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Abraham Rudnick - One of the best experts on this subject based on the ideXlab platform.
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Coercion and psychiatric rehabilitation: a conceptual and Ethical Analysis
BMC Psychiatry, 2007Co-Authors: Abraham RudnickAbstract:Psychiatric rehabilition is the theory and practice of assisting persons with severe mental illnesses achieve and maintain goals. This consists of personal skills training and environmental accommodations, aimed at the person with the mental illness fulfilling roles. Although coercion in relation to psychiatric treatment has been discussed at length, coercion has not been sufficiently discussed in relation to psychiatric rehabilitation [1]. The objective of this paper is to conduct a conceptual and Ethical Analysis of coercion in psychiatric rehabilitation. Although the leading theoretical approach to psychiatric rehabilitation is client-centered, there is also a more paternalistic approach to psychiatric rehabilitation [2]. Coercion is conceptually incompatible with client-centered psychiatric rehabilition, as coercion can be defined as the restriction or modification of a person's range of choice or actual choice by one or more other persons, whereas client-centered psychiatric rehabilitation aims to preserve or expand the mentally ill person's range of choice or actual choice by means of one or more other persons. Coercion is conceptually compatible with paternalistic psychiatric rehabilitation, but it is Ethically questionable in relation to psychiatric rehabilitation, as in this context it involves a change of goals and roles, which can be much more intrusive and forceful than coercion in relation to treatment, psychiatric or other. To the extent that psychiatric rehabilitation and treatment are integrated, psychiatric rehabilitation may have to accommodate some coercion when psychiatric treatment requires it, such as in situations of considerable physical risk due to the mental illness.
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The goals of psychiatric rehabilitation: an Ethical Analysis.
Psychiatric rehabilitation journal, 2002Co-Authors: Abraham RudnickAbstract:This study addressed the question under what conditions ought client-centered psychiatric rehabilitation work towards goals set by its clients. This was done by means of an Ethical Analysis of goal setting in psychiatric rehabilitation, using standard Ethical principles of health care and a case study for illustration. The Analysis demonstrated that client-centered psychiatric rehabilitation ought to work towards goals set by its clients under the conditions that they not involve serious danger and are not induced by severe mental impairment. When these conditions are not fulfilled, it may be most helpful to engage the clients in critical dialogue so as to reach an agreement regarding the setting of goals for their psychiatric rehabilitation. Special ways of engaging clients with severe mental impairments in such dialogue may have to be explored.
Robert M. Nelson - One of the best experts on this subject based on the ideXlab platform.
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Randomized, controlled trials as minimal risk: an Ethical Analysis.
Critical care medicine, 2007Co-Authors: Marilyn C. Morris, Robert M. NelsonAbstract:Objective:We aim to clarify the circumstances in which randomized, controlled trials should be designated as minimal risk, allowing institutional review boards to approve their conduct with a waiver of informed consent if obtaining informed consent is not feasible.Methods:An Ethical Analysis of the
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The European Union Directive and the protection of incapacitated subjects in research: an Ethical Analysis.
Intensive care medicine, 2004Co-Authors: Henry Silverman, Christiane Druml, François Lemaire, Robert M. NelsonAbstract:Objective We perform an Ethical Analysis of European Union Directive 2001/20/EC on the simplification and harmonization of guidelines regarding good clinical practice in the conduct of clinical trials involving drugs.
Bjørn Hofmann - One of the best experts on this subject based on the ideXlab platform.
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Ethical Analysis in HTA of complex health interventions
BMC medical ethics, 2016Co-Authors: Kristin Bakke Lysdahl, Wija Oortwijn, Gert Jan Van Der Wilt, Pietro Refolo, Dario Sacchini, Kati Mozygemba, Ansgar Gerhardus, Louise Brereton, Bjørn HofmannAbstract:Background In the field of health technology assessment (HTA), there are several approaches that can be used for Ethical Analysis. However, there is a scarcity of literature that critically evaluates and compares the strength and weaknesses of these approaches when they are applied in practice. In this paper, we analyse the applicability of some selected approaches for addressing Ethical issues in HTA in the field of complex health interventions. Complex health interventions have been the focus of methodological attention in HTA. However, the potential methodological challenges for Ethical Analysis are as yet unknown.
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Different methods for Ethical Analysis in health technology assessment: An empirical study
International journal of technology assessment in health care, 2011Co-Authors: Samuli I. Saarni, Bjørn Hofmann, Annette J Braunack-mayer, Gert Jan Van Der WiltAbstract:OBJECTIVES: Ethical Analysis can highlight important Ethical issues related to implementing a technology, values inherent in the technology itself, and value-decisions underlying the health technology assessment (HTA) process. Ethical Analysis is a well-acknowledged part of HTA, yet seldom included in practice. One reason for this is lack of knowledge about the properties and differences between the methods available. This study compares different methods for Ethical Analysis within HTA. METHODS: Ethical issues related to bariatric (obesity) surgery were independently evaluated using axiological, casuist, principlist, and EUnetHTA models for Ethical Analysis within HTA. The methods and results are presented and compared. RESULTS: Despite varying theoretical underpinnings and practical approaches, the four methods identified similar themes: personal responsibility, self-infliction, discrimination, justice, public funding, and stakeholder involvement. The axiological and EUnetHTA models identified a wider range of arguments, whereas casuistry and principlism concentrated more on analyzing a narrower set of arguments deemed more important. CONCLUSIONS: Different methods can be successfully used for conducting Ethical Analysis within HTA. Although our study does not show that different methods in ethics always produce similar results, it supports the view that different methods of ethics can yield relevantly similar results. This suggests that the key conclusions of Ethical analyses within HTA can be transferable between methods and countries. The systematic and transparent use of some method of ethics appears more important than the choice of the exact method.
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Ethical Analysis to improve decision-making on health technologies
Bulletin of the World Health Organization, 2008Co-Authors: Samuli I. Saarni, Bjørn Hofmann, Kristian Lampe, Dagmar Lühmann, Marjukka Mäkelä, Marcial Velasco-garrido, Ilona Autti-rämöAbstract:Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend beyond effectiveness and costs to also considering the social, organizational and Ethical implications of technologies. However, a commonly accepted method for analysing the Ethical aspects of health technologies is lacking. This paper describes a model for Ethical Analysis of health technology that is easy and flexible to use in different organizational settings and cultures. The model is part of the EUnetHTA project, which focuses on the transferability of HTAs between countries. The EUnetHTA ethics model is based on the insight that the whole HTA process is value laden. It is not sufficient to only analyse the Ethical consequences of a technology, but also the Ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs, and their implementation may also have significant impact on people other than the patient. These are essential considerations for health policy. The ethics model is structured around key Ethical questions rather than philosophical theories, to be applicable to different cultures and usable by non-philosophers. Integrating Ethical considerations into HTA can improve the relevance of technology assessments for health care and health policy in both developed and developing countries.
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Ethical Analysis to improve decision-making on health
2008Co-Authors: Bjørn Hofmann, Kristian Lampe, Ilona Autti-rämöAbstract:Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend beyond effectiveness and costs to also considering the social, organizational and Ethical implications of technologies. However, a commonly accepted method for analysing the Ethical aspects of health technologies is lacking. This paper describes a model for Ethical Analysis of health technology that is easy and flexible to use in different organizational settings and cultures. The model is part of the EUnetHTA project, which focuses on the transferability of HTAs between countries. The EUnetHTA ethics model is based on the insight that the whole HTA process is value laden. It is not sufficient to only analyse the Ethical consequences of a technology, but also the Ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs, and their implementation may also have significant impact on people other than the patient. These are essential considerations for health policy. The ethics model is structured around key Ethical questions rather than philosophical theories, to be applicable to different cultures and usable by non-philosophers. Integrating Ethical considerations into HTA can improve the relevance of technology assessments for health care and health policy in both developed and developing countries. Bulletin of the World Health Organization 2008;86:617-623.
Jean Frederic Menard - One of the best experts on this subject based on the ideXlab platform.
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A ‘Nudge’ for Public Health Ethics: Libertarian Paternalism as a Framework for Ethical Analysis of Public Health Interventions?
2010Co-Authors: Jean Frederic MenardAbstract:Is it possible to interfere with individual decision-making while preserving freedom of choice? The purpose of this article is to assess whether ‘libertarian paternalism’, a set of political and Ethical principles derived from the observations of behavioural sciences, can form the basis of a viable framework for the Ethical Analysis of public health interventions. First, the article situates libertarian libertarianism within the broader context of the law and economics movement. The main tenets of the approach are then presented and particular attention is given to its operationalization through the notion of a ‘nudge’. Essentially, a ‘nudge’ consists in an intervention, which aims to suggest one choice over another by gently steering individual choices in welfare-enhancing directions yet without imposing any significant limit on available choices. Finally, the article concludes that, while it fails as an overreaching framework of Ethical Analysis, libertarian paternalism nonetheless constitutes a valuable addition to the conceptual toolbox of public health ethics.
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a nudge for public health ethics libertarian paternalism as a framework for Ethical Analysis of public health interventions
2010Co-Authors: Jean Frederic MenardAbstract:Is it possible to interfere with individual decision-making while preserving freedom of choice? The purpose of this article is to assess whether ‘libertarian paternalism’, a set of political and Ethical principles derived from the observations of behavioural sciences, can form the basis of a viable framework for the Ethical Analysis of public health interventions. First, the article situates libertarian libertarianism within the broader context of the law and economics movement. The main tenets of the approach are then presented and particular attention is given to its operationalization through the notion of a ‘nudge’. Essentially, a ‘nudge’ consists in an intervention, which aims to suggest one choice over another by gently steering individual choices in welfare-enhancing directions yet without imposing any significant limit on available choices. Finally, the article concludes that, while it fails as an overreaching framework of Ethical Analysis, libertarian paternalism nonetheless constitutes a valuable addition to the conceptual toolbox of public health ethics.
Samuli I. Saarni - One of the best experts on this subject based on the ideXlab platform.
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Different methods for Ethical Analysis in health technology assessment: An empirical study
International journal of technology assessment in health care, 2011Co-Authors: Samuli I. Saarni, Bjørn Hofmann, Annette J Braunack-mayer, Gert Jan Van Der WiltAbstract:OBJECTIVES: Ethical Analysis can highlight important Ethical issues related to implementing a technology, values inherent in the technology itself, and value-decisions underlying the health technology assessment (HTA) process. Ethical Analysis is a well-acknowledged part of HTA, yet seldom included in practice. One reason for this is lack of knowledge about the properties and differences between the methods available. This study compares different methods for Ethical Analysis within HTA. METHODS: Ethical issues related to bariatric (obesity) surgery were independently evaluated using axiological, casuist, principlist, and EUnetHTA models for Ethical Analysis within HTA. The methods and results are presented and compared. RESULTS: Despite varying theoretical underpinnings and practical approaches, the four methods identified similar themes: personal responsibility, self-infliction, discrimination, justice, public funding, and stakeholder involvement. The axiological and EUnetHTA models identified a wider range of arguments, whereas casuistry and principlism concentrated more on analyzing a narrower set of arguments deemed more important. CONCLUSIONS: Different methods can be successfully used for conducting Ethical Analysis within HTA. Although our study does not show that different methods in ethics always produce similar results, it supports the view that different methods of ethics can yield relevantly similar results. This suggests that the key conclusions of Ethical analyses within HTA can be transferable between methods and countries. The systematic and transparent use of some method of ethics appears more important than the choice of the exact method.
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Ethical Analysis to improve decision-making on health technologies
Bulletin of the World Health Organization, 2008Co-Authors: Samuli I. Saarni, Bjørn Hofmann, Kristian Lampe, Dagmar Lühmann, Marjukka Mäkelä, Marcial Velasco-garrido, Ilona Autti-rämöAbstract:Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend beyond effectiveness and costs to also considering the social, organizational and Ethical implications of technologies. However, a commonly accepted method for analysing the Ethical aspects of health technologies is lacking. This paper describes a model for Ethical Analysis of health technology that is easy and flexible to use in different organizational settings and cultures. The model is part of the EUnetHTA project, which focuses on the transferability of HTAs between countries. The EUnetHTA ethics model is based on the insight that the whole HTA process is value laden. It is not sufficient to only analyse the Ethical consequences of a technology, but also the Ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs, and their implementation may also have significant impact on people other than the patient. These are essential considerations for health policy. The ethics model is structured around key Ethical questions rather than philosophical theories, to be applicable to different cultures and usable by non-philosophers. Integrating Ethical considerations into HTA can improve the relevance of technology assessments for health care and health policy in both developed and developing countries.