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  1. Bedside rationing in cancer care: Patient advocate perspective.Ornella Gonzato - 2022 - Clinical Ethics 17 (4):358-362.
    Rationing in healthcare remains very much a taboo topic. Before COVID-19, it rarely received public attention, even when it occurred in everyday practices, mainly in the form of implicit rationing, as it continues to do today. There are different definitions, types and levels of healthcare rationing, according to different perspectives. With the aim of contributing to a more coherent debate on such a highly emotional healthcare issue as rationing, here are provided a number of reflections from a patient advocate perspective (...)
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  • Are physicians willing to ration health care? Conflicting findings in a systematic review of survey research.Daniel Strech, Govind Persad, Georg Marckmann & Marion Danis - 2009 - Health Policy 90 (2):113-124.
    Several quantitative surveys have been conducted internationally to gather empirical information about physicians’ general attitudes towards health care rationing. Are physicians ready to accept and implement rationing, or are they rather reluctant? Do they prefer implicit bedside rationing that allows the physician–patient relationship broad leeway in individual decisions? Or do physicians prefer strategies that apply explicit criteria and rules?
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  • Normative and Non-normative Concepts: Paternalism and Libertarian Paternalism.Kalle Grill - 2013 - In Daniel Strech, Irene Hirschberg & Georg Marckmann (eds.), Ethics in Public Health and Health Policy: Concepts, Methods, Case Studies. Dordrecht: Springer. pp. 27-46.
    This chapter concerns the normativity of the concepts of paternalism and libertarian paternalism. The first concept is central in evaluating public health policy, but its meaning is controversial. The second concept is equally controversial and has received much attention recently. It may or may not shape the future evaluation of public health policy. In order to facilitate honest and fruitful debate, I consider three approaches to these concepts, in terms of their normativity. Concepts, I claim, may be considered nonnormative, normatively (...)
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  • Systematic Reviews in Bioethics: Types, Challenges, and Value.R. Mcdougall - 2014 - Journal of Medicine and Philosophy 39 (1):89-97.
    There has recently been interest in applying the techniques of systematic review to bioethics literature. In this paper, I identify the three models of systematic review proposed to date in bioethics: systematic reviews of empirical bioethics research, systematic reviews of normative bioethics literature, and systematic reviews of reasons. I argue that all three types yield information useful to scholarship in bioethics, yet they also face significant challenges particularly in relation to terminology and time. Drawing on my recent experience conducting a (...)
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  • The Ethical Duty to Reduce the Ecological Footprint of Industrialized Healthcare Services and Facilities.Corey Katz - 2022 - Journal of Medicine and Philosophy 47 (1):32-53.
    According to the widely accepted principles of beneficence and distributive justice, I argue that healthcare providers and facilities have an ethical duty to reduce the ecological footprint of the services they provide. I also address the question of whether the reductions in footprint need or should be patient-facing. I review Andrew Jameton and Jessica Pierce’s claim that achieving ecological sustainability in the healthcare sector requires rationing the treatment options offered to patients. I present a number of reasons to think that (...)
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  • Public Preferences about Fairness and the Ethics of Allocating Scarce Medical Interventions.Govind Persad - 2017 - In Meng Li & David P. Tracer (eds.), Interdisciplinary Perspectives on Fairness, Equity, and Justice. Springer. pp. 51-65.
    This chapter examines how social- scientific research on public preferences bears on the ethical question of how those resources should in fact be allocated, and explain how social-scientific researchers might find an understanding of work in ethics useful as they design mechanisms for data collection and analysis. I proceed by first distinguishing the methodologies of social science and ethics. I then provide an overview of different approaches to the ethics of allocating scarce medical interventions, including an approach—the complete lives system—which (...)
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  • We Need to Talk About Rationing: The Need to Normalize Discussion About Healthcare Rationing in a Post COVID-19 Era.Neera Bhatia - 2020 - Journal of Bioethical Inquiry 17 (4):731-735.
    The global COVID-19 pandemic has brought the issue of rationing finite healthcare resources to the fore. There has been much academic debate, media attention, and conversation in the homes of everyday individuals about the allocation of medical resources, diagnostic testing kits, ventilators, and personal protective equipment. Yet decisions to prioritize treatment for some individuals over others occur implicitly and explicitly in everyday practices. The pandemic has propelled the socially taboo and unavoidably prickly issue of healthcare rationing into the public spotlight—and (...)
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  • (1 other version)Wie können Ärzte ethisch vertretbar Kostenerwägungen in ihren Behandlungsentscheidungen berücksichtigen? Ein Stufenmodell.Georg Marckmann & Jürgen in der Schmitten - 2011 - Ethik in der Medizin 23 (4):303-314.
    ZusammenfassungTrotz aller Rationalisierungsbemühungen werden sich Leistungseinschränkungen im deutschen Gesundheitswesen nicht vermeiden lassen. Zwar sollten diese so weit möglich oberhalb der individuellen Arzt-Patient-Beziehung erfolgen, aus pragmatischen Gründen wird es sich aber nicht vermeiden lassen, dass Ärzte auch im Einzelfall Verantwortung für die Kosten ihrer Entscheidungen übernehmen, wie es bereits heute häufig der Fall ist. Der vorliegende Beitrag widmet sich deshalb der Frage, wie Ärzte in einer medizinisch rationalen und ethisch vertretbaren Art und Weise Kostenerwägungen in ihren Entscheidungen berücksichtigen können. Vorgeschlagen wird (...)
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  • A Paradoxical Ethical Framework for Unpredictable Drug Shortages.Rebecca Bamford, C. D. Brewer, Bayly Bucknell, Heather DeGrote, Loren Fabry, Madeleine E. M. Hammerlund & Bryan M. Weisbrod - 2012 - American Journal of Bioethics 12 (1):16 - 18.
    The American Journal of Bioethics, Volume 12, Issue 1, Page 16-18, January 2012.
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  • How factual do we want the facts? Criteria for a critical appraisal of empirical research for use in ethics.D. Strech - 2010 - Journal of Medical Ethics 36 (4):222-225.
    Most contributions to the current debate about the consideration and application of empirical information in ethics scholarship deal with epistemological issues such as the role and the meaning of empirical research in ethical reasoning. Despite the increased publication of empirical data in ethics literature we still lack systematic analyses and conceptual frameworks that would help us to understand the rarely discussed methodological and practical problems in appraising empirical research. This paper demonstrates the need for critical appraisal and its crucial methodological (...)
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  • How to write a systematic review of reasons.Daniel Strech & Neema Sofaer - 2012 - Journal of Medical Ethics 38 (2):121-126.
    Systematic reviews, which were developed to improve policy-making and clinical decision-making, answer an empirical question based on a minimally biased appraisal of all the relevant empirical studies. A model is presented here for writing systematic reviews of argument-based literature: literature that uses arguments to address conceptual questions, such as whether abortion is morally permissible or whether research participants should be legally entitled to compensation for sustaining research-related injury. Such reviews aim to improve ethically relevant decisions in healthcare, research or policy. (...)
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  • Rationing at the bedside: Immoral or unavoidable?Morten Magelssen, Per Nortvedt & Jan Helge Solbakk - 2016 - Clinical Ethics 11 (4):112-121.
    Although most theorists of healthcare rationing argue that rationing, including rationing that takes place in the physician–patient relationship (“bedside rationing”) is unavoidable, some health professionals strongly disagree. In a recent essay, Vegard Bruun Wyller argues that bedside rationing is immoral and thoroughly at odds with a sound view of the physician–patient relationship. We take Wyller to be an articulate exponent of the reluctance to participate in rationing found among some clinicians. Our essay attempts to refute the five crucial premises of (...)
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  • Systematische Literaturrecherchen in den Datenbanken PubMed und BELIT – Ein Werkstattbericht.Oliver Rauprich, Matthias Nolte & Jochen Vollmann - 2010 - Ethik in der Medizin 22 (1):59-67.
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  • Systematic reviews of empirical bioethics.D. Strech, M. Synofzik & G. Marckmann - 2008 - Journal of Medical Ethics 34 (6):472-477.
    Background: Publications and discussions of survey research in empirical bioethics have steadily increased over the past two decades. However, findings often differ among studies with similar research questions. As a consequence, ethical reasoning that considers only parts of the existing literature and does not apply systematic reviews tends to be biased. To date, we lack a systematic review (SR) methodology that takes into account the specific conceptual and practical challenges of empirical bioethics. Methods: The steps of systematically reviewing empirical findings (...)
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  • “Priority of Liberty” and the Design of a Two-Tier Health Care System.Friedrich Breyer & Hartmut Kliemt - 2015 - Journal of Medicine and Philosophy 40 (2):137-151.
    Libertarian views on rights tend to rule out coercive redistribution for purposes of public health care guarantees, whereas liberal conceptions support coercive funding of potentially unlimited access to medical services in the name of medical needs. Taking the “priority of liberty” seriously as supreme political value, a plausible prudential argument can avoid these extremes by providing systematic reasons for both delivering and limiting publicly financed guarantees. Given impending demographic change and rapid technical progress in medicine, only a two-tier system with (...)
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  • End-of-life decisions as bedside rationing. An ethical analysis of life support restrictions in an Indian neonatal unit.I. Miljeteig, K. A. Johansson, S. A. Sayeed & O. F. Norheim - 2010 - Journal of Medical Ethics 36 (8):473-478.
    Introduction Hundreds of thousands of premature neonates born in low-income countries are implicitly denied treatment each year. Studies from India show that treatment is rationed even for neonates born at 32 gestational age weeks (GAW), and multiple external factors influence treatment decisions. Is withholding of life-saving treatment for children born between 28 and 32 GAW acceptable from an ethical perspective? Method A seven-step impartial ethical analysis, including outcome analysis of four accepted priority criteria: severity of disease, treatment effect, cost effectiveness (...)
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  • Doctors’ perceptions of how resource limitations relate to futility in end-of-life decision making: a qualitative analysis.Eliana Close, Ben P. White, Lindy Willmott, Cindy Gallois, Malcolm Parker, Nicholas Graves & Sarah Winch - 2019 - Journal of Medical Ethics 45 (6):373-379.
    ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic (...)
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  • Legal Barriers to Physicians' Stewardship Role.Jessica Mantel - 2014 - American Journal of Bioethics 14 (9):40-42.
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  • The Limits to Setting Limits on Critical-Care Delivery: Response to Open Peer Commentaries on “Balancing Legitimate Critical-Care Interests: Setting Defensible Care Limits Through Policy Development”.Jeffrey Kirby - 2016 - American Journal of Bioethics 16 (1):5-8.
    Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of (...)
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  • Operating room time as a limited resource: ethical considerations for allocation.Patrick David Kelly, Joseph B. Fanning & Brian Drolet - 2022 - Journal of Medical Ethics 48 (1):14-18.
    Scheduling surgical procedures among operating rooms is mistakenly regarded as merely a tedious administrative task. However, the growing demand for surgical care and finite hours in a day qualify OR time as a limited resource. Accordingly, the objective of this manuscript is to reframe the process of OR scheduling as an ethical dilemma of allocating scarce medical resources. Recommendations for ethical allocation of OR time—based on both familiar and novel ethical values—are provided for healthcare institutions and individual surgeons.
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  • In Defense of Bunkering.David Wasserman & Alan Wertheimer - 2014 - American Journal of Bioethics 14 (9):42-43.
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  • Rationing in pediatric hospitalizations during COVID-19: A step back to move forward.Binh Phung - 2023 - Clinical Ethics 18 (1):3-6.
    The latest Omicron variant of the novel coronavirus has itself created a novel situation—bringing attention to the topic of healthcare rationing among hospitalized pediatric patients. This may be the first time that many pediatricians, nurses, parents, and public health officials have been compelled to engage in uncomfortable discussions about the allocation of medical care/resources. Simply put, finite budgets, resources, and a dwindling healthcare workforce do not permit all patients to receive unlimited medical care. Triage and bedside rationing decisions are happening (...)
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  • Flattening the Rationing Curve: The Need for Explicit Guidelines for Implicit Rationing during the COVID-19 Pandemic.Kayte Spector-Bagdady, Naomi Laventhal, Megan Applewhite, Janice I. Firn, Norman D. Hogikyan, Reshma Jagsi, Adam Marks, Renee McLeod-Sordjan, Lisa S. Parker, Lauren B. Smith, Christian J. Vercler & Andrew G. Shuman - 2020 - American Journal of Bioethics 20 (7):77-80.
    Volume 20, Issue 7, July 2020, Page 77-80.
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  • Priority Setting from the Lens of Justice in Existing Health Care Industry of Pakistan.Faisal Nadeem - 2017 - Journal of Clinical Research and Bioethics 9 (1).
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  • The Regulation of COVID-19 “Challenge” Studies.Jerry Menikoff - 2020 - American Journal of Bioethics 20 (7):80-82.
    Volume 20, Issue 7, July 2020, Page 80-82.
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  • (1 other version)How can physicians make cost-conscious treatment decisions in an ethically justified manner? A stepwise model.Georg Marckmann & Jürgen in der Schmitten - 2011 - Ethik in der Medizin 23 (4):303-314.
    Trotz aller Rationalisierungsbemühungen werden sich Leistungseinschränkungen im deutschen Gesundheitswesen nicht vermeiden lassen. Zwar sollten diese so weit möglich oberhalb der individuellen Arzt-Patient-Beziehung erfolgen, aus pragmatischen Gründen wird es sich aber nicht vermeiden lassen, dass Ärzte auch im Einzelfall Verantwortung für die Kosten ihrer Entscheidungen übernehmen, wie es bereits heute häufig der Fall ist. Der vorliegende Beitrag widmet sich deshalb der Frage, wie Ärzte in einer medizinisch rationalen und ethisch vertretbaren Art und Weise Kostenerwägungen in ihren Entscheidungen berücksichtigen können. Vorgeschlagen wird (...)
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  • Balancing Legitimate Critical-Care Interests: Setting Defensible Care Limits Through Policy Development.Jeffrey Kirby - 2016 - American Journal of Bioethics 16 (1):38-47.
    Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of (...)
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  • Patents and Drug Shortages: Will the New Congressional Efforts Save Us from Impending Drug Shortages?Dov Greenbaum - 2012 - American Journal of Bioethics 12 (1):18 - 20.
    The American Journal of Bioethics, Volume 12, Issue 1, Page 18-20, January 2012.
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