Financial Profit in Medicine: A Position Paper From the American College of Physicians.

The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States, helping to spur for-profit and private equity investment. Proponents say that this trend makes the health care system more efficient, encourages innovation, and provides financial stability to ensure access and improve care. Critics counter that such moves favor profit over care and erode the patient-physician relationship. American College of Physicians (ACP) underscores that physicians are permitted to earn a reasonable income as long as they are fulfilling their fiduciary responsibility to provide high-quality, appropriate care within the guardrails of medical professionalism and ethics. In this position paper, ACP considers the effect of mergers, integration, private equity investment, nonprofit hospital requirements, and conversions from nonprofit to for-profit status on patients, physicians, and the health care system.

Ethics in Eye Banking: Understanding Professional Attitudes Toward Industry Changes.

PURPOSE: To describe the ethical attitudes of corneal surgeons and eye bank leadership toward for-profit entities in corneal donation, processing, and distribution. METHODS: Fifty postfellowship corneal surgeons practicing in the United States and 25 eye bank leaders (eg, eye bank directors, CEOs, or presidents) for the Eye Bank Association of America-accredited eye banks completed a 22-question interview, focusing on corneal donation industry changes, including the entry of for-profit institutions. RESULTS: Most participants in both study groups agreed that they have concerns with the entry of for-profit businesses into eye banking (62% corneal surgeons, 68% eye bank leadership), although physicians partnered with a for-profit corneal processor were significantly more likely to have no concerns with the entry of for-profits into eye banking than corneal surgeons partnered with a nonprofit processor (P = 0.04). The most frequently identified concerns with the entry of for-profit businesses into corneal banking were the hypothetical loss of donor trust (56% corneal surgeons, 64% eye bank leadership, P = 0.04) and the potential exploitation of donor generosity (72% corneal surgeons, 60% eye bank leadership). Qualitative theme analysis suggests that both study groups may view increased research/innovation as a potential benefit (64% corneal surgeons, 66% eye bank leadership) of for-profits in eye banking. CONCLUSIONS: Key stakeholders in eye banking do hold relevant ethical beliefs toward recent industry changes, and these attitudes should be considered in the future creation of the ethical corneal donation policy. Further research is needed to assess the attitudes of potential donors and donor families.

Objeción de conciencia institucional y regulación en salud: ¿existe una excusa legítima frente al aborto en Chile? / Institutional conscientious objection and health regulation: is there a legitimate excuse to abortion in Chile? / Objecció de consciència institucional i regulació en salut: existeix una excusa legítima enfront de l'avortament a Xile?

El objetivo de este trabajo es analizar distintos aspectos de la regulación chilena en materias de salud y la teoría bioética, y esclarecer eventuales conflictos con la objeción de conciencia, en torno a la posibilidad de excusarse de practicar abortos en instituciones privadas de salud. La tesis a desarrollar es que existen poderosos argumentos para que una institución de salud no pueda negarse a la realización de abortos, y que la objeción de conciencia no puede constituirse como excusa para tal negativa a pesar de su reciente consagración normativa para instituciones privadas

The objective of the paper is to analyse the various aspects of Chilean health regulation and Bioethics theory, and to clarify its eventual conflicts with conscientious objection, regarding the possibility of excusing oneself from practising abortions in private health institutions. The idea is to show that there are powerful arguments proving a health institution cannot deny an abortion procedure, and that conscientious objection is not a valid excuse for that denial in spite of its recent legal acceptance

L'objectiu d'aquest treball és analitzar diferents aspectes de la regulació xilena en matèria de salut i la teoria bioètica, i esclarir els eventuals conflictes amb l'objecció de consciència pel que fa a la possibilitat d'excusar-se de practicar avortaments en institucions privades de salut. La tesi que s’hi desenvolupa és que existeixen poderosos arguments perquè una institució de salut no pugui negar-se a la realització d'avortaments, i que l'objecció de consciència no pot constituir-se en una excusa per aquesta negativa malgrat la seva recent consagració normativa per a institucions privades

Estudio de eventos adversos en sanidad privada. Proyecto Confianza de seguridad del paciente / Study of adverse events in private healthcare. Confidence project for patient safety

Objetivos. Investigar e identificar áreas y problemas prioritarios de la seguridad del paciente y analizar las características de los pacientes y de la asistencia que se asocian a la aparición de eventos adversos (EA). Método. Estudio de cohortes retrospectivo en el que para identificar los EA se revisó la historia clínica (HC) de los pacientes hospitalizados en ocho centros comprometidos con el proyecto. Se recogió información de todos los pacientes atendidos entre el 15 y el 30 de noviembre de 2009. Resultados. De los 927 pacientes, en 40 pacientes se detectó alguna lesión, y en 23 de ellos la asistencia sanitaria estaba relacionada. Así, el porcentaje de pacientes con algún EA relacionado con la asistencia sanitaria fue del 2,48% (intervalo de confianza del 95%, 1,43%-3,54%). La edad, la comorbilidad y los dispositivos invasivos explican la aparición de EA. Se consideró leves al 33,3% (8 EA), moderados al 33,3% (8) y graves al 33,3% (8). Se consideró evitable al 50% de los EA. Conclusiones. La frecuencia hallada de EA es menor, posiblemente debido al diseño del estudio y la idiosincrasia de los pacientes atendidos: edad, comorbilidad y uso de dispositivos invasivos. Los EA encontrados presentan impacto y evitabilidad parecidos a los detectados en el sector público(AU)

Objectives. To investigate and identify priority areas and issues of patient safety and analyse which patient and health care characteristics are related to Adverse Events (AE). Methods. Retrospective cohort study to identify AE reviewing medical records of in-patients. Information was obtained from all patients attended between 15 and 30 November 2009 in eight facilities committed to the project. Results. Of the 927 patients, 40 patients had any injury, of which 23 were related to healthcare. Thus, the percentage of patients with any AE associated with health care was 2.48% (95%CI, 1.43%-3.54%). Age, comorbidity and use of invasive devices explained the occurrence of an AE. Of these, 33.3% (8 AE) were considered slight, 33.3% (8) moderate and 33.3% (8) severe. Half (50%) of AE were considered preventable. Conclusions. The frequency of AE found was low, possibly due to study design and the idiosyncrasy of the patients: age, comorbidity and use of invasive devices. The AE found have a similar impact and preventability as those identified in public sector(AU)

Bioética para una salud pública con responsabilidad social / Bioethics for a socially responsable public health

¿Es posible un aporte bioético de las ciencias económicas en el campo de la salud pública? Nuestro propósito fue abrir un diálogo con tendencias económicas desarrolladas en las últimas décadas y ver cómo y en qué medida pueden dar su aporte en el campo de la salud pública dentro del contexto latinoamericano. Con este fin individualizamos algunos indicadores de responsabilidad social seguidos por las empresas que intentan llevar a la práctica dichas tendencias y estudiamos los efectos que se podrían provocar al aplicarlos en algunas problemáticas bioéticas que presenta la gestión de la salud pública. Encontramos en las pautas culturales que proponen estas tendencias un "humus" propicio para el abordaje de dilemas planteados. Así también distinguimos nuevas claves que podrían ayudar a revertir actitudes nocivas en la gestión de la salud, presentes en el Estado, en la sociedad, y en las empresas privadas.

Is it possible for economy sciences to offer a bioethics' contribution for Public Health? Our aim was to establish a dialogue with economic trends developed during the last decades and to see how and up to what extent they can contribute to Public Health within the Latinamerican context. For this purpose we individualized some social responsibility indicators undertaken by enterprises that tried to apply those tendencies. We studied the effects that could be caused when applying them to certain bioethical issues presented by Public Health's management. We found a favourable "humus" to approach the dilemmas that were set up within the cultural patterns that these tendencies establish. We also distinguished new clues that could help revert undesirable attitudes of the health management which are present at the State, society and private enterprises.

É possível uma abordagem bioética das ciências econômicas no campo da saúde pública? Nosso propósito é de diálogar com tendências econômicas desenvolvidas nas últimas décadas e ver como e em que medida estas podem dar sua contribuição no campo da saúde pública no contexto latino americano. Com este objetivo, individualizamos alguns indicadores de responsabilidade social seguidos por empresas que tentam colocar em prática tais tendências e estudamos os efeitos que se poderiam provocar ao aplicar algumas problemáticas bioéticas que se apresentam na gestão da saúde pública. Encontramos nas pautas culturais que propõem estas tendências um "humus" propício para a abordagem dos dilemos apresentados. Distinguimos também novas chaves que poderiam ajudar a reverter atitudes nocivas na gestão da saúde, presentes no Estado, na sociedade e nas empresas privadas.