Righting Health Policy: Bioethics, Political Philosophy, and the Normative Justification of Health Law and Policy

In Righting Health Policy, D. Robert MacDougall argues that bioethics needs but does not have adequate tools for justifying law and policy. Bioethics’ tools are mostly theories about what we owe each other. But justifying laws and policies requires more; at a minimum, it requires tools for explaining the legitimacy of actions intended to control or influence others. It consequently requires political, rather than moral, philosophy. After showing how bioethicists have consistently failed to use tools suitable for achieving their political aims, MacDougall develops an interpretation of Kant’s political philosophy. On this account the legitimacy of health laws does not derive from the morality of the behaviors they require but derives instead from their role in securing our equal freedom from each other. MacDougall uses this Kantian account to show the importance of political philosophy for bioethics. First, he shows how evaluating kidney markets in terms of the legitimacy of prohibiting sales rather than the morality of selling kidneys reverses the widely accepted view that Kantian philosophy supports legally prohibiting markets. Second, MacDougall argues that an account of political authority is necessary for settling longstanding bioethics debates about the legal and even moral standards that should govern informed consent

Must Consent Be Informed? Patient rights, state authority, and the moral basis of the physician\u27s duties of disclosure

Legal standards of disclosure in a variety of jurisdictions require physicians to inform patients about the likely consequences of treatment, as a condition for obtaining the patient’s consent. Such a duty to inform is special insofar as extensive disclosure of risks and potential benefits is not usually a condition for obtaining consent in non-medical transactions. What could morally justify the physician’s special legal duty to inform? I argue that existing justifications have tried but failed to ground such special duties directly in basic and general rights, such as autonomy rights. As an alternative to such direct justifications, I develop an indirect justification of physicians’ special duties from an argument in Kant’s political philosophy. Kant argues that pre-legal rights to freedom are the source of a duty to form a state. The state has the authority to conclusively determine what counts as “consent” in various kinds of transactions. The Kantian account can subsequently indirectly justify at least one legal standard imposing a duty to inform, the reasonable person standard, but rules out one interpretation of a competitor, the subjective standard

Intervention principles in pediatric health care: the difference between physicians and the state.

According to various accounts, intervention in pediatric decisions is justified either by the best interests standard or by the harm principle. While these principles have various nuances that distinguish them from each other, they are similar in the sense that both focus primarily on the features of parental decisions that justify intervention, rather than on the competency or authority of the parties that intervene. Accounts of these principles effectively suggest that intervention in pediatric decision making is warranted for both physicians and the state under precisely the same circumstances. This essay argues that there are substantial differences in the competencies and authorities of physicians and the state, and that the principles that guide their interventions should also be conceived differently. While both the best interests standard and the harm principle effectively incorporate important aspects of physicians’ ethical obligations, neither adequately reflects the state’s ethical obligations. In contrast to physicians, the state has major obligations of distributive justice and neutrality that should form an integral part of any proposed ethical principles guiding state intervention in pediatric decision making. The differences are illustrated by examining recent cases involving parental refusal of chemotherapy in aboriginal Canadian communities and parental refusal of blood transfusions by Jehovah’s Witnesses

Sometimes Merely as a Means: Why Kantian Philosophy Requires the Legalization of Kidney Sales

Several commentators have tried to ground legal prohibitions of kidney sales in some form of Kant’s moral arguments against such sales. This paper reconsiders this approach to justifying laws and policies in light of Kant’s approach to law in his political philosophy. The author argues that Kant’s political philosophy requires that kidney sales be legally permitted, although contracts for such sales must remain unenforceable. The author further argues that Kant’s approach to laws, such as those governing kidney distribution, was formed in part by considering and rejecting an assumption frequently employed in the bioethics literature, namely, that legal duties can be grounded directly in moral duties. The author explains some of Kant’s reasons for rejecting this assumption and concludes that arguments pertaining to the legality of kidney sales developed on the basis of Kant’s moral philosophy should no longer be considered tenable

Whistleblowing: Don’t Encourage It, Prevent It Comment on “Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations”

In a recent article, Mannion and Davies argue that there are a multitude of ways in which organizations (such as the National Health Service [NHS]) can deal with wrongdoing or ethical problems, including the formation of policies that encourage and protect would-be whistleblowers. However, it is important to distinguish internal reporting about wrongdoing from whistleblowing proper, because the two are morally quite different and should not be dealt with in the same way. This article argues that we should not understand the authors’ conclusions to apply to “whistleblowing” proper, because their recommended approach would be both unfeasible and undesirable for addressing whistleblowing defined in this wa

The x-ray light valve: a low-cost, digital radiographic imaging system- spatial resolution

ABSTRACT In recent years, new x-ray radiographic systems based on large area flat panel technology have revolutionized our capability to produce digital x-ray radiographic images. However, these active matrix flat panel imagers (AMFPIs) are extraordinarily expensive compared to the systems they are replacing. Thus there is a need for a low cost digital imaging system for general applications in radiology. Different approaches have been considered to make lower cost, integrated x-ray imaging devices for digital radiography, including: scanned projection x-ray, an integrated approach based on computed radiography technology and optically demagnified x-ray screen/CCD systems. These approaches suffer from either high cost or high mechanical complexity and do not have the image quality of AMFPIs. We have identified a new approach -the X-ray Light Valve (XLV). The XLV has the potential to achieve the immediate readout in an integrated system with image quality comparable to AMFPIs. The XLV concept combines three well-established and hence lowcost technologies: an amorphous selenium (a-Se) layer to convert x-rays to image charge, a liquid crystal (LC) cell as an analog display, and an optical scanner for image digitization. Here we investigate the spatial resolution possible with XLV systems. Both a-Se and LC cells have both been shown separately to have inherently very high spatial resolution. Due to the close electrostatic coupling in the XLV, it can be expected that the spatial resolution of this system will also be very high. A prototype XLV was made and a typical office scanner was used for image digitization. The Modulation Transfer Function was measured and the limiting factor was seen to be the optical scanner. However, even with this limitation the XLV system is able to meet or exceed the resolution requirements for chest radiography

AAPM/SNMMI Joint Task Force: report on the current state of nuclear medicine physics training

The American Association of Physicists in Medicine (AAPM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) recognized the need for a review of the current state of nuclear medicine physics training and the need to explore pathways for improving nuclear medicine physics training opportunities. For these reasons, the two organizations formed a joint AAPM/SNMMI Ad Hoc Task Force on Nuclear Medicine Physics Training. The mission of this task force was to assemble a representative group of stakeholders to:• Estimate the demand for board-certified nuclear medicine physicists in the next 5-10 years,• Identify the critical issues related to supplying an adequate number of physicists who have received the appropriate level of training in nuclear medicine physics, and• Identify approaches that may be considered to facilitate the training of nuclear medicine physicists.As a result, a task force was appointed and chaired by an active member of both organizations that included representation from the AAPM, SNMMI, the American Board of Radiology (ABR), the American Board of Science in Nuclear Medicine (ABSNM), and the Commission for the Accreditation of Medical Physics Educational Programs (CAMPEP). The Task Force first met at the AAPM Annual Meeting in Charlotte in July 2012 and has met regularly face-to-face, online, and by conference calls. This manuscript reports the findings of the Task Force, as well as recommendations to achieve the stated mission

The Utility of Video Diaries for Organizational Research

This article assesses the utility of video diaries as a method for organization studies. While it is frequently suggested that video-based research methodologies have the capacity to capture new data about the minutiae of complex organizational affairs, as well as offering new forms of dissemination to both academic and professional audiences, little is known about the specific benefits and drawbacks of video diaries. We compare video diaries with two established and “adjacent” methods: traditional diary studies (written or audio) and other video methods. We evaluate each in relation to three key research areas: bodily expressions, identity, and practice studies. Our assessment of video diaries suggests that the approach is best used as a complement to other forms of research and is particularly suited to capturing plurivocal, asynchronous accounts of organizational phenomena. We use illustrations from an empirical research project to exemplify our claims before concluding with five points of advice for researchers wishing to employ this method