Reconceptualizing Autonomy for Bioethics

Autonomy plays a central role in bioethics, but there is no consensus as to how we should understand this concept. This paper critically considers three different conceptions of autonomy: the default conception prevalent in bioethics literature; a broader procedural account of autonomy drawing moral philosophical approaches; and a substantive, perfectionist account. Building on Rebecca Walker’s critique of the default conception of autonomy, we will argue that a substantive, perfectionist approach both fulfils Walker’s criteria for a conception of autonomy in bioethics and lends itself to application in practical scenarios. In so doing, we draw on scenarios from genomic medicine to show that a substantive, perfectionist approach not only offers a more conceptually adequate understanding of autonomy in more complex cases, but also lends itself to practical application by helping health professionals identify how they can maximize people’s capacity to exercise their autonomy

Thematic Analysis: A Practical Guide

Book Revie

The Role of Acceptance and Commitment Therapy in Cardiovascular and Diabetes Healthcare: A Scoping Review

Acceptance and commitment therapy (ACT) is an adapted form of cognitive behavioural therapy. ACT focuses on how thinking affects behaviour and promotes psychological flexibility. The prevalence of psychological distress among people living with cardiovascular disease (CVD) and/or type 2 diabetes mellitus (T2DM) is high, and ACT may offer an alternative treatment approach. This scoping review explored the use of ACT as an intervention to support adults living with CVD and/or T2DM. A systematic search of the literature resulted in the inclusion of 15 studies. Studies were reviewed using the Joanna Briggs Institute approach to conducting scoping reviews. Most studies (n = 13) related to people living with T2DM, and most (n = 10) used a pre-post design, four studies were randomised controlled trials, and one was a qualitative study. Eight studies reported an improvement in the outcome(s) assessed post-intervention, suggesting that ACT was an acceptable and valid intervention to support people living with CVD or T2DM. However, studies were underpowered and only limited studies involved people living with CVD. ACT was assessed as a valuable approach to improve a range of patient-reported outcomes for those living with CVD or T2DM, and further research involving robust study designs and larger cohorts are warranted

Ethical issues in reproductive genetic carrier screening

Reproductive Carrier Screening (RCS) involves testing individuals or couples to determine their likelihood of having a child with certain inherited genetic conditions. RCS raises ethical considerations, including: the acceptable goals of screening, how to choose the genes to test for, ensuring recipients make choices consistent with their preferences, reporting results, funding models, and ensuring that RCS programs reflect community values. The Australian Reproductive Genetic Carrier Screening Project (ARGCSP; ‘Mackenzie’s Mission’) is a research project investigating how RCS could be provided nationally in future. In this paper we outline the ethical issues in RCS as relevant to initiatives like the ARGCSP

Embracing diversity: embedding reflexivity and understanding equality in healthcare within the MSc Health Psychology curriculum

"As a South Asian student, it is refreshing to see the department implement an incredibly diverse curriculum; especially one incorporating in-depth study of my own demographic. Within the course, we dissected aspects of South Asian culture and its relationship with healthcare and delivery. I personally know how underrepresented South Asian voices are within healthcare, so generic resources do not address these differences, rendering them insufficient. Therefore, knowing that future healthcare workers from LJMU will be equipped with a sound cultural understanding is promising.”      The MSc Health Psychology reviews equality in healthcare and encourages students to reflect on the needs of all population and patient groups.  Students consider awkward questions such as ‘Do all people have access to the same healthcare?’; ‘Why do minority ethnic groups have worse clinical outcomes than White patients?’ Students learn about the changing ethnic make-up of the UK population, the prevalence and risk of health conditions across population groups and we discuss issues related to access and (in)equality in healthcare provision.    For example, the research analysis module utilises real-world interview transcripts focusing on healthcare equality and ethnic minority patient needs. We discuss issues such as racism; stereotyping; health professionals' role, skill, ability, amongst other challenging concepts. The students discuss their analytical memos, asking questions such as ‘there is conflict between health professional messages; what implications does this have for healthcare delivery?’  Students are encouraged to think critically about the analysis of their data, whilst also reflecting on the reality of providing healthcare to minority ethnic populations. This process is enhanced further, as students engage in researcher reflexivity, and are challenged to consider their role, position, experience, race, ethnicity, healthcare needs as they analyse this data.  We present how this approach has been integrated into the curriculum and offer insight through a student's lived experience

Obligations and preferences in knowing and not knowing: the importance of context

Commentary on Davies: "The right not to know and the obligation to know

A qualitative exploration of the experiences of pregnant women living with obesity and accessing antenatal care.

Women are advised to optimise weight before pregnancy. However, many are either already living with overweight or obesity prior to becoming pregnant, increasing the risks for adverse outcomes. Health care professionals (HCP) are responsible for advising women of risks throughout and following pregnancy. However, midwives often find broaching the conversation around maternal obesity difficult. This study explored the experiences of pregnant women living with obesity in accessing antenatal care. Seventeen women completed a semi-structured interview. Transcripts were analysed thematically. Four themes were developed: 1) antenatal care is inconsistent, 2) additional support is needed, 3) women feel judged about their weight, and 4) weight cycling is highly prevalent. Findings suggest that pregnant women living with obesity often experience weight bias from HCPs, feel judged because of their weight and are left feeling confused and overlooked. Women reported inconsistencies in advice and care offered and acknowledged a lack of continuity of care throughout pregnancy. We call for an urgent need for further multidisciplinary training to address the concerns, experiences and needs of pregnant women living with obesity