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La Revolución Ciudadana and social medicine: Undermining community in the state provision of health care in Ecuador
Published in Emily E. Vasquez, Amaya Perez-Brume, Richard G. Parker, Social Inequities and Contemporary Struggles for Collective Health in Latin America, 2020
Karin Friederic, Brian J. Burke
The statist worldview of Buen Vivir and the Citizens’ Revolution may work well in places where neoliberal policies, state weakness, and the lack of public services were accepted passively. Prior to the Citizens’ Revolution, however, the people of Las Colinas3 had already self-organized as an active citizenry engaged in substantial self-governance. They had claimed their ‘citizen’s power’ by mobilising to get what they needed from the central government and from other actors via patronage, citizenship demands, and transnational alliances, but according to their own desires rather than the vision from Quito. These efforts can be thought of as ‘vernacular statecraft’ (Colloredo-Mansfeld, 2009) or the construction of ‘state-ness’ (Martínez, 2017). What follows, then, is a description of what happens when the state-led revolution is enacted upon already active communities. How do vernacular states respond to the reconstitution of the national state?
Resisting pharmaceuticalised governance
Published in Kevin Dew, Public Health, Personal Health and Pills, 2018
In this book, I have focused on how the use of pharmaceuticals in everyday life brings into play different forms of self-governance, or pharmaceuticalised governance. Many dimensions of this have been explored, and the particular ways in which this plays out at broad cultural, institutional and interactional levels. But any therapeutic regime requires forms of self-governance, although they are likely to take different shapes from that of pharmaceutical governance as there are different social forces at play. Using CAM brings into play particular forms of self-governance. Cancer survival strategies for those post-diagnosis are entwined with imperatives to diet and exercise to prevent recurrence and progression of disease (Bell 2010). Some negative effects of such imperatives are illustrated by Alex Broom and Philip Tovey in their discussion of the use of CAM in cases of incurable cancer (Broom and Tovey 2008). In some situations, the use of alternative approaches can be at great personal and financial cost. They highlight one case of a man in his 80s who undertakes a very rigorous and costly dietary regime and the use of enemas to detoxify his body in an unsuccessful effort to keep the cancer at bay. The demands to take responsibility, and in this case to put so much energy into what was a futile attempt to extend life, takes its toll on individuals and their families.
The legal aspects
Published in Glyn Elwyn, June Smail, Integrated Teams in Primary Care, 2018
If the various employing authorities are prepared to delegate both the budget and the associated responsibilities then the team can make considerable progress, but it is essential that this process be monitored by the parent organisations. There is also a concept known as ‘self-governance’ that encourages professionals to accept the responsibility for their own actions.9 Self-governance calls for all team members to ‘own’ their decisions, to manage their own work and build relationships and achieve desirable outcomes. The principles of partnership, equity, accountability and ownership apply to every person in the organisation. Since the concept is essentially horizontal, there is no place for hierarchical relationships in shared governance. There is considerable scope for the development of self-governance in integrated primary healthcare teams, but this will only take place if the organisations and senior management facilitate the necessary autonomy.
Translational Justice in Human Gene Editing: Bringing End User Engagement and Policy Together
Published in The American Journal of Bioethics, 2023
Megan A. Allyse, Karen M. Meagher, Marsha Michie, Rosario Isasi, Kelly E. Ormond, Natasha Bonhomme, Yvonne Bombard, Heidi Howard, Kiran Musunuru, Kirsten A. Riggan, Sabina Rubeck
In addition, we are engaging with scientists/clinicians, recognizing that science policy and self-governance are the result of many contextual factors. Policy and governance supporting responsible clinical translation are built not only on “value-neutral” technical criteria of safety and efficacy but the social values and political choices underlying such determinations. In crafting policies, clinical/scientific stakeholders respond to advances in science, changes in social and political values, and negative publicity around events that are seen to damage moral credibility or scientific progress (de Jong et al. 2010). Historically, this has been particularly true in areas where genetics and reproductive medicine overlap. Within this framework, groups are influenced by their clinical knowledge and skills as well as the broader social, moral, and political environments in which they are embedded. As such, understanding individual convictions regarding risk-benefit assessments and ethical values is central to understanding how policy-making ‘works’ in the real world and how peer attitudes could shape the direction of governance (Iacomussi 2019). This knowledge will ultimately contribute to informed debate about the direction of policy and governance that underpins the clinical translation of HGE.
Normative account of Islamic bioethics in end-of-life care
Published in Global Bioethics, 2022
The different scenarios posed by EoLC led ethicists to investigate the moral status and ethical justifications for euthanasia, physician-assisted suicide, and withholding or withdrawing medical treatment, among other issues. Ethicists typically start from the normative framework provided by Beauchamp and Childress. They suggest that, in general, bioethical interrogations are best addressed through what they call “common morality,” which they describe as “a range of norms that all morally serious persons share” (2008, p. 3). These norms manifest themselves in four normative principles. The first is the principle of autonomy, which requires decision-makers to respect the individual's right to self-governance. The second is nonmaleficence, a normative principle that requires evaluators to minimize harm. The third is beneficence, a normative principle that requires evaluators to maximize benefits. And the fourth is justice, a set of norms designed to ensure fair distribution of benefits, risks, and costs (2008, p. 12).
Physiotherapy in Madagascar: current challenges and opportunities for development
Published in Disability and Rehabilitation, 2022
Randrianaivo Rovaniaina Sarobidy, Claire McIvor, Philomena Commons, M. Anne Chamberlain, Rory J. O’Connor
Physiotherapists in Madagascar feel that their role is not respected and that patients do not fully understand the contribution that they can make. Kay reports similar attitudes towards physiotherapy in Vietnam [9]. One of the contributing factors to this situation is that physiotherapists do not have clinical autonomy and must follow the prescriptions of physicians. All physiotherapists surveyed in our study expressed their desire to increase their professional autonomy, however, none were able to recognise how this could be achieved. Physicians prescribing treatment for physiotherapists to deliver is common practice in LMICs [10]. The World Physiotherapy policy statement on the autonomy of physiotherapists encourages professionals to strive to achieve autonomy while recognising that responsible self-governance by physiotherapists must be in place [11].