Http Dx Doi Org 10 1080 15265160903197531, Oct 30, 2009
Public engagement in ethically laden pandemic planning decisions may be important for transparenc... more Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness (e.g., recognition of an extant duty not to infect others), while some also acknowledged strong self-interest. Participants conveyed desire for opportunities for public input and education, and articulated distrust of government. Social distancing measures may be challenging to implement and sustain due to strains on family resources and lack of trust in government.
... than lack of medical effectiveness. Children with Down syndrome, like Sarah Palin'sson, ... more ... than lack of medical effectiveness. Children with Down syndrome, like Sarah Palin'sson, have been and continue to be safe from rationing on the basis of quality of life judgments under this act. They and their families are actually ...
ABSTRACT Setting priorities for public health requires making tradeoffs among a number of competi... more ABSTRACT Setting priorities for public health requires making tradeoffs among a number of competing goals and subpopulations. For example, some public health programs are likely to produce more aggregate health in a population yet exacerbate relative disparities between better and worse off groups. Other interventions may reduce health disparities but be cost-inefficient. Still other investments may target one vulnerable population, such as children, diverting investments from other vulnerable groups, such as frail elders. Each of these investments might be justifiable according to ethical principles integral to US public health, such as maximization, distributive equity, efficiency, and protection of vulnerable groups. How ought such tradeoffs be decided? What approach to setting priorities in public health is ethically defensible? This presentation defends the general thesis that public deliberation is an ethical approach to setting public health priorities. Public deliberation is a method of public engagement that has made significant inroads in public policy and has increasingly been used to engage citizens in bioethics and health policy issues. In the past year, the Institutes of Medicine endorsed deliberation as a method of public engagement and the Agency of Healthcare Research and Quality undertook a study to evaluate different methods of public deliberation. This presentation will identify core elements of public deliberation; differentiate public deliberation from community-based participation; and analyze the ethical merits of public deliberation as a method for setting public health priorities. These areas will be discussed using an innovative project that combines public deliberation with dynamic system modeling as a case study.
Cambridge Quarterly of Healthcare Ethics, Oct 1, 2000
ABSTRACT usually brings to mind images of picket signs held by laborers striking for better wages... more ABSTRACT usually brings to mind images of picket signs held by laborers striking for better wages and benefits. Collective action, however, need not be limited to the withholding of labor. Nor need it involve only the working or middle classes, as airline pilots have recently demonstrated. Finally, collective action need not have as its only purpose the self-interest of the group. Collective action does, however, always involve a joining together of individuals united by common goals or interests in order to consolidate power for the purpose of negotiating with another group or entity. Examples of collective action obviously include striking, other withholding labor actions, and slowdowns, but can also include many other activities. for example, have been threatened or used by house officer organizations in the past. In a paper strike, patient care continues but without documentation, and thus, the institution suffers from absent or delayed financial remuneration.
African Americans' mistrust of healthcare is often cited as a cause of racial disparities in ... more African Americans' mistrust of healthcare is often cited as a cause of racial disparities in health and has been linked to cultural mistrust. African-American parents' level of cultural mistrust while in a general healthcare setting has not been previously measured. To determine the performance, participant acceptance, feasibility of administration and demographic associations of a measure of cultural mistrust, the Cultural Mistrust Inventory (CMI), in African-American parents seeking healthcare. A cross-sectional sample of 69 self-identified African-American parents of minor children recruited in a university-affiliated, urban pediatric/family practice outpatient clinic completed an anonymous, self-administered questionnaire containing demographic items and the CMI. The response rate was 91% (n=63), and 49 (78%) -- answered all questions. Measured mistrust did not vary with gender, insurance or education. The CMI's internal consistency was similar to previously publishe...
In response to three articles on managed care by Allen Buchanan, David Mechanic, and Ezekiel Eman... more In response to three articles on managed care by Allen Buchanan, David Mechanic, and Ezekiel Emanual and Lee Goldman (this issue), I discuss doctor-patient and organization-member trust and the moral obligations of those relationships. Trust in managed care organizations (providers of and payers for health care) stands in stark contrast to the current contractual model of health insurance purchase, but is more coherent with consumer expectations and with the provider role of such organizations. Such trust is likely to differ from that between doctors and patients. Financial reimbursement systems for physicians, one example of organizational change in our health system, can be evaluated for their impact on both kinds of trust according to their intrusiveness, openness, and goals. Although involving managed care enrollees in value-laden decisions that affect them is commendable, restrictions on or regulation of physician incentive systems may be better accomplished on a national level.
Http Dx Doi Org 10 1080 15265160903197531, Oct 30, 2009
Public engagement in ethically laden pandemic planning decisions may be important for transparenc... more Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness (e.g., recognition of an extant duty not to infect others), while some also acknowledged strong self-interest. Participants conveyed desire for opportunities for public input and education, and articulated distrust of government. Social distancing measures may be challenging to implement and sustain due to strains on family resources and lack of trust in government.
... than lack of medical effectiveness. Children with Down syndrome, like Sarah Palin'sson, ... more ... than lack of medical effectiveness. Children with Down syndrome, like Sarah Palin'sson, have been and continue to be safe from rationing on the basis of quality of life judgments under this act. They and their families are actually ...
ABSTRACT Setting priorities for public health requires making tradeoffs among a number of competi... more ABSTRACT Setting priorities for public health requires making tradeoffs among a number of competing goals and subpopulations. For example, some public health programs are likely to produce more aggregate health in a population yet exacerbate relative disparities between better and worse off groups. Other interventions may reduce health disparities but be cost-inefficient. Still other investments may target one vulnerable population, such as children, diverting investments from other vulnerable groups, such as frail elders. Each of these investments might be justifiable according to ethical principles integral to US public health, such as maximization, distributive equity, efficiency, and protection of vulnerable groups. How ought such tradeoffs be decided? What approach to setting priorities in public health is ethically defensible? This presentation defends the general thesis that public deliberation is an ethical approach to setting public health priorities. Public deliberation is a method of public engagement that has made significant inroads in public policy and has increasingly been used to engage citizens in bioethics and health policy issues. In the past year, the Institutes of Medicine endorsed deliberation as a method of public engagement and the Agency of Healthcare Research and Quality undertook a study to evaluate different methods of public deliberation. This presentation will identify core elements of public deliberation; differentiate public deliberation from community-based participation; and analyze the ethical merits of public deliberation as a method for setting public health priorities. These areas will be discussed using an innovative project that combines public deliberation with dynamic system modeling as a case study.
Cambridge Quarterly of Healthcare Ethics, Oct 1, 2000
ABSTRACT usually brings to mind images of picket signs held by laborers striking for better wages... more ABSTRACT usually brings to mind images of picket signs held by laborers striking for better wages and benefits. Collective action, however, need not be limited to the withholding of labor. Nor need it involve only the working or middle classes, as airline pilots have recently demonstrated. Finally, collective action need not have as its only purpose the self-interest of the group. Collective action does, however, always involve a joining together of individuals united by common goals or interests in order to consolidate power for the purpose of negotiating with another group or entity. Examples of collective action obviously include striking, other withholding labor actions, and slowdowns, but can also include many other activities. for example, have been threatened or used by house officer organizations in the past. In a paper strike, patient care continues but without documentation, and thus, the institution suffers from absent or delayed financial remuneration.
African Americans' mistrust of healthcare is often cited as a cause of racial disparities in ... more African Americans' mistrust of healthcare is often cited as a cause of racial disparities in health and has been linked to cultural mistrust. African-American parents' level of cultural mistrust while in a general healthcare setting has not been previously measured. To determine the performance, participant acceptance, feasibility of administration and demographic associations of a measure of cultural mistrust, the Cultural Mistrust Inventory (CMI), in African-American parents seeking healthcare. A cross-sectional sample of 69 self-identified African-American parents of minor children recruited in a university-affiliated, urban pediatric/family practice outpatient clinic completed an anonymous, self-administered questionnaire containing demographic items and the CMI. The response rate was 91% (n=63), and 49 (78%) -- answered all questions. Measured mistrust did not vary with gender, insurance or education. The CMI's internal consistency was similar to previously publishe...
In response to three articles on managed care by Allen Buchanan, David Mechanic, and Ezekiel Eman... more In response to three articles on managed care by Allen Buchanan, David Mechanic, and Ezekiel Emanual and Lee Goldman (this issue), I discuss doctor-patient and organization-member trust and the moral obligations of those relationships. Trust in managed care organizations (providers of and payers for health care) stands in stark contrast to the current contractual model of health insurance purchase, but is more coherent with consumer expectations and with the provider role of such organizations. Such trust is likely to differ from that between doctors and patients. Financial reimbursement systems for physicians, one example of organizational change in our health system, can be evaluated for their impact on both kinds of trust according to their intrusiveness, openness, and goals. Although involving managed care enrollees in value-laden decisions that affect them is commendable, restrictions on or regulation of physician incentive systems may be better accomplished on a national level.
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