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BMC Medicine Nov 2023Is disease demotion more important than health promotion? The question is crucial for the ethos of medicine and for priority setting in healthcare. When things get...
Is disease demotion more important than health promotion? The question is crucial for the ethos of medicine and for priority setting in healthcare. When things get tough, where should our attention and resources go: to health or disease? This study investigates two general perspectives on health and disease to address whether there is a stronger moral appeal from people's disease than from their health. While naturalist conceptions of health and disease are mute on moral appeal, normativist conceptions give diverse answers. Classical utilitarianism provides a symmetrical view of health and disease, according to which we have an equally strong moral appeal to further health as we have to reduce disease. Other normativist positions argue that there is an asymmetry between health and disease providing substantial support for a stronger moral appeal from disease than from health. This has a wide range of radical implications, especially within priority setting. In particular, treatment, palliation, and prevention of disease should have priority to the promotion and enhancement of health.
Topics: Humans; Morals; Health Promotion; Disease; Motivation
PubMed: 37926829
DOI: 10.1186/s12916-023-03110-3 -
Frontiers in Public Health 2024This article deals with combat experiences and their consequences and could be potentially disturbing.
TRIGGER WARNING
This article deals with combat experiences and their consequences and could be potentially disturbing.
INTRODUCTION
Moral injury (MI) is a severe form of combat trauma that shatters soldiers' moral bearings as the result of killing in war. Among the myriad ways that moral injury affects veterans' reintegration into civilian life, its impact on political and societal reintegration remains largely unstudied but crucial for personal, community, and national health.
METHODS
13 in-depth interviews examine combat soldiers' exposure to potentially morally injurious events (PMIEs) that include killing enemy combatants, harming civilians, and betrayal by commanders, the military system, and society. Interviewees also described their political activities (e.g., voting, fundraising, advocacy, protest) and social activism (e.g., volunteering, teaching, charitable work). Interviewees also completed the Moral Injury Symptom Scale.
RESULTS
Two distinct narratives process PMIEs. In a narrative, soldiers hold themselves or their in-group morally responsible for perpetrating, witnessing, or failing to prevent a morally transgressive act such as killing or injuring civilians or placing others at unnecessary risk. In contrast, a perspective blames an out-group for leaving soldiers with no choice but to act in ways that trigger moral distress. Associated with shame and guilt, the humanitarian perspective triggered amends-making and activism after discharge. In contrast, a national security perspective associated with anger and frustration fostered protest and intense activism.
DISCUSSION
Despite its harmful health effects, moral trauma and injury can drive intense political and social activism, depending upon the narrative veterans adopt to interpret PMIEs. Aside from moral injury's personal, familial, and social effects, moral injury drives veterans' return to the political arena of civil society. As such, veterans play a central role in politics and dramatically affect post-war policy in democratic nations following conflict.
Topics: Humans; Veterans; Male; Adult; Israel; Political Activism; Morals; Military Personnel; Female; Middle Aged; Interviews as Topic; Qualitative Research
PubMed: 38932767
DOI: 10.3389/fpubh.2024.1336406 -
BMC Medical Ethics Oct 2023Healthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of...
BACKGROUND
Healthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals' moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.
METHOD
Semi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person's thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally's taxonomy.
RESULTS
Among 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The "rules" category of justice and the "welfare of others" category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.
CONCLUSIONS
The nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider's responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended.
Topics: Humans; East Asian People; Judgment; Morals; Social Justice; Nurses
PubMed: 37794440
DOI: 10.1186/s12910-023-00960-7 -
Hong Kong Medical Journal = Xianggang... Dec 2023Healthcare workers in intensive care units often experience moral distress, depression, and stress-related symptoms. These conditions can lower staff retention and...
INTRODUCTION
Healthcare workers in intensive care units often experience moral distress, depression, and stress-related symptoms. These conditions can lower staff retention and influence the quality of patient care. This study aimed to evaluate the prevalence of moral distress and psychological status among healthcare workers in a newly established paediatric intensive care unit (PICU) in Hong Kong.
METHODS
A cross-sectional questionnaire survey was conducted in the PICU of the Hong Kong Children's Hospital; healthcare workers (doctors, nurses and allied health professionals) were invited to participate. The Revised Moral Distress Scale (MDS-R) Paediatric Version and Depression Anxiety and Stress Scale-21 items were used to assess moral distress and psychological status, respectively. Demographic characteristics were examined in relation to moral distress, depression, anxiety, and stress scores to identify risk factors for poor psychological outcomes. Correlations of moral distress with depression, anxiety, and stress were examined.
RESULTS
Forty-six healthcare workers completed the survey. The overall median MDS-R moral distress score was 71. Nurses had a significantly higher median moral distress score, compared with doctors and allied health professionals (102 vs 47 vs 20). Nurses also had the highest median anxiety and stress scores (11 and 20, respectively). Moral distress scores were correlated with depression (r=0.445; P=0.002) and anxiety scores (r=0.417; P<0.05). Healthcare workers intending to quit their jobs had significantly higher moral distress scores (P<0.05).
CONCLUSION
Among PICU healthcare workers, nurses had the highest level of moral distress. Moral distress was associated with greater depression, anxiety, and intention to quit. Healthcare workers need support and a sustainable working environment to cope with moral distress.
Topics: Humans; Child; Cross-Sectional Studies; Intensive Care Units, Pediatric; Health Personnel; Intensive Care Units; Patient Care; Surveys and Questionnaires; Morals; Stress, Psychological
PubMed: 38111367
DOI: 10.12809/hkmj209246 -
Environmental Science & Technology Dec 2023Pollution by chemicals and waste impacts human and ecosystem health on regional, national, and global scales, resulting, together with climate change and biodiversity... (Review)
Review
Pollution by chemicals and waste impacts human and ecosystem health on regional, national, and global scales, resulting, together with climate change and biodiversity loss, in a triple planetary crisis. Consequently, in 2022, countries agreed to establish an intergovernmental science-policy panel (SPP) on chemicals, waste, and pollution prevention, complementary to the existing intergovernmental science-policy bodies on climate change and biodiversity. To ensure the SPP's success, it is imperative to protect it from conflicts of interest (COI). Here, we (i) define and review the implications of COI, and its relevance for the management of chemicals, waste, and pollution; (ii) summarize established tactics to manufacture doubt in favor of vested interests, i.e., to counter scientific evidence and/or to promote misleading narratives favorable to financial interests; and (iii) illustrate these with selected examples. This analysis leads to a review of arguments for and against chemical industry representation in the SPP's work. We further (iv) rebut an assertion voiced by some that the chemical industry should be directly involved in the panel's work because it possesses data on chemicals essential for the panel's activities. Finally, (v) we present steps that should be taken to prevent the detrimental impacts of COI in the work of the SPP. In particular, we propose to include an independent auditor's role in the SPP to ensure that participation and processes follow clear COI rules. Among others, the auditor should evaluate the content of the assessments produced to ensure unbiased representation of information that underpins the SPP's activities.
Topics: Humans; Ecosystem; Conflict of Interest; Environmental Pollution; Biodiversity
PubMed: 37943968
DOI: 10.1021/acs.est.3c04213 -
BMC Psychiatry Oct 2023Nurses' Job performance could be affected by occupational stress. Previous studies reported contradictory results in this regard. Factors such as moral and emotional...
BACKGROUND
Nurses' Job performance could be affected by occupational stress. Previous studies reported contradictory results in this regard. Factors such as moral and emotional intelligence could impact occupational stress. However, the extent of any mediating effect is unclear. Thus, this study aimed to determine the effect of occupational stress on nurses' Job performance and the mediating impact of moral and emotional intelligence.
METHODS
This cross-sectional study was conducted in Urmia teaching hospitals (Imam Khomeini, Motahari, Taleghani, Kosar, and Seyed al-Shohada Hospitals). Six hundred twenty-one nurses were selected using quota sampling from February 2022 to April 2022. Data were collected using demographic questionnaires, the Nursing Stress Scale, Paterson's Job Performance Questionnaire, Siberia Schering's Emotional Intelligence Standard Questionnaire, and Lennik and Keil's Moral Intelligence Questionnaire. Data were analyzed using SPSS ver. 23 and SmartPLS ver. 2.
RESULTS
Occupational stress had a positive, direct, and minor effect on nurses' job performance (β = 0.088, t-value = 2.245, p < 0.01). Occupational stress had a positive and direct impact on moral intelligence (β = 0.161, t-value = 2.945, p < 0.01) and a negative and direct effect on emotional intelligence (β = -0.351, t-value = 7.484, p < 0.01). Occupational stress negatively and indirectly affected job performance through moral intelligence (β =-0.560, t-value = 14.773, p < 0.01). Occupational stress also positively and indirectly impacted job performance through emotional intelligence (β = 0.098, t-value = 2.177, p < 0.01).
CONCLUSIONS
Occupational stress slightly affects nurses' job performance, and emotional and moral intelligence mediates the impact of occupational stress and improves nurses' job performance. Low occupational stress improves nurses' job performance, but too much occupational stress could harm nurses' job performance. Healthcare administrators should work to help reduce nurses' occupational stress and improve their job performance by adopting practical strategies to help nurses manage and control their stress. Holding stress reduction classes, eliminating the nursing shortage, reducing working hours, reducing workload, and providing financial and spiritual support to nurses would be recommended. It is also recommended to provide theoretical and practical emotional and moral intelligence-oriented courses for nursing students and hold training workshops for nurses to improve their emotional and moral intelligence.
Topics: Humans; Work Performance; Iran; Cross-Sectional Studies; Job Satisfaction; Occupational Stress; Emotional Intelligence; Hospitals, Teaching; Morals; Surveys and Questionnaires; Nurses
PubMed: 37865748
DOI: 10.1186/s12888-023-05277-8 -
The Gerontologist Apr 2024Policies and measures often restrict the mobility of people with dementia living in residential care environments to protect them from harm. However, such measures can... (Review)
Review
BACKGROUND AND OBJECTIVES
Policies and measures often restrict the mobility of people with dementia living in residential care environments to protect them from harm. However, such measures can violate human rights and affect the quality of life. This review aims to summarize the literature on what is known about measures used to modulate the life-space mobility of residents with dementia living in a residential care environment. Furthermore, moral and sex and gender considerations were explored.
RESEARCH DESIGN AND METHODS
A scoping review framework was referenced to summarize the literature. A total of 5 databases were searched: PubMed, Embase, CINAHL, SCOPUS, and Web of Science. The studies for eligibility using the Rayyan screening tool.
RESULTS
A total of 30 articles met the inclusion criteria. A narrative description of the findings of the articles is presented across 3 themes: (1) measures and strategies used to modulate the life-space mobility; (2) moral aspects; and (3) sex and gender considerations.
DISCUSSION AND IMPLICATIONS
Various measures are used to modulate the life-space mobility of people with dementia living in residential care facilities. Research exploring the sex and gender differences of people with dementia is lacking. With a focus on human rights and quality of life, measures used to restrict or support mobility must support the diverse needs, capacity, and dignity of people with dementia. Noting the capacity and diversity of people with dementia will require society and public space to adopt strategies that promote safety and mobility to support the quality of life of people with dementia.
Topics: Female; Male; Humans; Quality of Life; Morals; Assisted Living Facilities; Databases, Factual; Dementia
PubMed: 37330640
DOI: 10.1093/geront/gnad071 -
Clinical Rheumatology Aug 2023Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim...
INTRODUCTION/OBJECTIVES
Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim of this study is to describe the sociocultural and moral narratives that influence the decision to vaccinate in general and to vaccinate against COVID-19 specifically, among patients at the rheumatology units of two hospitals.
METHODS
Qualitative study involving individual semi-structured interviews following an interview guide. We conducted a thematic analysis using the ATLAS.ti software, with further triangulation to verify concordance and aid in the interpretation of the data from a medical anthropology framework and using a narrative ethics approach to gain insight into the participants' underlying moral values.
RESULTS
We interviewed 37 patients in total, along with 3 rheumatologists. Five core themes emerged from the analysis to understand the decision to vaccinate: (1) information about vaccines and disease, (2) perceived risk-benefit of vaccination, (3) the physician-patient relationship, (4) governance of vaccination programs, (5) attitudes towards vaccines. Individual and family experiences with vaccination are diverse depending on the type of vaccine. The COVID-19 vaccine, as a new medical technology, is met with more controversy leading to hesitancy.
CONCLUSIONS
The decision to vaccinate among Mexican rheumatic disease patients can sometimes involve doubt and distrust, especially for those with a lupus diagnosis, but ultimately there is acceptance in most cases. Though patients make and value autonomous decisions, there is a collective process involving sociocultural and ethical aspects. Key points • The complexity of vaccine decision-making is better identified through a narrative, qualitative approach like the one used in this study, as opposed to solely quantitative approaches • Sociocultural and moral perspectives of vaccination shape decision-making and, therefore, highlight the importance of including patients in the development of effective clinical practice guidelines as well as ethically justified public policy • Sociohistorical context and personal experiences of immunization influence vaccine decision-making much more than access to biomedical information about vaccines, showing that approaches based on the information deficit model are inadequate to fight vaccine hesitancy.
Topics: Humans; Narration; COVID-19 Vaccines; Health Knowledge, Attitudes, Practice; Decision Making; COVID-19; Vaccination; Vaccines; Morals; Rheumatic Diseases
PubMed: 37129776
DOI: 10.1007/s10067-023-06609-5 -
Deutsches Arzteblatt International Oct 2023
Topics: Humans; Conflict of Interest; Disclosure
PubMed: 37970670
DOI: 10.3238/arztebl.m2023.0197 -
Health and Human Rights Dec 2023
Topics: Humans; Human Rights; Social Justice
PubMed: 38145147
DOI: No ID Found