Biomedical subjects
Publications and source records attributed to S M Gallagher.
Modern healthcare in America is thought to be strongly individualistic in nature in that it largely focuses on curative treatment of individuals instead of preventive medicine that would affect whole segments of the population. This article describes the terms individualism, entitlement, and respect for personal autonomy within the context of ethically sound public policy formation.
A lottery was implemented to encourage the elderly clients of a residential home to use activity materials any time they wished, independently of staff intervention and the institutional routine of the home. During baseline, there were minimal levels of independent use of activity materials by residents. Various conditions were implemented but only the introduction of a ł20 lottery prize brought about a significant increase in the frequency of independent use of activity materials. A follow-up suggested that the reinforcing properties of the activity materials themselves eventually maintained the target behavior.
The unique needs of many elderly Americans are often not heard. However, in the face of an ever-growing aging population, clinicians are more actively planning healthcare for older adults across practice settings. This article examines the home care needs of elderly patients who wish for care, but not aggressive, acute care. The author reviews bioethical considerations that apply to elderly individuals and groups and presents suggestions to promote quality care that is ethically sound. This article also describes clinicians' obligation to identify what quality care means to the very old person and explains the deficiency model of aging along with its impact on medical intervention.
Escalating costs have led to the increasing interest in outcome research in all areas of industry. In healthcare, providers, payors, and consumers are making every effort to improve the quality of patient care while managing costs. Because the overriding issue of cost is driving much of outcome research, it is increasingly important to recognize the fragile balance that exists between cost and quality. In addition, clinicians face a number of other ethical and legal concerns such as confidentiality, informed consent, and the needs of the underserved. This column describes outcome research, along with ethical principles that influence this research.
Lay caregivers increasingly are accepting responsibility for the care of loved ones in the home health setting. These caregivers are often not prepared emotionally or physically for such responsibility. The rights of caregivers are examined herein as they relate to the obligations of clinicians to ease the caregivers transition to their new and sometimes unexpected role.
Criteria-based protocols are an ethically appropriate strategy to addressing issues such as allocation of scarce resources; however, protocols can conflict with the ethical ideal of respect for individual autonomy. This article illustrates the conflict that can occur between individual patient situations and standardized criteria-based protocols. Furthermore, ordinary care and treatment outlined in criteria-based protocols can become extraordinary in some cases. The case study presented illustrates why it is important to distinguish between ordinary and extraordinary care in some situations. The distinction between the two is described herein.
Americans are increasingly interested in and willing to participate in alternative or adjunctive healthcare, which is sometimes called complementary healthcare. Some believe this is because of wide-spread cultural diversity or an increasing awareness of options in health practice, while others contend it is a reaction to dissatisfaction with Western health practices. Diversity among cultures and subcultures has posed challenges for clinicians. This article addresses the impact of culture on health and healing, examining alternative health practices and their impact on chronic care, specifically chronic wound care.
Many professional organizations and healthcare institutions have developed codes of ethics for a number of reasons. Unlike legal mandates, codes of ethics provide professionals with a framework for ethical behavior within their specific discipline. Professionals today face challenges because the necessary ethical debates cannot keep pace with the rapidly changing environment in which ethical dilemmas quickly emerge. This article describes components of codes of ethics, outlines the evolving nature of ethics, and argues for a dynamic quality in these codes as a way to provide timely, sensitive guidance for professional practice.
Clinicians are faced with the consequences of advanced technology in every aspect of their practice--from computerized documentation to local wound care treatments to clarifying information located by patients on the Internet. Americans are preoccupied with the promise of new and different technologies. The technological imperative describes the human drive to use technology once it becomes available simply because it is available. This raises a number of patient care issues--including ethical issues. Nonmaleficence and respect for personal autonomy are addressed in this ethical analysis of advanced technology. Opportunities for wound care clinicians are discussed herein.
Fifty-four percent of American adults are overweight. Obesity is a chronic disease associated with a number of conditions, such as diabetes, heart disease, hypertension, certain types of cancers, and breathing problems. The direct and indirect costs related to obesity exceed $70 billion annually. Because of the many cost and quality issues related to obesity, national attention is turning toward the special needs of this population. Strategies to restructure therapeutic intervention with attention to risk management, economic implications, and patient satisfaction are important considerations when managing the obese patient.
Ethics is the philosophical study of mortality--the study of goodness, moral values, and right action. Citizenship ethics is the part of public ethics that is concerned with the right action of citizens in the public arena. This article defines citizenship ethics and examines the ethics of individual citizens or groups as it relates to opportunities for healthcare professionals in their respective communities. The spirit of volunteerism among three professionals is highlighted as they make a positive contribution to their communities, and an appeal is made to healthcare professionals to seek their own opportunities to make a positive impact on their communities.
Nonmaleficence refers to the maxim Primum non nocere, "Above all, do no harm." Nonmaleficence is an important ethical principle, especially in the face of advanced technology and other superordinary or extraordinary therapeutic interventions available to patients today. Chronic illness poses challenges in balancing the benefits with the burdens of therapeutic intervention. A discussion of nonmaleficence as a principle to consider in chronic conditions is presented.
Otherness holds special meaning in healthcare planning. When clinicians assign the quality of "otherness" to a patient or a patient group, they may justify inadequate care by blaming the patient for the numerous management difficulties he or she presents. This response suggests that as a culture we need to be aware of the moral dimensions of otherness and recognize how this influences care. A case study is offered to illustrate the numerous barriers otherness poses in healthcare planning.
The principle of beneficence is one of four bioethical principles, which also include non-maleficence, autonomy, and justice. Beneficence is a moral term; it is the obligation to act for the benefit of others. Social policy is developed from informed choices with regard to a balance between costs, risks, and beneficence. Wound care clinicians conduct clinical and economic outcome studies to guide those responsible for making reimbursement decisions for patients with costly complications of chronic illness. This column discusses the balance of benefits, costs, and risks in the face of the principle of beneficence. Prevention, as an alternative to costly treatment of recurrent wounds, is presented as a strategy to balance cost, risk, and beneficence.
The Georgetown Mantra of Bioethics, which includes the principles of beneficence, non-maleficence, autonomy, and justice, has largely been regarded as the mainstay of ethical principles in the healthcare setting. Moral or ethical decisions have been discussed using this framework. The purpose of this article is to argue that the ethics of compassion is a critical principle in making clinical decisions, especially in the case of the chronically ill patient. This suggests that the ethics of compassion may serve as an important adjunct to the Georgetown Mantra.
Wound care clinicians are regularly asked to make decisions of an ethical nature within their work settings. Business and business practices are influenced by a number of factors, such as history, culture, and individual choices. This article describes business practices and ultimately business ethics from an historical context, the meaning of business culture within the dominant culture, and the debate over business ethics as it relates to choices and challenges for wound care clinicians.
Medical information is part of the growing global resource that constitutes the World Wide Web. Researching health information is one of the most common reasons for using the Internet. In 1997, nearly half of U.S. users spent time looking for health information or support on the Internet. More recently, the Internet allows medically naive users to question physicians and other clinicians about health-related topics by e-mail and other digital communication methods. In the face of this growing technology, the term "access" now encompasses the availability of specialized information to the general public. This article reviews the meaning of access in terms of the growing information Movement, looks at opportunities this presents to clinicians, and analyzes barriers to widespread and appropriate information access.
The debate surrounding euthanasia may have existed before recorded history, yet it continues today. Advanced technology, with its implication on prolonging life and postponing death in some cases, further complicates the debate. This column includes a historical review of euthanasia, related terminology, and proposed guidelines. The implications of recent legislation on enhancing discussions around terminal care are also reviewed.