1,721,196 research outputs found
Your liberty or your life: reciprocity in the use of restrictive measures in contexts of contagion
No full textIn this paper, we explore the role of reciprocity in the employment of restrictive measures in contexts of contagion. Reciprocity should be understood as a substantive value that governs the use, level and extent of restrictive measures. We also argue that independent of the role reciprocity plays in the legitimisation the use of restrictive measures, reciprocity can also motivate support and compliance with legitimate restrictive measures. The importance of reciprocity has implications for how restrictive measures should be undertaken when preparing and evaluating public health responses to contagion
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Communicable Disease Control in the New Millenium: A Qualitative Inquiry on the Legitimate Use of Restrictive Measures in an Era of Rights Consciousness
Get PDFBackground: When Canadian public health officials issued thousands of quarantine orders during the SARS outbreak in 2003, it raised difficult questions about the legitimacy and acceptability of restrictive measures to achieve public health goals. While public health interventions have traditionally been justified on utilitarian grounds, this project aims to establish an empirical basis to justify public health action. The objectives are: 1) Descriptive: To describe the views of members of society on the justifiability of using restrictive measures to achieve public health goals; 2) Analytic: To analyze the use of restrictive measures at the intersection of public health policy, human rights norms, and ethics; and 3) Normative: To situate public health ethics within a Habermasian model of communicative ethics that can serve as the basis of justification for the legitimate use of restrictive measures based on the intersubjective recognition of public health and human rights. Methods: Individual interviews were conducted with 62 participants, including 23 health care providers, 16 members of the public, 13 community and/or spiritual leaders from the Greater Toronto Area, as well as six public health officials and four health care regulators at the local, provincial, and federal levels of jurisdiction. Findings: Participant views were analyzed and organized into themes that revolve around the following concepts: 1) common good; 2) types of quarantine; 3) compliance; 4) reciprocity; 5) uncertainty; and 6) communication. Conclusions: Combining empirical research with conceptual scholarship, it is argued that the recognition of and commitment to the common good by participants, which emerged as an overarching theme, provide justificatory power for the use of quarantine during communicable disease outbreaks. But to respect rights, while being committed to the common good, it is argued that we must move beyond the see-sawing between ostensibly competing requirements toward a conception that gives equal weight to public health and human rights; that is, both imperatives – the community and the individual – refer to one another without dissolving into one another. Following a Habermasian account of opening processes of decision-making to a moral-practical discourse, it is argued that public health ethics offers an important site for integrating his model of discourse ethics within public health deliberations to expand the scope of moral argumentation on--and ultimately to ground the justification of--the use of restrictive measures.Ph
Public Engagement through the Toronto Health Policy Citizens Council: What do Citizens Value in Health Care?
Get PDFHealth policy making is fraught with difficult decisions that result from conflicts between people’s values. Citizens are important stakeholders in this process, and it is through methods of public engagement that they can be involved in developing health policy. Deliberative forms, in particular, have the ability to improve decision quality and promote greater acceptance of decisions. This study used the Toronto Health Policy Citizens Council to examine citizens’ values on 7 specific health policy questions asked over a two-year period. A thematic analysis was performed on the transcript content derived from the audiotaped deliberations from Council meetings. Nineteen values were identified. The results suggest that it may be a combination of factors of the health policy topic discussed that shapes the values elicitation seen in this kind of public engagement. In conclusion, citizens councils appear effective at eliciting citizens’ values, and are a good way to actively educate participants about health care.MAS
Communicable Disease Control in the New Millenium: A Qualitative Inquiry on the Legitimate Use of Restrictive Measures in an Era of Rights Consciousness
No full textBackground: When Canadian public health officials issued thousands of quarantine orders during the SARS outbreak in 2003, it raised difficult questions about the legitimacy and acceptability of restrictive measures to achieve public health goals. While public health interventions have traditionally been justified on utilitarian grounds, this project aims to establish an empirical basis to justify public health action. The objectives are: 1) Descriptive: To describe the views of members of society on the justifiability of using restrictive measures to achieve public health goals; 2) Analytic: To analyze the use of restrictive measures at the intersection of public health policy, human rights norms, and ethics; and 3) Normative: To situate public health ethics within a Habermasian model of communicative ethics that can serve as the basis of justification for the legitimate use of restrictive measures based on the intersubjective recognition of public health and human rights. Methods: Individual interviews were conducted with 62 participants, including 23 health care providers, 16 members of the public, 13 community and/or spiritual leaders from the Greater Toronto Area, as well as six public health officials and four health care regulators at the local, provincial, and federal levels of jurisdiction. Findings: Participant views were analyzed and organized into themes that revolve around the following concepts: 1) common good; 2) types of quarantine; 3) compliance; 4) reciprocity; 5) uncertainty; and 6) communication. Conclusions: Combining empirical research with conceptual scholarship, it is argued that the recognition of and commitment to the common good by participants, which emerged as an overarching theme, provide justificatory power for the use of quarantine during communicable disease outbreaks. But to respect rights, while being committed to the common good, it is argued that we must move beyond the see-sawing between ostensibly competing requirements toward a conception that gives equal weight to public health and human rights; that is, both imperatives – the community and the individual – refer to one another without dissolving into one another. Following a Habermasian account of opening processes of decision-making to a moral-practical discourse, it is argued that public health ethics offers an important site for integrating his model of discourse ethics within public health deliberations to expand the scope of moral argumentation on--and ultimately to ground the justification of--the use of restrictive measures.Ph
Limiting the Collateral Damage of SARS: The Ethics of Priority Setting
No full textThe 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in Canada highlights a broad range in ethical challenges, particularly in priority setting. Presently, a leading theory in ethical priority setting is Daniels’ and Sabin’s Accountability for Reasonableness (A4R), which enhances fair and legitimate procedural decision making in typical healthcare settings. A4R attempts to mitigate conflicting interests and facilitate fairness in deliberations over priority setting issues. Whether this framework may be applied to public health emergencies has yet to be examined. This qualitative study describes the outbreak through the lens of A4R and explores the applicability of A4R in atypical or emergent circumstances.
Findings from 25 structured key informant interviews of public health officials suggest refinements to the framework may be required for emergency events. The presence of such a framework may minimize collateral damage during and after a response. The lessons may guide future preparedness efforts such as pandemic planning.MAS
Is Evidence-based Psychiatric Practice, Ethical Practice?: A Conceptual and Qualitative Study
Get PDFSince its addition to the medical lexicon in 1992, the concept of ‘evidence-based medicine’ (EBM) has captured the imagination of the medical world, attracting both passionate advocates and ardent opponents. EBM is defined clinically as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Yet, its boldest claim is an ethical one: that EBM, rather than any other method, is the most effective way to fulfill our moral duty to help patients achieve better health. Academic debate on this point has been deeply polarized, from those who assert that ethical practice is evidence-based practice to those who argue that evidence-based practice impoverishes practice and robs it of ethical substance. Mainstream psychiatrists have endorsed EBM which holds out the promise of greater ethical legitimacy for psychiatric disorders and treatments through improved scientific substantiation. Evidence-based psychiatry arises through the straightforward application of EBM to the practice of psychiatry and thus shares the same ethical goal of EBM, to improve patients’ health. Given the ethical debates that have framed psychiatry since its inception as a medical specialty, and the particular nature of mental disorders and their treatments, it is unclear if EBM can be applied to psychiatry, and therefore, whether it can deliver on its ethical promises. This thesis project involved two phases. The first, a conceptual phase, included an analysis of EBM’s ethical commitments as they are represented in its two authoritative textbooks (‘literal’ EBM). This provisional analysis was then extended by a qualitative analysis of the views of three groups of participants concerning the ethics of EBM: 1) EBM developers; 2) mental health practitioners; and 3) philosophers or bioethicists. Combining the analyses from both phases, a more complete depiction of the ethics of EBM was developed in order to address the main thesis question. Evidence-based psychiatric practice cannot be ethical practice by itself. Instead, it can play a small ethical role in clinical practice, only if it is situated within the larger value structure of contemporary medicine and psychiatry.Ph
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Is Evidence-based Psychiatric Practice, Ethical Practice?: A Conceptual and Qualitative Study
No full textSince its addition to the medical lexicon in 1992, the concept of ‘evidence-based medicine’ (EBM) has captured the imagination of the medical world, attracting both passionate advocates and ardent opponents. EBM is defined clinically as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Yet, its boldest claim is an ethical one: that EBM, rather than any other method, is the most effective way to fulfill our moral duty to help patients achieve better health. Academic debate on this point has been deeply polarized, from those who assert that ethical practice is evidence-based practice to those who argue that evidence-based practice impoverishes practice and robs it of ethical substance. Mainstream psychiatrists have endorsed EBM which holds out the promise of greater ethical legitimacy for psychiatric disorders and treatments through improved scientific substantiation. Evidence-based psychiatry arises through the straightforward application of EBM to the practice of psychiatry and thus shares the same ethical goal of EBM, to improve patients’ health. Given the ethical debates that have framed psychiatry since its inception as a medical specialty, and the particular nature of mental disorders and their treatments, it is unclear if EBM can be applied to psychiatry, and therefore, whether it can deliver on its ethical promises. This thesis project involved two phases. The first, a conceptual phase, included an analysis of EBM’s ethical commitments as they are represented in its two authoritative textbooks (‘literal’ EBM). This provisional analysis was then extended by a qualitative analysis of the views of three groups of participants concerning the ethics of EBM: 1) EBM developers; 2) mental health practitioners; and 3) philosophers or bioethicists. Combining the analyses from both phases, a more complete depiction of the ethics of EBM was developed in order to address the main thesis question. Evidence-based psychiatric practice cannot be ethical practice by itself. Instead, it can play a small ethical role in clinical practice, only if it is situated within the larger value structure of contemporary medicine and psychiatry.Ph
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