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Biomedical subjects

L R Churchill

Publications and source records attributed to L R Churchill.

At least 19 recordsLinked to original sources
PubMed2004

Gaps, conflicts, and consensus in the ethics statements of professional associations, medical groups, and health plans.

BACKGROUND: Patients today interact with physicians, physician groups, and health plans, each of which may follow distinct ethical guidelines. METHOD: We systematically compared physician codes of ethics with ethics policies at physician group practices and health plans, using the 1998-99 policies of 38 organisations-18 medical associations (associations), nine physician group practices (groups), and 12 health plans (plans)-selected using random and stratified purposive sampling. A clinician and a social scientist independently abstracted each document, using a 397-item health care ethics taxonomy; a reconciled abstraction form was used for analysis. This study focuses on ethics policies regarding professional obligation towards patients, resource allocation, and care for the vulnerable in society. RESULTS: A majority in all three groups mention "fiduciary obligations" of one sort or another, but associations generally address physician/patient relations but not health plan obligations, while plans rarely endorse physicians' obligations of advocacy, beneficence, and non-maleficence. Except for occasional mentions of cost effectiveness or efficiency, ethical considerations in resource allocation rarely arise in the ethics policies of all three organisational types. Very few associations, groups, or plans specifically endorse obligations to vulnerable populations. CONCLUSIONS: With some important exceptions, we found that the ethics policies of associations, groups, and plans are narrowly focused and often ignore important ethical concerns for society, such as resource allocation and care for vulnerable populations. More collaborative work is needed to build integrated sets of ethical standards that address the aims and responsibilities of the major stakeholders in health care delivery.

Conflict, Psychological↗
PubMed2001

Universal health care for children: why every self-interested person should support it.

By comparison to other developed nations, both the health care and the health status of children in the U.S. are poor. Ethical arguments for covering all children for health services are numerous, but most of them require the suppression of self-interested motivations. Drawing from and developing the arguments of David Hume, this essay argues that self-interested motives need not work against an inclusive system, and can strengthen the case for covering children in particular. Anyone who hopes to benefit from the inter-generational transfers currently required by Social Security and Medicare policies should be an advocate for health care for all children.

Bioethics↗
PubMed1999

The United States health care system under managed care. How the commodification of health care distorts ethics and threatens equity.

Describing the U.S. health care system means describing managed care under commercial forces. Managed care creates new moral tension for practitioners, but more importantly, in its current form it intensifies the commercialization of health expectations and interactions. The largely unregulated marketing of health services under managed care has been a major factor in the increasing number of uninsured citizens, while claims for cost reduction through managed care are equivocal. Risk-rating practices integral to the current medical marketplace thwart concerns for justice in allocation and create vulnerabilities for almost everyone. The political-moral concern of the early 1990s for a right to health care is nowhere in sight.

Cost Control↗
PubMed1999

Looking to Hume for justice: on the utility of Hume's view of justice for American health care reform.

This essay argues that Hume's theory of justice can be useful in framing a more persuasive case for universal access in health care. Theories of justice derived from a Rawlsian social contract tradition tend to make the conditions for deliberation on justice remote from the lives of most persons, while religiously-inspired views require superhuman levels of benevolence. By contrast, Hume's theory derives justice from the prudent reflections of socially-encumbered selves. This provides a more accessible moral theory and a more realistic path to the establishment of universal access.

Beneficence↗
PubMed1996

A prospective study of the impact of patient preferences on life-sustaining treatment and hospital cost.

OBJECTIVES: Ethicists advise that life-sustaining treatment decisions should be made in keeping with patient preferences. Until recently, there has been little systematic study of the impact of patient preferences on the use of various life-sustaining treatments or the consequent cost of hospital care. This prospective study was designed to answer the following questions: a) Do patient treatment preferences about the use of life-sustaining treatment influence the treatments they receive? and b) Do patient treatment preferences influence the total cost of their hospitalization? DESIGN: A prospective, cohort study. SETTING: A university teaching hospital. PATIENTS: Hospitalized patients, at least 50 yrs of age, with short life expectancy due to end-stage heart, lung, or liver disease, metastatic cancer, or lymphoma. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were interviewed to determine their desire for life-sustaining treatment and other characteristics and then were followed for 6 months to determine life-sustaining treatment use and costs during hospitalization. Two hundred forty-four patients were interviewed. Fifty-eight percent of patients expressed a desire for life-sustaining treatments to prolong life for 1 wk. During 245 subsequent hospitalizations, there were 20 episodes of mechanical ventilation, 63 episodes of intensive care, and 66 cancer treatments given. Bivariate and multivariate analyses showed no significant association between patient desire to receive treatment to prolong life and either life-sustaining treatment use (p = .59) or hospital costs (p = .20). CONCLUSION: In a university teaching hospital setting, there is no systematic evidence that patient preferences determine life-sustaining treatment use or hospital costs.

Aged↗
PubMed1990

Hermeneutics in science and medicine: a thesis understated.

Drew Leder's "Clinical Interpretation: The Hermeneutics of Medicine" is an essay which understates its case and thereby opens itself to misinterpretation. This response to Leder argues for a more thorough-going hermeneutic for both medicine and science. At the conceptual as well as the practical level, modern medicine and its scientific foundations are hermeneutic enterprises. The purpose of this essay is to argue that we should not back away from this more radical thesis. Embracing it will result in less alienation of physicians from patients, and of physicians from the tasks of medicine.

Clinical Competence↗
PubMed1990

AIDS and 'dirt': reflections on the ethics of ritual cleanliness.

AIDS and the responses and attitudes it evokes surpass the analytic abilities of standard bioethics. These responses and attitudes are explored in terms of literary and anthropological categories, such as dirt, disorder, pollution and ritual cleanliness. Implications for medical education are suggested.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The use of anencephalic organs: historical and ethical dimensions.

The condition of newborn infants with anencephaly, a neural tube defect, is incurable and uniformly fatal. Although physicians reached a consensus two decades ago on the appropriateness of using these infants' organs, ethical and legal questioning has since challenged the grounds on which medical authorities justified transplantation. Advocates have proposed three conceptual strategies to warrant procuring anencephalics' organs: redefining death, excluding the infants from possessing personhood, and intubating and ventilating them while keeping a vigil for brain death. Each of these conceptual schemes has arguable shortcomings in its construction, however; as such, the case for using anencephalic infants as sources of organs has yet to be conclusively demonstrated.

Anencephaly↗