Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

There is a widely acknowledged need for a single composite index that provides a comprehensive picture of the societal impact of disasters. A composite index combines and logically organizes important information policy-makers need to allocate resources for the recovery from natural disasters; it can also inform hazard mitigation strategies. This paper develops a Disaster Impact Index (DII) to gauge the societal impact of disasters on the basis of the changes in individuals’ capabilities. The DII can be interpreted as the disaster (...) impact per capita. Capabilities are dimensions of individual well-being and refer to the genuine opportunities individuals have to achieve valuable states and activities (such as being adequately nourished or being mobile). After discussing the steps required to construct the DII, this article computes and compares the DIIs for two earthquakes of similar magnitude in two societies at different levels of development and of two disasters (earthquake and wind storm) in the same society. (shrink)

‘Zero tolerance’ of avoidable infection events is explicit in UK and international policy documents describing strategies for the control of healthcare-associated infection. I consider what principles governing avoidable infections acquired in healthcare institutions might be reasonably rejected from the contractualist perspective of Thomas Scanlon. Many hospital infections can be cost-effectively avoided. There would seem to be additional reasons to take the prevention of avoidable infection acquired in hospitals seriously in addition to optimizing the cost-effectiveness of healthcare. These include the irretrievable (...) nature of the harm of some of the infections; the reasonable rejection of avoidable harm when the patient could not rationally consent to the risk of harm and the social consequences such as loss of trust in healthcare providers. Despite these reasons, a principle of ‘zero tolerance’ has implausible implications, promotes unrealistic patient expectations and can be reasonably rejected from the perspective of those who will suffer unacceptable opportunity costs. However, the contractualist perspective would also seem to reject a principle of tolerance of harm when there is a feasible reconfiguration of institutional arrangements that reduces the risk of harm without a redistribution of a proportionate or greater burden to others. (shrink)