technologies such as molecular medicine and concepts of disease. It is widely acknowledged that new technologies often not only produce new ‘ontologies’, but also new roles and new ethical responsibilities. The technological constitution of disease raises extensive philosophical debates, but ethical analyses of new biomedical technologies only rarely include conceptual clarification of disease concepts implied by these new technologies. The author argues that it is useful to start with an analysis of concepts of disease which are implied in new emerging technologies, when anticipating ethical issues of biomedical technologies. Thus, a conceptual analysis should precede the ethical debate. The third article in this issue also deals with a conceptual problem. The policy responses to suicide and schizophrenia in the UK—and in many other countries—are predicated on notions of global irrationality as a justification for paternalistic interventions. Jeanette Hewitt argues that it is theoretically possible that suicide may not be an irrational response to the suffering experienced by people with a severe and enduring mental illness and that suicide is not necessarily a consequence of their mental illness per se. What has been conceptualized as ‘‘psychopathological’’ by psychiatric perspectives may be a normal reaction of hopelessness to a realistic appraisal of the course and consequences of living with schizophrenia. However, this point of view does not preclude intervention of any kind to prevent suicide. Also the fourth article in this issue is analytic and argumentative in nature. Dan Egonsson comes up with a new interpretation of the Substituted Judgement Standard (SJS). SJS is commonly understood in a counterfactual and purely hypothetical way culminating in the question what decision the patient here and now would have made, had he or she been competent. Egonsson believes there is another reading in which the emphasis is more on the past, in so far that it bears on the present situation, than on the now. He proposes an alternative, factual, interpretation of the SJS in which the surrogate is required to infer what the patient in the past actually thought about a particular treatment that is being considered. A few decades ago, medical ethics moved from a predominantly theoretical discipline to a discipline that not only explicitly reflects on empirical findings, but also considers empirical research as an important part of its endeavour. The next two articles are in line with this empirical turn in bioethics. Yvonne Denier et al. report about the findings of an empirical, qualitative study based on in-depth interviews with 18 nurses from Flanders W. Dekkers (&) B. Gordijn UMC St Radboud Nijmegen, 114 IQ Healthcare, Section Ethics, PO Box 9101, 6500 HB Nijmegen, The Netherlands e-mail: v.hulsman@iq.umcn.nl

Caregiver experience in mental illness: A perspective from a rural community in South Africa

After the democratization of South Africa in 1994, the health-care system was reorganized in accordance with the primary health-care philosophy advocated by the World Health Organization. This was accompanied by a process of deinstitutionalization of mental health-care services, which has led families to become the main providers of care to individuals with mental illness. This study explores the experiences of informal family caregivers of persons with mental illness in a rural area in South Africa. Data were collected through eight individual semistructured interviews of informal caregivers who cared for relatives with mental illness and collect medications monthly at a community clinic in the Makhuduthamaga local municipality in Limpopo, South Africa. A qualitative research design was used, which was explorative, descriptive, and contextual. The data analysis revealed four major themes: (i) experiences of providing for physiological/physical needs; (ii) experiences of providing for emotional needs; (iii) experiences of providing for security needs; and (iv) experiences associated with the medical health-care programme. The study revealed that the experiences of family caregivers were conceptualized negatively, although the interview questions were intentionally neutral. This is believed to be due to the cultural explanatory models of mental illness prevalent in this region of South Africa. It is suggested that to increase compliance with medication, reduce relapse, and mitigate stigma associated mental illness, medical professionals need to incorporate aspects of cultural explanatory models into their explanations of the causes of illness.

On the notion of home and the goals of palliative care

The notion of home is well known from our everyday experience, and plays a crucial role in all kinds of narratives about human life, but is hardly ever systematically dealt with in the philosophy of medicine and health care. This paper is based upon the intuitively positive connotation of the term “home.” By metaphorically describing the goal of palliative care as “the patient’s coming home,” it wants to contribute to a medical humanities approach of medicine. It is argued that this metaphor can enrich our understanding of the goals of palliative care and its proper objectives. Four interpretations of “home” and “coming home” are explored: (1) one’s own house or homelike environment, (2) one’s own body, (3) the psychosocial environment, and (4) the spiritual dimension, in particular, the origin of human existence. Thinking in terms of coming home implies a normative point of view. It represents central human values and refers not only to the medical-technical and care aspects of health care, but also to the moral context.

From notions of health to causality

In 2005 the European Society for Philosophy of Medicine and Health Care (ESPMH) initiated an annual contest for young scholars. Every year an ESPMH prize is awarded to a scholar younger than 35 years of age for a scientific contribution on ethical, epistemological, or other philosophical topics relating to medicine and health care. The first paper in this issue, ‘On the relationship between individual and population health’, has been written by the winner of this prize in 2007, Onyebuchi A. Arah. Compared to the idea of individual health, ‘population health’ is a relatively new, rather fashionable term in the field of medicine and health care. The relationship between individual and population health is partially built on the dichotomization of medicine into clinical medicine and public health. Individual and population health are often seen as absolute and independent concepts. Onyebuchi A. Arah argues that the relationship between the two is largely relative and dynamic. His argument is based on an attempt to include a population perspective on health in definitions of health, particularly by emphasizing the role of the ‘context’ component of any notion of health. The second contribution in this issue, written by Shawn H. E. Harmon, also deals with public health, but this paper is more practical in nature. After having reminded us of the fact that public health is a multidisciplinary and complex phenomenon, the author argues that public health promotion is a moral duty and that, although multiple actors are relevant and necessary to fulfilling this duty, the role of international actors is paramount. The paper especially focuses on one of the most important international organizations in this field, that is, the World Health Organization (WHO). Shawn H. E. Harmon argues that better health can and must be better promoted through a more robust interpretation of the WHO’s role. Together with other international organizations, he argues, the WHO has not yet played its necessary part in promoting ‘health for all’. The third paper, written by Rui Nunes, Guilhermina Rego and Christina Brandao, leaves the difference between individual and public health for what it is. The authors evaluate the role of independent regulatory agencies in the field of health care, as compared to the role of traditional public regulations, with regard to a fair process of equal access to health care and of setting limits to health care. In their argument Norman Daniels’ and James Sabin’s theory of accountability for reasonableness plays a central role. The authors conclude that accountability for reasonableness should be regarded as a landmark of any health care reform. The rationale for limit-setting decisions must be clearly communicated toward the public. Karin Dahlberg, Les Todres and Kathleen Galvin focus on individual health care. They critically review the common standard of ‘patient-centred’ or ‘patient-led’ health care and argue that current patient-led approaches hinder a focus on a deeper understanding of what patient-led care could be. Based on various phenomenological and existential insights they present an alternative interpretation of patient-led care which they call ‘lifeworld-led care’. A philosophy of the person, a view of well-being, and a philosophy of care should be key elements in the further development of this ‘lifeworld-led care’. With the paper of Juha Raikka, ‘The ethical and political evaluation of biotechnology strategies’, we enter a new category of topics in this issue, that is, regulatory aspects of research and new biotechnologies. Juha Raikka focuses on W. Dekkers (&) B. Gordijn UMC St Radboud Nijmegen, 114 IQ Healthcare, Section Ethics, PO Box 9101, 6500 Nijmegen, HB, The Netherlands e-mail: w.dekkers@iq.umcn.nl

New ways of working: how mental health practitioners perceive their training and role

This paper outlines advances in the mental health workforce by detailing the development, education and training of graduates from the social sciences in mental health practice. The mental health practitioner (MHP) programme is a partnership between higher education and the National Health Service to provide graduates with a new point of entry into the mental health workforce. The MHP is a new role in mental health i.e. in principle, trans-disciplinary, traversing psychology, nursing and occupational therapy. The role is informed by a bio-psychosocial philosophy of collaborative mental health care and therefore acts as a bridge between the different professions that constitute a multidisciplinary team on acute inpatient units and in the community. However, MHPs form part of the nursing team and work most closely with mental health nurses. They see their role as linked to, but other than, nursing. This paper will discuss the development of this programme and its philosophy of care, and will present outcome research on trainee perceptions and experiences of occupying the MHP role in mental health. It will present findings from the first stage of a longitudinal study (employing interviews and survey data) about trainee perceptions of their role and training before the programme commenced, 6 months into their training and at graduation.

23rd European Conference on Philosophy of Medicine and Health Care: “Sources and Perspectives of Bioethics”, Tübingen, Germany, 19–22 August 2009

23rd European Conference on Philosophy of Medicine and Health Care: “Sources and Perspectives of Bioethics”, Tübingen, Germany, 19–22 August 2009

The European Society for Philosophy of Medicine and Health Care

The European Society for Philosophy of Medicine and Health Care

Therapists are ideally placed to create a collaborative self-management approach

A biopsychosocial, patientcentred approach and good governance are central to health-care philosophy. The core of rehabilitation today focuses on the management of chronic conditions. This has enabled a shift in therapy from a conventional therapist-centred model to a patient-centred one which emphasizes managing conditions rather than curing them. In terms of patient–therapist interactions, this has necessitated a move to a concept of collaboration where goals and strategies are jointly planned and negotiated. This is more than simple adherence to treatment guidelines; it incorporates the psychological as well as the social management of living with chronic illness (Newman and Mulligan 2004). Self-management is a highly skilled approach that can only be successful in a setting that encourages self-efficacy and a decrease in stress as a management aim, thus moving from a passive to a more active treatment paradigm for the patient.

Registration Form: 22st European Conference on Philosophy of Medicine and Health Care

Registration Form: 22st European Conference on Philosophy of Medicine and Health Care

Call for Abstracts: XXIInd European Conference on Philosophy of Medicine and Health Care

Call for Abstracts: XXIInd European Conference on Philosophy of Medicine and Health Care

Medical humanities and philosophy of medicine

Medical humanities and philosophy of medicine

XXIInd European conference on philosophy of medicine and health care

XXIInd European conference on philosophy of medicine and health care

Medical humanities: Introduction to the theme

The Twentieth European Conference on Philosophy of Medicine and Health Care was held in Helsinki, Finland, in August 2006 and highlighted the theme "Medicine, Philosophy and the Humanities." The four papers in this thematic section are developed from presentations made at that conference. They are the work of physicians and philosophers and present fundamentally philosophical reflections on the medical humanities. The authors show that philosophy offers both a substantial way of humanizing the theory and practice of medicine and a way to orchestrate the contributions of all the medical humanities.

XXIInd European Conference on Philosophy of Medicine and Health Care

XXIInd European Conference on Philosophy of Medicine and Health Care

The 22nd European Conference on Philosophy of Medicine and Health Care

The 22nd European Conference on Philosophy of Medicine and Health Care

Technology and the self

The most exciting breakthroughs of the 21st century will not occur because of technology but because of an expanding concept of what it means to be human (John Naisbitt, futurist) Technologies affect what we do, how we work, think and communicate. Mobile telephones, for example, have enabled approximeeting, “arranging to meet someone without making firm plans about time or place, and then finalising details via mobile phone while out and about” (The Phone of the Future, 2006). Another example is the Internet, which facilitates the creation of a new identity and the beginning of a new virtual life as a three-dimensional avatar, a representation of your person in the form of a model to be used to explore 3-D virtual worlds and socialize with other virtual persons. Additionally, current technological developments are increasingly triggering questions about selfhood and what it means to be human. Progress in genetics, for example, has prompted the question of what it means to be 98 percent chimpanzee (Jonathan Marks, 2002). Moreover, we are beginning to use technologies to change ourselves in accordance with our desires. At this early stage it is impossible to say just where our efforts at autotransformation for the purpose of enhancement will lead us to; but we will undoubtedly enter new territory — not only in a medical sense, but also anthropologically, psychologically and politically. The current issue of Medicine, Health Care and Philosophy focuses on technology and the self. It starts with a thematic section on “Psychopharmacology and the Self”, which originates from a parallel session on psychopharmacology held during the 19th European Conference on Philosophy of Medicine and Health Care in Barcelona in August 2005. The topicality of the subject matter can hardly be overstated against the backdrop of the emerging neuroethics debate. The first paper of the other Scientific Contributions focuses on nanomedicine. The pace of developments in nanomedicine is quite amazing. In March 2005, the first issue of Nanomedicine: Nanotechnology, Biology, and Medicine was published, the first international peer reviewed academic journal exclusively focusing on providing the latest information both in nanomedical research and clinical applications. Moreover, it is the Official Journal of the American Academy of Nanomedicine, the first professional academic society devoted to moving ahead research in nanomedicine. It was launched earlier in 2005 and held its First Annual Meeting at the Johns Hopkins University in Baltimore, Maryland, USA (August 15–16, 2005). In their paper “Nanomedicine — emerging or re-emerging ethical issues? A discussion of four ethical themes”, Lenk and Biller-Andorno analyse important ethical concerns associated with the further development of nanomedicine, such as the risks, issues of human identity and enhancement as well as implications for civil liberties. In doing so they clearly demonstrate the need for further ethical debate so as to form a basis for responsible political decisionmaking. The next paper, written by Brassington, focuses on “Heidegger’s concept of technology and its application in medicine”. Drawing on the distinction between chronological and historical modernity, the author argues that medical technology does not incorporate the dangers that Heidegger regards as associated with modern technology. Subsequently, Tengland’s paper, “Empowerment: A goal or a means for health promotion?”, endeavours to explain what empowerment exactly involves. Moreover, it investigates whether empowerment is a goal or a means for health promotion. In the next scientific contribution, “Disablement and personal identity”, Edwards analyses the claim that the disabling characteristics of a disabled person are part of the identity of that person. Drawing on an account of narrative identity, the author demonstrates that the identity claim can indeed be accepted. The final paper, “Edwards on disablement and personal identity” by van Hooft, is a commentary on Edward’s article.