Suchergebnisse

Menschen, die im öffentlichen Gesundheitswesen tätig sind, müssen schwierige Entscheidungen treffen. Eine Kriterienberatung für solche ethischen Entscheidungen ist in Deutschland jedoch bislang selten. Peter Schröder-Bäck nimmt dieses Manko zum Anlass, einen Reflexionsrahmen zu entwickeln, der es den Akteuren in ihrer alltäglichen Praxis ermöglicht, ethische Herausforderungen zu erkennen, zu benennen und reflektierte Lösungsansätze zu finden.

Menschen, die im öffentlichen Gesundheitswesen tätig sind, müssen schwierige Entscheidungen treffen. Eine Kriterienberatung für solche ethischen Entscheidungen ist in Deutschland jedoch bislang selten. Peter Schröder-Bäck nimmt dieses Manko zum Anlass, einen Reflexionsrahmen zu entwickeln, der es den Akteuren in ihrer alltäglichen Praxis ermöglicht, ethische Herausforderungen zu erkennen, zu benennen und reflektierte Lösungsansätze zu finden. Peter Schröder-Bäck, Dr. phil., ist assoziierter Professor am Department of International Health der Universität Maastricht.

In the aftermath of the economic crisis that started in 2008, resources have become scarcer than ever in some countries, also in health care. Priority setting and rationalisation of existing resources also affect pharmaceutical innovations, including those that would contribute to what is called personalised medicine. In this paper, we will highlight the ethical issues surrounding rationalisation and its impact on personalised medicine through the lens of the capability approach. Thereby, challenges to and opportunities for personalised medicine will be examined, assessing how they affect patients' 'real options' to access innovative therapies. In our focus on the 'first challenge: citizens and patients' of the so-called Strategic Research and Innovation Agenda, the strength of the capability approach becomes particularly apparent in identifying what different values are at stake in this context.

Ethik sollte eine Kerndisziplin in den Gesundheitswissenschaften und Public Health sein. Das vorliegende Buch widmet sich daher dem aktuellen Stand der fachphilosophischen Ethikdiskussion und den verschiedenen Themen und Methoden der Disziplin, in denen sich ethische Fragen und Probleme ergeben. Gesundheit ist ein vielschichtiger Begriff, in dem ein moralischer Kern steckt. Dies wird in der handlungsorientierten Multidisziplin Gesundheitswissenschaften und Public Health oft nicht ausreichend bedacht, was weitreichende Folgen sowohl für die Gesellschaft insgesamt als auch für einzelne Gruppen hat. Denn die Frage nach richtigem und gutem Handeln - und somit nach Gesundheit erhaltenden bzw. wiederherstellenden Lebensbedingungen - kann nicht ohne Bezugnahme auf Werte und Normen beantwortet werden. Das vorliegende Buch ist das erste umfassend einführende Buch in die Ethik des Handelns in den Gesundheitswissenschaften und Public Health. Es stellt philosophisch-ethische Grundlagen vor und zeigt anhand zahlreicher Beispiele, wo sich ethische Herausforderungen, Konflikte und Dilemmata zwischen Mensch und Gesellschaft ergeben, die ethisch reflektierter Lösungsansätze bedürfen.

Abstract Aim: Unwanted pregnancy is an important social issue, not least among teenagers. Emergency contraceptives (EMCs) can prevent from unintended pregnancy, if taken quickly after unprotected sex. This study's objective was assessing abortion/birth rates among adult and teenage women in Europe before/after an EMC switch to non-prescription status. Methods: National authorities were consulted for EMC consumption data and abortion/live birth statistics. Rates (n=26 countries) in the year before the switch (= year of reference) were compared with rates before/after the change (up to ±15 years). The focus was laid on the European Union and further countries closely related to the European Union. Results: All countries with available data (n=12) experienced a substantial increase of EMC consumption after the switch. On average, abortion rates among women aged 15–49 years were 83% higher 15 years before (compared with the year of reference) and 14% lower 15 years after the switch. Correspondingly, teenage abortion rates were 35% higher 15 years before and 40% lower 15 years after the switch. In 2017, no country had higher teen abortion rates than at time of the switch. Teen birth rates continued decreasing at almost the same rate after the switch as before. Conclusion: An EMC switch to non-prescription status increases EMC use and may contribute reducing unwanted pregnancy among teenage girls. Conflicts of interest: None declared.

On 1 January 2015, a new long-term care reform entered into force in the Netherlands, entailing amongst others a decentralization of long-term care responsibilities from the national government to the municipalities by means of a new law: the Social Support Act 2015. Given the often disputed nature of the reform, being characterized on the one hand by severe budget cuts and on the other hand by a normative reorientation towards a participation society, this article examines to what extent municipalities in the Netherlands take (potential) moral conflicts into account in their execution of the Social Support Act 2015. In doing so, the article applies a 'coherentist' approach (consisting of both rights-based and consequentialist strands of ethical reasoning), thereby putting six ethical principles at the core (non-maleficence & beneficence, social beneficence, respect for autonomy, social justice, efficiency and proportionality). It is argued that while municipalities are indeed aware of (potential) moral conflicts, the nature of the new law itself leaves insufficient room for municipalities to act in a sufficiently proactive and supportive/empowering manner on these challenges.

The current protracted economic crisis is giving rise to the scarcity of public health resources across Europe. In response to budgetary pressures and the Eurozone public debt crisis, decision-makers resort to a short-term solution: the introduction of austerity measures in diverse policy fields. Health and social policy tend to be easy targets in this regard and budget cuts often include a reduction of healthcare expenditure or social welfare benefits. We suggest incorporating discussions from the field of ethics in policy making processes and in the academic debate on austerity. This includes recognising procedural justice as a social value. On the road to economic recovery, governments are compelled to resort to fiscal consolidation and austerity packages but decisions taken to save our European ships in crisis should be anchored in values such as (procedural) justice, equity and solidarity. ; Open access journal

To inform policymakers well, there is a need to promote different types of health examination surveys as additional sources of valuable information which, otherwise, would not be available through routine/administrative statistics. This is especially important for former communist countries of South Eastern Europe including Albania, where the existing health information system (HIS) is weak.Among many efforts to strengthen the HIS in Albania, there is currently a commitment to undertake a second round of a nationwide Demographic and Health Survey (DHS). This survey will involve a nationwide representative sample of about 17,000 private households, where all women aged 15-59 years and their respective partners will be interviewed and examined.Externally, the upcoming Albanian DHS will contribute to the European Union accession requirements regarding provision of standardized and valid health information. Furthermore, the DHS will considerably enhance the core functions of the Albanian health system in line with the WHO recommendations. Internally, the DHS will promote societal participation and responsibility in transitional Albania. Importantly, the forthcoming survey will promote good governance including transparency, accountability and health system responsiveness. Also, the DHS will allow for collection of internationally valid and standardized baseline socio-demographic and health information for: assessment of future national trends; monitoring and evaluation of health programs and interventions; evidencing health disparities and inequities; and cross-national comparisons between Albania and different countries of the European Region. Ultimately, findings of the DHS will enable rational decision-making and evidence-based policy formulation in Albania including appropriate planning, prioritization and sound resource allocation. However, transfer of the information collected and implementation in public health policies and interventional programs is rather challenging for most of the countries, particularly for transitional post-communist countries of South Eastern Europe including Albania.

BACKGROUND: Prevention of the impact of chemicals on human health and the environment is an increasing focus of public health polices and policy makers. The World Health Organization European Centre for Environment and Health wanted to know what were stakeholders' priorities for improving chemicals management and prevention. METHODS: Semi-structured interviews were undertaken with 18 diverse stakeholders to answer this question. The interview questionnaire was developed using current WHO chemical meeting reports, the Evidence Implementation Model for Public Health Systems and categories of the theory of diffusion. Stakeholder views were attained on three main questions within the questionnaire. (i) What priority actions should be undertaken to minimize the negative impact of chemicals? (ii) Who needs to be more involved and what roles should they have? (iii) How can science and knowledge on chemicals and health be translated into policies more effectively and what are the greatest barriers to overcome? RESULTS: Cross cutting issues, such as legislation strengthening and enforcement, further collection of information, capacity building, education and awareness raising were considered priorities. The responders had the same vision on roles and responsibilities of different stakeholders. The greatest barrier to adoption, implementation and enforcement of evidence-based policies reported was leadership and political commitment to chemical safety. CONCLUSIONS: Priorities raised differed depending on knowledge, professional background and type of stakeholder. Factors influencing priority identification at the national level include international and global context, availability of information, knowledge of the current situation and evidence-based good practice, and risks and priorities identified through national assessments.

BACKGROUND: The ability to successfully transfer knowledge across international boundaries to improve health across the European Region is dependent on an in-depth understanding of the many factors involved in policy creation. Across countries we can observe various approaches to evidence usage in the policy-making process. This study, which was a part of the Models of Child Health Appraised (MOCHA) project assessing patterns of children's primary care in Europe, focused on how and what kind of evidence is used in child health policy-making processes in European countries and how it is applied to inform policy and practice. METHOD: In this study, a qualitative approach was used. The data were analysed in accordance with the thematic analysis protocol. The MOCHA project methodology relies on experienced country agents (CA) recruited for the project and paid to deliver child health data in each of 30 European countries. CAs are national experts in the child health field who defined the country-specific structured information and data. A questionnaire designed as a semi-structured survey instrument asked CAs to indicate the sources of evidence used in the policy-making process and what needed to be in place to support evidence uptake in policy and practice. RESULTS: In our data we observed two approaches to evidence usage in child health policy formulation. The scientific approach in our understanding refers to the so-called bottom-up initiatives of academia which identify and respond to the population's needs. Institutional approaches can be informed by scientific resources as well; however, the driving forces here are governmental institutions, whose decisions and choices are based not only on the population needs but also on political, economic and organizational factors. The evidence used in Europe can also be of an external or internal nature. Various factors can affect the use of evidence in child health policy-making. Facilitators are correlated with strong scientific culture development, whereas barriers ...

Aim: Antimicrobial resistance (AMR) is one of the major health challenges of the future, but the concrete impact of counteracting measures is still unclear. To study possible outcomes within the European Union, a scenario analysis for the year 2050 was performed on the possible influence of the European Commission (EC). Methods: Scenario planning and development of strategies based on different scenarios. Results: Rational use of antimicrobials in animals and humans, surveillance and monitoring, new antimicrobial therapies, travel and globalization, exposure to the environment, and awareness were recognized as the main driving elements. Four Scenarios were developed: An efficient and implicated EC sorts out AMR; An implicated but unsuccessful EC withstands AMR; AMR is managed regardless of the EC disinterest; and A neutral and inefficient EC fails to manage AMR. Conclusion: All the strategies developed on the basis of the four scenarios probe for an increase in European Union's dedication to achieve positive outcomes. These include the development of effective legislation and international coordination.

Aim: Antimicrobial resistance (AMR) is one of the major health challenges of the future, but the concrete impact of counteracting measures is still unclear. To study possible outcomes within the European Union, a scenario analysis for the year 2050 was performed on the possible influence of the European Commission (EC). Methods: Scenario planning and development of strategies based on different scenarios. Results: Rational use of antimicrobials in animals and humans, surveillance and monitoring, new antimicrobial therapies, travel and globalization, exposure to the environment, and awareness were recognized as the main driving elements. Four Scenarios were developed: An efficient and impli-cated EC sorts out AMR; An implicated but unsuccessful EC withstands AMR; AMR is managed regardless of the EC disinterest; and A neutral and inefficient EC fails to manage AMR. Conclusion: All the strategies developed on the basis of the four scenarios probe for an increase in European Union's dedication to achieve positive outcomes. These include the development of effective legislation and international coordination. Acknowledgment: Peter Schröder-Bäck, Helmut Brand and Kiranjeet Kaur's contribution is co-funded through a grant of the European Commission within the Erasmus+ programme (Project: Prevent it. Project reference: 598515-EPP-1-2018-1-IN-EPPKA2-CBHE-JP). Conflict of interests: None declared.