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Results for “FAIR principles”

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PubMed1989

[Ethics in psychotherapy].

After introducing the terms "morality" and "ethics" as defined by Patzig, the discussion focuses on applying to the practicing of psychotherapy the guidelines for ethics in medicine formulated by Beauchamp and Childress, i.e. respect of the autonomy of the patient, the doctor's duty to prevent injury, the obligation to give assistance and the principle of fairness. In particular, it is pointed out that to hale respect for the autonomy of the patient, a thorough and patient inquiry concerning diagnosis, indication and therapy is necessary in order for the patient to develop intrinsic motivation based on insight into his condition and evaluation of the prognosis. In connection with the discussion of the nil nocere, reference is made to the therapist's duty to take a patient's various limits of tolerance into account. Emphasis is also placed on the psychotherapist's duty to "service" his own psychic apparatus with the help of continued education and in-service training, supervision and self-analysis. Applied to psychotherapy, the obligation to give assistance means encouraging the patient to go in the direction of greater autonomy which means the reduction of helplessness. In psychotherapy, problems of distributing resources fairly may be manifested in unjustifiably long waiting lists or in the form of patient selection carried out in a way that is not justifiable on medical grounds but based rather on a tendency to eliminate certain groups of disorders by using contra-indications that are basically rationalizations of countertransference reactions and which are not in keeping with the professional and personal identity of therapists.

Ethics, Medical↗

PubMed1983

Is sex selection ethical?

The argument of this paper is that sex selection, except to avoid sex-linked disorders, is unethical. Two reasons are given: 1) Prima facie examination of any argument for sex selection cannot overcome the unfair and sexist basis of a choice to select the sex of a child. The desire to control the sex of a child is not rational, since any claim that is made for the parents' preference for one sex can be demonstrated to be provided also by the other sex. 2) On an examination of the consequences of sex selection, if it were practiced by parents in significant numbers, the harmful consequences would far outweigh the few fleeting beneficial consequences. The hypothesis that sex selection might reduce population in less developed or overpopulated nations cannot be demonstrated without violation of ethical principles of fairness and beneficence. The paper clarifies and, to an extent, revises a position taken earlier by the author on sex selection by amniocentesis. In an effort to argue that the motives of parents who desire to choose the sex of their child should not be singled out for harsh judgment in societies that allow abortion, the author's position about the ethics of sex selection itself was not directly stated. This paper attempts to strengthen the ethical content of the author's views and recommends a policy for physicians who receive requests from parents to assist them in sex selection.

Choice Behavior↗

PubMed1994

Health information, privacy, confidentiality and ethics.

Electronic patient records are becoming tologically reified entities that play the role of epistemic patient analogues in information space. The traditional property-model of patient records is therefore no longer appropriate. A shift in paradigm is required. This paper suggests a new paradigm, examines its ethical implications and explores ways in which these could be reflected in legal and regulatory mechanisms. Special attention is paid to privacy, security and access relative to the so-called 'fair information principles'.

Computer Security↗

PubMedDate not supplied

Long-term health care and the ethics of the marketplace.

This article reflects on the ageist attitudes that hold sway in he intellectual debate over long-term nursing care. The once proud claim of cradle to grave health care is being undermined with older people seen as economic dependents, savings being means tested and continuing care places being cut. For society to be seen as fair, the principle that no one should be disadvantaged because of circumstances over which they have little control-of which age is surely one-must be reinstated at the heart of the NHS.

Aged↗

PubMed2003

[Barriers to the fair allocation of healthcare resources].

The gap between infinite healthcare needs and finite health resources imposes on practicing physicians a dual commitment to patients' needs and to the fair allocation of health care resources. The ethical principles of a fair allocation of resources are egalitarianism, utilitarianism and a transition from individual to group-based ethics. These principles are ambiguous and occasionally conflicting. Their implementation is further impeded by practice norms, such as private practice by physicians employed by public institutions, incentives for physicians to save, and marketing of clinical interventions of unproven efficacy. Proposed approaches to these barriers to the fair allocation of resources include respect of patient autonomy with full disclosure of the limitations in the services provided by the health plan; adherence to clinical practice guidelines; and an open access for patients to second medical opinion. I believe that the fairness of resource allocation may be further improved by the prohibition of private practice by physicians employed in public health care institutions, and by enhancement of physicians' self-awareness of subconscious discrimination against some patients.

Delivery of Health Care↗

PubMed2003

Unmanaged care: towards moral fairness in health care coverage.

Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.

Actuarial Analysis↗

PubMed2005

Health, wealth and fairness based on gender: the support for ethical principles.

Sex differences in health, and the reality of a gender system, are well-known, but we know little about how this connects to opinions on fairness and desired change. This study aims to explore two principal questions: how to compare the position of women and men within-state and how to choose between-states, where a state is defined as a situation in which individuals have a particular set of resources, rights and duties, and if components in the set are altered, a new state for the same individuals appears. Based on various normative rules (monistic view or separate spheres, equity as choice or ethics of care, equity by attainment or shortfall; variants of welfarism, feminism and conservatism), a survey among Swedish public health workers was carried out. The results demonstrate a major rejection of the idea of compensation between health, power, influence and resources, and of considering past processes when judging fairness as to women and men. Moreover, most respondents believe that a biologically based difference in health is fair and reject health maximization as a guiding principle. The support for gender equality is strong when contrasted with the conservative goal, and subsists when contrasted against the Pareto criterion and trading-off health/income as well. Results that call for additional research and exchange of views include that common notions in research and policy-making are rejected by a majority, and that females and males differ considerably when judging change from a societal perspective.

Data Collection↗

PubMed2006

Examining the principles in principled conservatism: the role of responsibility stereotypes as cues for deservingness in racial policy decisions.

Why do educated conservatives oppose affirmative action? Those in the "principled conservatism" camp say opposition is based on principled judgments of fairness about the policies. Others, however, argue that opposition is based on racism. The present article offers an alternative perspective that may reconcile these contradictory points of view. In 2 studies, the authors show 2 major findings: (a) that conservatives oppose affirmative action more for Blacks than for other groups, in this case women, and (b) that the relationship between conservatism and affirmative action attitudes is mediated best by group-based stereotypes that offer deservingness information and not by other potential mediators like old-fashioned racism or the perceived threat that affirmative action poses to oneself. The authors conclude that educated conservatives are indeed principled in their opposition to affirmative action, but those principles are group based not policy based.

Adult↗

PubMed2005

Waiting for radiotherapy a national call for ethical discourse on waiting lists in radiotherapy: findings from a preliminary survey.

BACKGROUND AND PURPOSE: Growing incidence of cancer and the demographic changes of the society can cause severe shortage in radiotherapy services. This can lead to the use of waiting lists, which can serve as an indicator model for shortage of medical service. To investigate whether and how waiting lists are used in Germany, a survey was undertaken among German radio-oncologists. Their opinion concerning the use of waiting lists and their attitude toward the involved ethical problems were the central topics of this study. MATERIAL AND METHODS: A questionnaire was developed which consisted of 18 items: four items covered general aspects, four were about the management of waiting lists, seven concerned problems of waiting lists, and three were about the future aspects. From all items, at least ten touched ethical aspects such as patient information or the doctor-patient relationship. 19 consecutive radio-oncologists answered the questionnaire via telephone. The main interest of this study was to generate further hypotheses for future research. RESULTS: From all doctors (n = 19), most did not use waiting lists (n = 12) in their practice, whereas the remaining did use them (n = 7). Limited resources were seen as the central underlying problem (n = 16). Two guiding principles were most often quoted for managing waiting lists: patients with complaints such as pain before those without (n = 18) and curative before palliative radiotherapy (n = 15). Concerning the information given to patients about the use of waiting lists, some doctors voted for detailed information (n = 7), which covers negative side effects of waiting lists such as tumor progression during waiting time, others voted against (n = 11). There was a profound disagreement on the question of whether curative and palliative radiotherapy should be differently treated in the context of waiting lists. 70% of the group, who used waiting lists, could give a moral justification for waiting lists, whereas only 28% of the group, who did not use them, could offer a justification. CONCLUSION: The survey showed that doctors were most concerned about the ethical aspects of waiting lists. Open questions are: (1) What is the best principle for a fair distribution of limited radiotherapy places? (2) How should patients be informed about waiting lists? (3) What moral justifications can be given for waiting lists? These issues must therefore become topics of future research and national dialogue, because the answers to these questions are necessary for the clinical use of waiting lists in radiotherapy.

Data Collection↗

PubMed2006

Access, equity and the role of rights in health care.

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally. In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values--liberty and equity--can be evaluated and assessed.

Delivery of Health Care↗

PubMed2000

Implications of the Balanced Budget Act of 1997.

The sweeping and challenging changes in the health care industry emanating from the Balanced Budget Act of 1997 have exceeded those experienced by health care providers and consumers under the Tax Equity and Fiscal Responsibility Act of 1982, the Diagnosis Related Groupings in 1984, and the Resource-Based Relative Value Scale in 1992. To understand and cope with these changes, the financial impact of the Balanced Budget Act is examined in depth, particularly in terms of reimbursement or funding for all health care settings, providers, and medical education. The dramatic changes in the health care delivery process that have caused havoc and turmoil also are examined. For survival and growth under the Balanced Budget Act, reengineering strategies are presented. The ethical and social responsibilities that underlie the current and future impact of the Balanced Budget Act are analyzed to foster the principles of justice, fairness, and best interests of the public.

Budgets↗

PubMed2002

Substantial evidence of effect.

Pressures for rapid drug development, especially for treatments that may affect public health significantly, drive a need to reconsider what is necessary to establish the "substantial evidence" of efficacy and safety required for regulatory approval. The concept of substantial evidence of effect can be stated fairly simply in principle, but its application to the evaluation of findings from real clinical drug development programs can be quite complicated and depend on circumstances relating to the population studied and the condition being treated. This paper discusses a number of considerations that arise in attempting to address this issue. These include confirmation of efficacy/safety as opposed to replication of results, the use of surrogates for the clinical outcome, ethical considerations, the use of trials aimed at demonstrating equivalence or noninferiority instead of superiority of a new drug, and the balance between benefits and risks. Recent developments such as the International Conference on Harmonization (ICH) guidelines dealing with statistical principles and choice of control group, and Food and Drug Administration (FDA) guidances interpreting the 1998 Modernization Act identify useful alternative definitions of substantial evidence and also identify when a single study can be enough to demonstrate a clinically important effect. The primary difficulty with the use of noninferiority trials is the need to demonstrate assay sensitivity or validity, i.e., that the trial would have demonstrated the superiority of the active control treatment to placebo had the trial included a placebo group. Failure to demonstrate a significant difference between the presumed active treatments and an inactive control precludes a definitive conclusion of assay validity, but external evidence, e.g., from trials demonstrating the activity of the active control, may yet justify concluding that the trial was assay valid. Issues of interpretation of important unexpected findings are illustrated in the recent experience with the alpha- and beta-blocker carvedilol, where there was a significant reduction in mortality among patients on carvedilol relative to placebo, but a treatment effect could not be demonstrated for the primary outcome. Experience with trials of thrombolytic agents illustrates alternative strategies for demonstrating substantial evidence of effect. Finally, meta-analyses can contribute to the substantial evidence by synthesizing the findings from separate trials to provide a perspective on drug performance in a heterogeneous population of patients that no single trial could provide.

Carbazoles↗

PubMed2026

The Lipid Interactome: an interactive and open access platform for exploring cellular lipid-protein interactions.

SUMMARY: Lipid-protein interactions play essential roles in cellular signaling and membrane dynamics, yet their systematic characterization has long been hindered by the inherent biochemical properties of lipids. Recent advances in functionalized lipid probes-equipped with photoactivatable crosslinkers, affinity handles, and photocleavable protecting groups-have enabled proteomics-based identification of lipid interacting proteins with unprecedented specificity and resolution. Despite the growing number of published lipid interactomes, there remains no centralized effort to harmonize, compare, or integrate these datasets. The Lipid Interactome addresses this gap by providing a structured, interactive web portal that adheres to FAIR data principles-ensuring that lipid interactome studies are Findable, Accessible, Interoperable, and Reusable. Through standardized data formatting, interactive visualizations, and direct cross-study comparisons, this resource enables researchers to systematically explore the protein-binding partners of diverse bioactive lipids. By consolidating and curating lipid interactome proteomics data from multiple studies, the Lipid Interactome database serves as a critical tool for deciphering the biological functions of lipids in cellularsystems. AVAILABILITY AND IMPLEMENTATION: This site can be viewed at LipidInteractome.org. All data are available for download. No user information is collected or necessary for data navigation, interaction, or download.

Proteins↗

PubMed1992

Ethical principles governing research in child and adolescent psychiatry.

This paper examines the ethical principles governing research in child and adolescent psychiatry. The guidelines for protection of children and adolescents are research subjects are discussed. These include the principle of nonmaleficence and beneficence (the risk-benefit ratio), the principle of autonomy (informed consent and confidentiality), and the principle of justice (fair distribution of benefits and burdens of research). In the light of recent national efforts to help promote responsible research practice, the ethical standards relating to the protection of scientific integrity as well as research advocacy, training, and stewardship are also discussed.

Adolescent↗

PubMed1994

Fault and the allocation of spare organs.

This paper argues that rectificatory justice should supplement distributive justice in allocating priority of access to scarce medical resources. Where a patient is at fault for the scarcity of healthy organs a principle of restitution requires that she should give priority to the faultless. Such restitution is non-punitive, and is akin to reparation in civil law, not criminal law. However, it is doubtful whether such a principle can be fairly applied within the present culture of governmental complicity in cigarette advertising.

Complicity↗

PubMed2003

Affirmative action: essential to achieving justice and good health care for all in America.

Affirmative action is an established principle that brings fairness and justice to admissions policies and practices by setting goals that encourage and pressure institutions and individuals to create educational and professional opportunities for minorities and women, if it were not for affirmative action, we would waste the talents of countless individuals who would be discounted because they are minorities or women. The result would be a nation that is weaker because it would be segregated once again in a system in which white people and men would have the preponderance of opportunity and authority and in which access would be very limited for minorities and women. It may be time to reframe the argument for affirmative action in language that denotes its benefits to all Americans by increasing access for emerging majority citizens now and in the future. ADEA, academic dentistry, and the dental profession should continue to do everything it can to preserve the policies and practices of affirmative action, especially through the support of the University of Michigan admissions policies as challenged in the cases before the U.S. Supreme Court and in our own practices.

Education, Dental↗

PubMed1998

[Organ transplant network in Japan: current status and its role].

The Role of Organ Transplant Network are the encouragement of the organ transplantation and fair organ sharing. Its principled are united, neutral open and nonprofit organization, so as to secure the fair and quick organ sharing based on the uniform allocation policy. Japan Kidney Transplant Network was established in 1995 nad reorganized into multi-organ sharing network, Japan Organ Transplant Network in 1997, when Japan Organ transplant Act was enacted. It consists of transplant coordinators, physicians, transplant surgeons, kidney banks, local administration, academic standings, other organization/associations and others. There are several committee, in which special subjects on organ transplantation and related matters are consulted, and review system in which each case is assessed and judged. And principal and essential items are decided by the board of members and then by the general assembly. The new computer system was introduced and registrants data are renewed every year, and recipient selection is done based on the latest registrants data. Standardized HLA examination tray was introduced and class II antigen was examined by means of DNA typing since 1997, which enabled more precise and accurate search. Hereafter, the education and encouragement of transplant coordinators to raise themselves and the more effective and extended distribution of donor cards are indispensable to promote organ donation/transplantation.

Humans↗

PubMed2000

Influence of role and gender on the use of distributive versus procedural justice principles.

Differences in perceptions of fairness may result from differential emphasis on distributive and procedural justice. The author found that organizational role and gender influenced the extent to which distributive and procedural justice principles were used when participants allocated and evaluated pay raises. When participants took the role of a supervisor, they were more likely to use procedural justice principles; when they took the role of a subordinate, they were more likely to use distributive justice principles. Also, men were more likely to use distributive justice than procedural justice principles when allocating and evaluating raises. These findings suggest that organizations should become aware of individual and role-based differences in emphasis on justice-related factors that could potentially lead to perceptions of unfairness.

Adult↗