Religion and healthcare in the European Union : policy issues and trends

92 p. ; 24 cm.Libro ElectrónicoThe impact of religious doctrine on the law, policy and practice of healthcare is becoming increasingly significant for a whole range of issues – from euthanasia to fertility treatment; from belief-based exemption from performing abortion for doctors to the medication and dietary needs of religious patients; from organ donation to contraception; from circumcision to suicide. The relationship between religion and healthcare has a long history of evoking tension and debate in Europe. While developments in medical technologies and techniques question the religious beliefs of policy-makers, practitioners and patients across the European Union, research into the legal and policy responses by EU member states on such issues remains underdeveloped. The challenge of health policy, which is common across the European Union, is to balance fundamental human rights such as the right to equality, the right to health and the right to freedom of religion while adhering to secular principles. This report aims to map out the major issues at stake and to initiate a broader discussion on how the religious needs of the community, religious doctrine and religious practices across the European Union affect public health policy.Preface: The ‘Religion and Democracy in Europe’ initiative 7 About the authors 8 Introduction 9 Background 9 Purpose and conceptual framework 10 Terms, scope, methodology and structure 13 Summary of recommended main policy questions for further development 16 1 The legal and policy context in the European Union 17 1.1 European Union law 17 1.2 National law and policy 18 2 The influence of religion on national healthcare policy development 21 2.1 Conflict of duty in health‑service provision 22 2.1.1 Does national healthcare policy permit belief‑based exemption? 23 2.1.2 Scope and limits of belief‑based exemption in healthcare 23 2.1.3 Safeguards 27 2.2 Euthanasia 27 2.2.1 Active euthanasia 29 2.2.2 Passive euthanasia 30 2.2.3 Conflict of duty and safeguards related to euthanasia 32 2.3 Belief‑based patient decisions 34 2.3.1 Organ transplant and donation 34 2.3.2 Refusal of medical treatment 36 2.4 Emerging policy trends and outstanding policy questions 413 Healthcare policy and religious diversity 43 3.1 Healthcare policy and accommodating religious needs in hospitals 45 3.1.1 Religious assistance and faith space 45 3.1.2 Medication and dietary needs 47 3.1.3 The sex of the health practitioner and hospital clothing 48 3.1.4 After‑death issues: post‑mortem and burial 49 3.2 Healthcare policy and accommodating religion outside hospitals 50 3.2.1 Training of healthcare professionals 50 3.2.2 Substance abuse 52 3.3 Emerging policy trends and outstanding policy questions 53 4 Religion and sexual and reproductive healthcare 56 4.1 Contraception, HIV/AIDS and other sexually transmitted diseases 56 4.1.1 The influence of religion on contraception policy 57 4.1.2 The influence of religion on HIV/AIDS education and prevention policies 58 4.1.3 The4.1.3 The influence of religion on other STD policy 60 4.2 Abortion and sterilization 61 4.2.1 Some religious positions on abortion 61 4.2.2 National policy positions 62 4.2.3 Safeguards when abortion is denied 63 4.2.4 Sterilization 65 4.3 Fertility treatment and reproductive techniques 65 4.4 Circumcision 68 4.5 Female genital mutilation 70 4.6 Emerging policy trends and outstanding policy questions 71 5 Religion and mental healthcare 73 5.1 The European policy context and the influence of religious institutions 74 5.2 The influence of religion on mental illness 77 5.2.1 Diagnosis of mental illness 77 5.2.2 Treatment of mental illness 78 5.3 Emerging policy trends and outstanding policy questions 82 Conclusion 84 Appendix A Roundtable participants 86 Appendix B Belief‑based exemption from healthcare provision 87 Appendix C National policy on euthanasia in some EU states 88 Appendix D National policy on abortion in some EU states 8

The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semi-structured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra, and from a witness seminar on the topic of transformation in Maharashtra’s healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities, and the perceived benefits of work in larger providers. We describe a ‘re-professionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector, that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying ‘re-stratification’ within this part of the profession affords prestige and influence to ‘star doctors’ while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals’ bodies can, and should, play in contemporary transformation of private healthcare, and the implications of these trends for health systems more broadly

Dancing on a Pin: Health Planning in Arizona

This publication challenges us to step back and reflect on the past, present and future of health systems. Take a deeper look at planning and how we got here, review the roles of competition and regulation, and learn about the health planning matrix along with the concept of health planning bridges. Discover for yourself if these thoughts and tools help the signal of quality health planning rise more clearly from out of the noise

Quantifying innovation in surgery

Objectives: The objectives of this study were to assess the applicability of patents and publications as metrics of surgical technology and innovation; evaluate the historical relationship between patents and publications; develop a methodology that can be used to determine the rate of innovation growth in any given health care technology. Background: The study of health care innovation represents an emerging academic field, yet it is limited by a lack of valid scientific methods for quantitative analysis. This article explores and cross-validates 2 innovation metrics using surgical technology as an exemplar. Methods: Electronic patenting databases and the MEDLINE database were searched between 1980 and 2010 for “surgeon” OR “surgical” OR “surgery.” Resulting patent codes were grouped into technology clusters. Growth curves were plotted for these technology clusters to establish the rate and characteristics of growth. Results: The initial search retrieved 52,046 patents and 1,801,075 publications. The top performing technology cluster of the last 30 years was minimally invasive surgery. Robotic surgery, surgical staplers, and image guidance were the most emergent technology clusters. When examining the growth curves for these clusters they were found to follow an S-shaped pattern of growth, with the emergent technologies lying on the exponential phases of their respective growth curves. In addition, publication and patent counts were closely correlated in areas of technology expansion. Conclusions: This article demonstrates the utility of publically available patent and publication data to quantify innovations within surgical technology and proposes a novel methodology for assessing and forecasting areas of technological innovation

Exploring the evidence base for national and regional policy interventions to combat resistance

The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions