scholarly journals Should We Extend Voluntary Euthanasia to Non-medical Cases? Solidarity and the Social Context of Elderly Suffering

2020 ◽  
Vol 17 (2) ◽  
pp. 129-162
Author(s):  
Andreas T. Schmidt
Keyword(s):  
Public Health ◽  
Health Care ◽  
Social Context ◽  
Public Health System ◽  
Voluntary Euthanasia ◽  
Healthy Elderly ◽  
Existential Suffering ◽  
The Social ◽  
Societal Context ◽  
Care Health

Several Dutch politicians have recently argued that medical voluntary euthanasia laws should be extended to include healthy elderly citizens who suffer from non-medical ‘existential suffering’ (‘life fatigue’ or ‘completed life’). In response, some seek to show that cases of medical euthanasia are morally permissible in ways that completed life euthanasia cases are not. I provide a different, societal perspective. I argue against assessing the permissibility of individual euthanasia cases in separation of their societal context and history. An appropriate justification of euthanasia needs to be embedded in a wider solidaristic response to the causes of suffering. By classifying some suffering as ‘medical’ and some as ‘non-medical’, most societies currently respond to medical conditions in importantly different ways than they do to non-medical suffering. In medical cases, countries like the Netherlands have a health care, health research and public health system to systematically assign responsibilities to address causes of medical suffering. We lack such a system for non-medical suffering among elderly citizens, which makes completed life euthanasia importantly different from euthanasia in medical cases. Because of this moral ‘responsibility gap’, focusing on the permissibility of completed life euthanasia in separation of wider societal duties to attend to possible causes is societally inappropriate. To spell out this objection in more philosophical terms, I introduce the concept of acts that are morally permissible but contextually problematic.

scholarly journals Comparative analysis between prevention and treatment costs for gestational diabetes mellitus in primary and tertiary health care in a city in Southern Brazil

2021 ◽  
Vol 13 (1) ◽  
pp. 21-30
Author(s):  
Ricardo Reichenbach ◽  
◽  
Yasmin Reis ◽  
Maria Carolina Gullo ◽  
José Mauro Madi ◽  
...  
Keyword(s):  
Public Health ◽  
Diabetes Mellitus ◽  
Health Care ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health System ◽  
Public Health System ◽  
Economic Valuation ◽  
Southern Brazil ◽  
Economic Context

Objective: The present study’s purpose is to evaluate the economic context in which the Brazilian public health system, the only universal public health system with more than 200 million users, stands out. This evaluation will be made through the lens of the execution of gestational health care services in a city of approximately 500 thousand inhabitants in southern Brazil. The care costs of patients with gestational diabetes mellitus (GDM) will be compared to those of patients without GDM, analyzing the different economic valuation methods. And lastly, there was an intent to explore the generated costs in the context of economic valuation applied to health to comprehend better the complexity of the union of the financial and health areas to optimize the services offered. Methods: For the economic context in health, an analysis of health investments was performed through the Transparency Portal. The costs involved in preventing GDM were raised by the Sistema Único de Saúde (SUS) table of procedures performed ordinarily in low-risk pregnancies. The expenses involved in DMG patients were increased at the High-Risk Pregnancy and Fetal Medicine Clinic of DMG patients. Results: Preventing GDM is more cost-effective, cost-minimizing, and cost-useful than treating patients diagnosed with GDM. Conclusion: The result is an extremely interesting costopportunity, given the economic context in which it is presented

scholarly journals Delays and Unmet Need for Health Care Among Adult Primary Care Patients in a Restructured Urban Public Health System

2004 ◽  
Vol 94 (5) ◽  
pp. 783-789 ◽  
Author(s):  
Allison L. Diamant ◽  
Ron D. Hays ◽  
Leo S. Morales ◽  
Wesley Ford ◽  
Daphne Calmes ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Health System ◽  
Public Health System ◽  
Unmet Need ◽  
Primary Care Patients

Evidence-Based Global Public Health

2013 ◽  
Author(s):  
Vincanne Adams
Keyword(s):  
Public Health ◽  
Health Care ◽  
Global Health ◽  
Experimental Research ◽  
Evidence Based ◽  
Global Public Health ◽  
The Social ◽  
Research Populations ◽  
Based Medicine ◽  
The Impact

This chapter examines the impact of “evidence-based medicine” (EBM) on global public health. An epistemic transformation in the field of global health is underway, and it argues that the impact of EBM has been twofold: (1) the creation of an experimental metric as a means of providing health care; and (2) a shift in the priorities of caregiving practices in public health such that “people [no longer] come first.” The production of experimental research populations in and through EBM helps constitute larger fiscal transformations in how we do global health. Notably, EBM has created a platform for the buying and selling of truth and reliability, abstracting clinical caregiving from the social relationships on which they depend.

scholarly journals Analysing local public health action plans: development of a tool for the French CLoterreS Study

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Y Le Bodo ◽  
R Fonteneau ◽  
C Harpet ◽  
H Hudebine ◽  
F Jabot ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Promotion ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Care ◽  
Local Health ◽  
The Social ◽  
Prevention And Health Promotion ◽  
Living Circumstances

Abstract Background The potential contribution of local authorities to prevention and health promotion is well recognized. In France, since 2009, Local Health Contracts (LHCs) are mobilising Regional Health Agencies, local elected officials and stakeholders to intervene in 4 areas: health promotion, prevention, health care and social care. LHCs remain poorly documented policy instruments. Methods As part of the CLoterreS study, a multidimensional coding tool was developed and tested by two coders to explore the place of prevention and health promotion in LHCs. Its development was based on the WHO conceptual framework for action on the social determinants of health and the Self-assessment tool for the evaluation of essential public health operations in the WHO European Region. Preliminary results concern a random sample of 17 LHCs from as many French regions selected among the 165 LHCs signed between 2015 and March 2018. Results On average, the LHCs featured 26 action forms (AF) (min: 5; max: 56). In a LHC, the average proportion of AF addressing either the social determinants of health, living circumstances or other determinants targeted by health protection, promotion or primary prevention interventions (SDoH-HPP-P1) was 79% while 44% of the AF address secondary/tertiary prevention, social care or the organization of health care and services. Among the SDoH-HPP-P1 themes (double coding permitted): psychosocial life circumstances were addressed in the 17 LHCs and concerned, on average, 31% of their AF; material living circumstances were addressed to a lesser extent (16 LHCs, 13%); other key themes include environmental health (12, 14%), mental health (16, 12%), alcohol abuse (15, 11%), drug use (14, 11%), smoking (13, 9%), physical activity (13, 12%), healthy eating (12, 12%). Conclusions This work confirms that LHCs are instruments with prevention and health promotion at their core. Explanation of the differing investments in this area across our sample will be further explored. Key messages Local Health Contracts are promising instruments to address locally a broad range of health determinants. The CLoterreS analytical tool has proven effective in capturing multiple themes and shedding light on differences between Local Health Contracts’ action plans.

scholarly journals The preventive health care act and the future forum public health in Germany

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
F De Bock ◽  
Y Shajanian Zarneh ◽  
S Matusall
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Promotion ◽  
Health System ◽  
Public Health System ◽  
National Level ◽  
Preventive Health Care ◽  
Preventive Health ◽  
Life Course Perspective ◽  
Bottom Up

Abstract The public health system in Germany, similar to education and cultural affairs, is characterised by the federal structure. It is mainly regulated and decided at the state and municipal level, and not primarily at the national level. The preventive health care act (The Act to Strengthen Health Promotion and Preventive Health Care) (2015) underlines the setting-based approach of health promotion and takes a life course perspective by recommending goals of growing up healthy, living and working healthy and healthy ageing. The act formulates broad recommendations for prevention and health promotion at the national level, that in turn take on concrete forms in mandatory framework agreements at the federal state level with uniform health objectives. On the whole, the key objective of the act is to improve preventive health care and general health promotion. Also the financing of the act by the mandatory health insurance is a special feature and at the same time a novelty. At the same time a bottom-up project has been recently launched with the aim to develop a public health strategy in Germany. The project future forum public health (ZfPH) is a platform for public health professionals, researchers and students following incorporated concepts of policy analysis as well as methods that will ensure participation, transparency and transferability of the results into policy and practice. Over the next three years, ZfPH’s steering group will moderate a participatory process, including stakeholders from public health practice and research as well as policy makers. In an evidence-based approach, they will first analyse the current state of Germany’s public health system before developing concrete policy recommendations for a coherent and efficient public health system. The presentation will give a short overview over the German public health system and the preventive health care act, its structure and the achievements as well as the bottom-up project future forum public health.

PP155 The Impact Of Lawsuits In The Brazilian Public Health System

2017 ◽  
Vol 33 (S1) ◽  
pp. 141-141
Author(s):  
Carla Biella ◽  
Viviane Pereira ◽  
Fabiana Raynal ◽  
Jorge Barreto ◽  
Vania Canuto ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Public Health System ◽  
Scientific Evidence ◽  
Health Technology ◽  
Health Technologies ◽  
Access To Health ◽  
The Right ◽  
The Impact

INTRODUCTION:The increase of litigation in Brazil on the right to health, and the Brazilian Public Health System (SUS) targets of litigation, are phenomena that generate discussions both in the judiciary, and among researchers and managers of health. The lawsuits are based on the integrality that includes the right to any health technology. Our aim was to gather information on the use of scientific evidence by judges and other law professionals to support their decisions in lawsuits involving health care in Brazil.METHODS:A narrative review by literature search using key terms of legalization in specific databases was conducted.RESULTS:Twenty-five studies showed litigation matters relating to health care which were focused on legal claims about drugs. In general, law operators used the scientific evidences in a limited way when making decisions, by considering the medical report and medication label indications and disregarding therapeutic alternatives contemplated in the SUS list. The access to health technologies, by litigation, reveals that the gap between scientific knowledge and legal practice are similar to those found between science and decision-making in the formulation and implementation of health policies. The Health Technology Assessment studies have high potential for use by the judiciary as a reference source to support technical and scientific decisions in lawsuits on health care.CONCLUSIONS:For the judiciary to ensure not only access to health technologies, but also the efficacy and safety of technologies to system users, their decisions must be substantiated by scientific evidence. The National Committee for Health Technology Incorporation (CONITEC) in SUS has established actions in conjunction with law operators and society, such as a communication using e-mail, aiding the decision for the injunction and elaboration of technical reports and a policy brief, with the intention that the decisions are taken with the greatest possible knowledge about technologies provided by SUS, and based on scientific evidence.

scholarly journals Development of a gender-relevant tobacco cessation intervention for women in Brazil—an intervention mapping approach to planning

2019 ◽  
Vol 34 (5) ◽  
pp. 505-520
Author(s):  
N�dia Kienen ◽  
Tha�s Dist�fano Wiltenburg ◽  
Lorna Bittencourt ◽  
Isabel C Scarinci
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Health Care System ◽  
Tobacco Cessation ◽  
Public Health System ◽  
Intervention Mapping ◽  
The Public ◽  
Cessation Intervention ◽  
Care System

Abstract The purpose of this article is to describe the development of a theory-based, culturally and gender-relevant Community Health Worker (CWH)-led tobacco cessation intervention for low-income Brazilian women who augments the tobacco cessation program offered through the public health system using Intervention Mapping (IM). We began with the establishment of a network of representatives from different segments of society followed by comprehensive needs assessments. We then established a logical planning process that was guided by a theoretical framework (Social Cognitive Theory) and existing evidence-based tobacco cessation programs, taking into account socio-political context of a universal health care system. Given the gender-relevance of our intervention and the importance of social support in tobacco cessation among women, we chose an intervention that would be delivered within the public health system but augmented by CHWs that would be trained in behavior change by researchers. One of major advantages of utilizing IM was that decisions were made in a transparent and supportive manner with involvement of all stakeholders throughout the process. Despite the fact that this process is very taxing on researchers and the health care system as it takes time, resources and negotiation skills, it builds trust and promotes ownership which can assure sustainability.

scholarly journals The Challenges Confronting Public Hospitals in India, Their Origins, and Possible Solutions

2014 ◽  
Vol 2014 ◽  
pp. 1-27 ◽  
Author(s):  
Vikas Bajpai
Keyword(s):  
Public Health ◽  
Social Economic ◽  
Public Health System ◽  
Public Hospitals ◽  
Universal Health Care ◽  
The Public ◽  
The Social ◽  
Development Paradigm ◽  
Universal Health ◽  
Class Nature

Despite the implementation of National Rural Health Mission over a period of nine years since 2005, the public health system in the country continues to face formidable challenges. In the context of plans for rolling out “Universal Health Care” in the country, this paper analyzes the social, economic, and political origins of the major challenges facing public hospitals in India. The view taken therein holds the class nature of the ruling classes in the country and the development paradigm pursued by them as being at the root of the present problems being faced by public hospitals. The suggested solutions are in tune with these realities.

Sign in / Sign up

Export Citation Format

Share Document