Response—Corruption, Trust, and Professional Regulation

In their 2018 article in the Cambridge Quarterly of Healthcare Ethics, Little, Lipworth, and Kerridge unpack the concept of corruption and clarify the mechanisms that foster corruption and allow it to persist, noting that organizations are “corruptogenic.” To address the “so-what” question, I draw on research about trust and trustworthiness, emphasizing that a person’s well-being and sense of security require trust to be present at both the individual and organizational levels—which is not possible in an environment where corruption and misconduct prevail. I highlight similarities in Little et al.’s framing of corruption to the persistent problem of scientific misconduct in research and publishing. I acknowledge the challenges in stemming corruption in science and medicine and conclude with a discussion about the need to reinvigorate a web of stakeholders to actively engage in professional regulation.

Beyond biopolitics: the importance of the later work of Foucault to understand care practices of healthcare workers caring for undocumented migrants

Background Undocumented migrants experience multiple institutional and legal barriers when trying to access healthcare services. Due to such limitations, healthcare workers often experience ethical dilemmas when caring for undocumented migrants. This article aims to understand how individual healthcare workers who regularly take care of undocumented migrants deal with these dilemmas in practice. So far, the role of healthcare workers in this context has mainly been theorized through the lens of biopolitics, conceiving of healthcare workers as merely obedient instruments of humanitarian government or gatekeeping. Methods Based on semi-structured, in-depth interviews and ethnographic observations with healthcare workers in Belgium, we explore how they ascribe meaning, reflect upon and give shape to care practices in relation to undocumented migrants. We use Foucault’s later work on care of the self to interpret the accounts given by the healthcare workers. Results Healthcare workers in clinical roles exercise a certain degree of freedom in relation to the existing limitations to healthcare access of undocumented migrants. They developed techniques such as purposefully being inattentive to the undocumented status of the migrants. They also try to master their affective responses and transform their bodily attitude towards undocumented patients. They perform practical mental exercises to remind themselves of their role or position in the wider healthcare system and about their commitment to treat all patients equally. These techniques and exercises are inspired by colleagues who function as role models, inspiring them to relate in an ethical way to limitations in healthcare access. The developed care practices sometimes reproduce, sometimes transform the legal and institutional limitations to care for undocumented migrants. Conclusions The findings nuance the biopolitical analysis regarding the role of healthcare workers in healthcare delivery to undocumented migrants that has been dominant so far. Theoretically this article provides a reconceptualization of healthcare ethics as care of the self, an ethical practice that is somewhat independent of the traditional professional ethics. Trial Registration Medical ethics committee UZ Jette, Brussels, Belgium – Registration date: 18/05/2016 – Registration number: B.U.N. 143201628279.

Patient-focused pathogen genetic counselling—has the time come?

Ensuring accordance with principles of healthcare ethics requires improved communication of pathogen genomic data. This could include educating healthcare professionals in communicating pathogen genomic information to individuals, developing ethical frameworks for reporting pathogen genomic results to individuals, responsible media reporting guidelines, and counselling for individuals (‘pathogen genetic counselling’).

Bioethical Concerns During the COVID-19 Pandemic: What Did Healthcare Ethics Committees and Institutions State in Spain?

Objectives: Each new wave of the COVID-19 pandemic invites the possible obligation to prioritize individuals' access to vital resources, and thereby leads to unresolved and important bioethical concerns. Governments have to make decisions to protect access to the health system with equity. The prioritization criteria during a pandemic are both a clinical and legal-administrative decision with ethical repercussion. We aim to analyse the prioritization protocols used in Spain during the pandemic which, in many cases, have not been updated.Method: We carried out a narrative review of 27 protocols of prioritization proposed by healthcare ethics committees, scientific societies and institutions in Spain for this study. The review evaluated shared aspects and unique differences and proffered a bioethical reflection.Results: The research questions explored patient prioritization, the criteria applied and the relative weight assigned to each criterion. There was a need to use several indicators, being morbidity and mortality scales the most commonly used, followed by facets pertaining to disease severity and functional status. Although age was initially considered in some protocols, it cannot be the sole criterion used when assigning care resources.Conclusions: In COVID-19 pandemic there is a need for a unified set of criteria that guarantees equity and transparency in decision-making processes. Establishing treatment indications is not the aim of such criteria, but instead prioritizing access to care resources. In protocols of prioritization, the principle of efficiency must vary according to the principle of equity and the criteria used to guarantee such equity.

Linking Ethical Standards for Healthcare Professionals with Indian Cultural Values

Ethical standards of healthcare sector are important to the lives of people because healthcare is a profession that impacts the lives of people, their families and society. Healthcare professionals are inevitably involved in ethical decision-making in their working lives and address a conflict regarding competing values such as personal, organizational, professional, and community values. India is a country in South Asia where people are diverse in ethnicity, religion, and culture. So, revealing commonly accepted ethical standards for resolving ethical conflicts for healthcare professionals becomes more relevant for India. However, the research on this issue is limited. Therefore, the purpose of this paper is to reveal the link between ethical standards for healthcare professionals in general and Indian cultural values such as Dharma, Nishkama Karma and Jnana. This paper used a scoping review to screen the relevant articles which were selected from the Scopus and Google Scholar databases. The keywords used for searching the research articles were “ethical standard”, “ethics”, “healthcare ethics”, and “Indian cultural values”. Then, the constructs of healthcare ethics were identified and the relevant ethical standards for each construct were not only evaluated based on the two key theoretical viewpoints namely deontology and teleology, but also justified by Indian cultural values.

Best Interests Decisions in Clinical Practice: Reviewing the Current Evidence

"‘Best interests’ decisions are often needed when patients lack capacity to make their own healthcare decisions. Despite the ubiquity of ‘best interests’, there remains considerable ambiguity about what best interests are and how the standard should be applied, alongside a lack of understanding about how best interests decisions are actually made in clinical practice. Balancing Best Interests in Healthcare Ethics and Law (BABEL) is an interdisciplinary project, funded by a Wellcome Trust Collaborative Award, which aims to explore best interests decision-making in healthcare, both empirically and normatively. In this paper, we outline initial findings from a narrative review that asked, ‘what evidence do we have about how best interests decisions are made in clinical practice in England and Wales?’. Data were extracted from included papers using a standardised form, and then subjected to thematic analysis, focussing on what the papers told us about the process of decision-making, the stakeholders involved, the barriers and facilitators. Early results suggest we have some limited evidence about how best interests decisions are made in clinical settings, and the majority of this evidence concerns mental health and end-of-life care. Common factors taken into account in these decisions include: the patient’s clinical circumstances; risk assessment; the patient’s wishes; cost-effectiveness; avoiding harm; the patient’s well-being; autonomy; capacity assessment; and family’s wishes. "

A Proposed Model of Core Competencies for Research Ethics Consultants

Research ethics consultation services (RECS), which function as an advisory service to facilitate the resolution of complex ethical issues in clinical research, have been proliferating over the last decade. However, the qualification of an individual who provides RECS, or “a research ethics consultant,” has not been thoroughly investigated, in contrast to healthcare ethics consultants, whose core competencies have been discussed and clarified to a great extent. In this study, we investigated core competencies necessary for research ethics consultants, referring to the core competency models of ethics consultants developed in the healthcare practice context, and propose a competency model for research ethics consultants.