Patient safety has become a significant and pressing policy issue. Around the world, governments,... more Patient safety has become a significant and pressing policy issue. Around the world, governments, the health care sector and the public are increasingly cognizant of the need to improve the safety of care delivered by their health systems. Pressure for change has been created by highly publicized incidents in a number of countries involving unsafe acts that were significant both in scale and consequence and a number of empirical studies that revealed the high rates of unsafe acts and their consequences. The costs of unsafe health care – both personal and fiscal – to individuals, their families and their communities and to the state are massive.In this research project we explored one particular avenue for change – that is, the use of legal instruments by governments to improve patient safety. We did this through a comparative review of the use of legal instruments or frameworks in other countries (specifically Australia, Denmark, New Zealand, the United Kingdom, and the United State...
The post-confinement phase of the COVID-19 pandemic will require that governments navigate more c... more The post-confinement phase of the COVID-19 pandemic will require that governments navigate more complex ethical questions than had occurred in the initial, ‘curve-flattening’ phase, and that will occur when the pandemic is in the past. By looking at the unavoidable harms involved in the confinement and quarantine methods employed during the initial phase of the pandemic, we can develop a harm reduction approach to managing the phase during which society will be gradually reopened in a context of managed risk. The principles that are at the heart of such an approach include a reckoning with all of the harms involved in policy choice, including harms that might be given rise to by policy implementation itself; a focus on the harms to which already vulnerable populations are susceptible; and a strong preference for policies that economize on the use of prohibitions and of coercive state enforcement, and that instead emphasize the agency of citizens in realizing health-promoting behavio...
The apportionment of responsibility for health policy within multi-level states should be sensiti... more The apportionment of responsibility for health policy within multi-level states should be sensitive to a number of conflicting normative pressures, some of which militate for placing decision-making authority at the higher reaches of policy-making structures, while others would seem to require placing them lower down this structure. The principle of subsidiarity is a structural principle that addresses in a manner that is neutral with respect to these values a way of addressing the conflicting claims of these values. Standard accounts of federalism fare poorly with respect to the criterion of subsidiarity. While central governments are at first glance better equipped to apply such a principle to the issue of the distribution of authority, there are strong empirical grounds for thinking that centralized governments will non-neutrally privilege central authorities in applying the principle. Federal structures that admit of overlapping jurisdictions, and that therefore require that deliberation among federal parties occur as a condition of the problem of the distribution of powers over health care being solved, are most amenable to solving problems of distribution of authority.
This paper seeks to provide an overview of some of the main areas of debate that have emerged in ... more This paper seeks to provide an overview of some of the main areas of debate that have emerged in recent years at the interface between theories of justice and health care. First, the paper considers various positions as to what the index of justice with respect to health ought to be. It warns on practical and principled grounds against conceptual inflation of the notion of "health" as it appears in theories of distributive justice. Second, it considers how various standards according to which goods ought to be distributed in a just society apply to debates within health care.
International Journal of Health Policy and Management, 2018
Significant attention has been devoted to developing intersectoral strategies to reduce health in... more Significant attention has been devoted to developing intersectoral strategies to reduce health inequities; however, these strategies have largely neglected to consider how equity in health ought to be weighted and balanced with the pursuit of equity for other social goods (eg, education equity). Research in this domain is crucial, as the health sector’s pursuit of health equity may be at odds with policies in other sectors, which may consider the reduction of health inequities to be peripheral to, if not incompatible with, their own equity-related aims. It is therefore critical that intersectoral strategies to reduce health inequities be guided by a more general account of social justice that is capable of carefully balancing equity in health against the pursuit of equity in other sectors.
L'A. examine ce qu'il en est de la conscience d'un pluralisme ethique chez les etudia... more L'A. examine ce qu'il en est de la conscience d'un pluralisme ethique chez les etudiants, et les consequences a en tirer pour l'enseignement de l'ethique a l'universite. Il mene son propos a partir de l'opposition entre relativisme et monisme, cette derniere conception affirmant que «la raison est uniforme et univoque et qu'elle doit donc prendre, dans la sphere pratique, soit la forme de la raison calculante de l'utilitarisme soit celle de la raison formelle des kantiens»
Patient safety has become a significant and pressing policy issue. Around the world, governments,... more Patient safety has become a significant and pressing policy issue. Around the world, governments, the health care sector and the public are increasingly cognizant of the need to improve the safety of care delivered by their health systems. Pressure for change has been created by highly publicized incidents in a number of countries involving unsafe acts that were significant both in scale and consequence and a number of empirical studies that revealed the high rates of unsafe acts and their consequences. The costs of unsafe health care – both personal and fiscal – to individuals, their families and their communities and to the state are massive.In this research project we explored one particular avenue for change – that is, the use of legal instruments by governments to improve patient safety. We did this through a comparative review of the use of legal instruments or frameworks in other countries (specifically Australia, Denmark, New Zealand, the United Kingdom, and the United State...
The post-confinement phase of the COVID-19 pandemic will require that governments navigate more c... more The post-confinement phase of the COVID-19 pandemic will require that governments navigate more complex ethical questions than had occurred in the initial, ‘curve-flattening’ phase, and that will occur when the pandemic is in the past. By looking at the unavoidable harms involved in the confinement and quarantine methods employed during the initial phase of the pandemic, we can develop a harm reduction approach to managing the phase during which society will be gradually reopened in a context of managed risk. The principles that are at the heart of such an approach include a reckoning with all of the harms involved in policy choice, including harms that might be given rise to by policy implementation itself; a focus on the harms to which already vulnerable populations are susceptible; and a strong preference for policies that economize on the use of prohibitions and of coercive state enforcement, and that instead emphasize the agency of citizens in realizing health-promoting behavio...
The apportionment of responsibility for health policy within multi-level states should be sensiti... more The apportionment of responsibility for health policy within multi-level states should be sensitive to a number of conflicting normative pressures, some of which militate for placing decision-making authority at the higher reaches of policy-making structures, while others would seem to require placing them lower down this structure. The principle of subsidiarity is a structural principle that addresses in a manner that is neutral with respect to these values a way of addressing the conflicting claims of these values. Standard accounts of federalism fare poorly with respect to the criterion of subsidiarity. While central governments are at first glance better equipped to apply such a principle to the issue of the distribution of authority, there are strong empirical grounds for thinking that centralized governments will non-neutrally privilege central authorities in applying the principle. Federal structures that admit of overlapping jurisdictions, and that therefore require that deliberation among federal parties occur as a condition of the problem of the distribution of powers over health care being solved, are most amenable to solving problems of distribution of authority.
This paper seeks to provide an overview of some of the main areas of debate that have emerged in ... more This paper seeks to provide an overview of some of the main areas of debate that have emerged in recent years at the interface between theories of justice and health care. First, the paper considers various positions as to what the index of justice with respect to health ought to be. It warns on practical and principled grounds against conceptual inflation of the notion of "health" as it appears in theories of distributive justice. Second, it considers how various standards according to which goods ought to be distributed in a just society apply to debates within health care.
International Journal of Health Policy and Management, 2018
Significant attention has been devoted to developing intersectoral strategies to reduce health in... more Significant attention has been devoted to developing intersectoral strategies to reduce health inequities; however, these strategies have largely neglected to consider how equity in health ought to be weighted and balanced with the pursuit of equity for other social goods (eg, education equity). Research in this domain is crucial, as the health sector’s pursuit of health equity may be at odds with policies in other sectors, which may consider the reduction of health inequities to be peripheral to, if not incompatible with, their own equity-related aims. It is therefore critical that intersectoral strategies to reduce health inequities be guided by a more general account of social justice that is capable of carefully balancing equity in health against the pursuit of equity in other sectors.
L'A. examine ce qu'il en est de la conscience d'un pluralisme ethique chez les etudia... more L'A. examine ce qu'il en est de la conscience d'un pluralisme ethique chez les etudiants, et les consequences a en tirer pour l'enseignement de l'ethique a l'universite. Il mene son propos a partir de l'opposition entre relativisme et monisme, cette derniere conception affirmant que «la raison est uniforme et univoque et qu'elle doit donc prendre, dans la sphere pratique, soit la forme de la raison calculante de l'utilitarisme soit celle de la raison formelle des kantiens»
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