Reconsidering the Moralization of Health: Practices Versus Concepts, and What We Can Learn from Evidence-based Research

2019 ◽  
Vol 28 (02) ◽  
pp. 215-224 ◽  
Author(s):  
S. JOSHUA THOMAS

Abstract:This article aims to do two things. First, it argues that moralization of health occurs not only at the practical level of individual healthcare choices and health states, but also at the conceptual level of health itself. This is most evident in cases where the concept of health is presumed to possess the property of “overridingness” when compared to competing values and norms, that is, when it is treated as taking precedence over other values and norms it may come into conflict with. Second, the article makes a case for being critically skeptical of specific deployments of the concept of health when it has been moralized in this way. In such cases, what typically results is that some other personal value/norm, or set of values/norms, held by the individual is treated as intrinsically at odds with the concept of health, which is presumed, uncritically, to be superior, often because it is taken to be free-standing and self-justifying. Yet, a growing body of evidence-based research suggests that the role played by dimensions of personal meaningfulness in the quality of individuals’ overall health is quite underappreciated. It is useful to think of these dimensions of personal meaning and significance as representing the individual’s values. Thus, taking these data more seriously ought to lead to a reevaluation of the moralization of health at the conceptual level. In the first place, it is not obvious that if the concept of health runs afoul of other values/norms held by an individual, the latter should automatically yield. In the second place, they suggest that other values/norms held by an individual are not necessarily intrinsically opposed to the concept of health, but in fact may go a good distance in support of it.

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Victor M Lu ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Michael J Link ◽  
Fredric B Meyer ◽  
...  

Abstract Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.


2013 ◽  
Vol 17 (4) ◽  
pp. 276-282 ◽  
Author(s):  
Ashley O'Toole ◽  
Bjorn Thomas ◽  
Richard Thomas

Background: Atopic dermatitis (AD) is a chronic, relapsing, intensely pruritic dermatosis that usually affects infants, children, and young adults. The treatment of AD entails an individualized regimen that depends on the age of the patient, the stage and variety of lesions present, the sites and extent of involvement, the presence of infection, and the previous response to treatment. Objectives: To identify the evidence surrounding potential strategies for closing these gaps—ultimately improving the quality of care, the care process itself, and patient outcomes—and to encourage discussions that help develop tools to bridge the gap between suggested therapy and what is done by the patient. Methods: Review of the literature including searches on PubMed Central and Medline and in seminal dermatology texts. Results: There are several disconnections between the evidence-based guidelines in the management of AD, what the individual dermatologist recommends, and what the patient does. Conclusion: Applying the concept of the care triangle requires a balance of evidence-based medicine, the physician's experiences and the patient's needs and expectations in the decisions surrounding appropriate management of the disease.


2002 ◽  
Vol 11 (4) ◽  
pp. 237-247 ◽  
Author(s):  
Patrick D. McGorry ◽  
Eoin J. Killackey

SUMMARYObjective – Even in countries whose mental health services are comparatively well resourced, the care offered to those in the early stages of psychotic illnesses is not what it could be. Patients often have to progress to chronicity before receiving adequate interventions, by which stage there has been great potential for harm, not only through the psychosis, but also to the quality of life of the individual who has often missed or not completed adequately, several important developmental tasks. Further, evidence indicates that delay in treatment is positively associated with poorer outcome. This paper puts the case for early intervention in psychosis. Method – Based on the experience of the Early Psychosis Prevention and Intervention Centre in Melbourne, the paper reviews the evidence for and the criticisms of, early intervention. Using the concept of indicated prevention, it suggests ways in which clinicians can improve the interventions available to those experiencing the onset of psychosis and suggests that prepsychotic intervention may be possible. Results – Evidence discussed in this paper indicates that the development of mental illness is a major health issue in young people; that there is a positive correlation between duration of untreated psychosis and outcome; that it is possible to identify a proportion of those at high risk of developing mental illness; that through intervention it may be possible to reduce the transition rate to illness. Conclusion – Primary prevention is beyond the capacity of our present knowledge. Indicated prevention in the form of early intervention and optimal, sustained treatment is a paradigm for which there is increasing supportive evidence. It is a paradigm which is appealing to clinicians, patients, families and which has the potential to reduce the secondary impact of serious mental illness such as suicide, stigma, isolation and reduction in social status.


Author(s):  
Ioannis Apostolakis ◽  
Periklis Valsamos ◽  
Iraklis Varlamis

Evidence-based medicine (EBM) refers to the careful examination of all the available evidence when making decisions about the care of the individual patient. It assumes that well known medical practices and solutions are combined with the patient’s preferences and necessities in order to provide the most appropriate solution per case. The abundance of medical information in the web, the expansion of Semantic Web and the evolution of search services allowed the easier retrieval of scientific articles. Although the available infrastructure exists and continuously improves in performance, EBM still remains a complicated and sensitive process of high importance and has a need for Quality Assurance (QA). The purpose of this chapter is twofold: first, to provide an introduction on the concepts of Evidence-based Medicine, and second, to stress the necessity for structured methodologies that will assure the quality of the EBM process and ameliorate the final recommendations therapy. Since evidences are the building blocks of EBM, we capitalize on their quality and provide a critical overview of the existing methodologies in Quality Assurance of evidences.


2015 ◽  
Vol 34 (5) ◽  
pp. 288-290
Author(s):  
Deborah A. Raines

AbstractQuality appraisal is an essential step in the evidence-based practice process. This column focuses on evaluating the quality of the individual study and its applicability to practice.


2020 ◽  
Vol 4 (1) ◽  
pp. 47
Author(s):  
Zhaojing Li

The essence of teachers is to live a moral life with students and create a possible moral life together. At present, the alienation of teachers' moral life has reached an amazing degree. Based on this, at the conceptual level, rediscover the emotional dimension of teachers' moral life in a humanistic way and turn to the inner power of teachers' emotional life. At the practical level, it emphasizes the cultivation of emotional quality of moral life.


2021 ◽  
Vol 7 (4) ◽  
pp. 188-194
Author(s):  
Ayush Srivastava ◽  
Ranjoy Hazra ◽  
Dinesh Kumar ◽  
Amit Khattak ◽  
V S Legha ◽  
...  

Traditional methods will be rendered obsolete, if not supplemented by current techniques and evidence. This requires a clinician to continuously recognize, scrutinize and consolidate the best available scientific literature in the field. Continuous improvement in the quality of research conducted, as well as reporting the findings should be encouraged to improve upon current and future treatments. This review showcases the most prominent controversies in prosthodontics and how the current evidence answers the questions. A PubMed, Met line and google scholar search with the keywords, Evidence-based dentistry and Evidence-based Prosthodontics was done from the year 1960-2021. Meta-analysis of randomized control trials and systematic reviews related to the evidence in complete dentures, fixed partial dentures, implants and prosthodontics were considered in the inclusion criteria. Literature reviews and case reports were excluded from the search. Evidence-based practice is a new level of sophistication in the practice of dentistry. Rather than considering the cost of material or the individual preference of the operator, choosing the right technique to maximize clinical efficiency should be based on scientific evidence.


Author(s):  
Glynis H. Murphy ◽  
Peter McGill

Challenging behavior is not a diagnosis. It is behaviour of such an intensity, frequency or duration as to threaten the quality of life and/or the physical safety of the individual or others and is likely to lead to responses that are restrictive, aversive or result in exclusion. This definition is less pejorative, makes fewer assumptions about causality and reminds us that such behaviour is a challenge to services. Challenging behavior is more prevalent in those with an intellectual disability than those without with overall prevalence figures of 10–15% in those known to services. A number of long term high risk factors have been identified and evidence based interventions have included parent training and behavioural interventions. Positive Behavioural Support (PBS) is an intervention technology based on social, behavioural, educational, and biomedical science that combines evidence-based practices with formal systems change strategies, focused on both improving the valued lifestyle options available for an individual and reducing problem behaviours.


2018 ◽  
Vol 5 (1) ◽  
Author(s):  
Josée Lachance ◽  
Jean-François Desbiens ◽  
Marianne Xhignesse

Background / Purpose: Awakening the “Sensible” Being (ASB) is a formative practice geared toward care giving and support. It examines how experiencing one’s own body and its movement stimulates the development of self-awareness and awareness of others, both of which are desirable qualities for healthcare professionals. To our knowledge there is no theoretical model regarding the process that occurs and its potential effects on participants.Based on our research with physicians having undergone ASB training, we developed such a preliminary model. Methods: Grounded theory was used for a secondary analysis of thesis data (Lachance 2016). This analysis was inspired by the relationship between learning and caring (Honoré 1992, 2003) and the integration of consciousness according to Newman’s (1990, 1997) concept of health. Results: The model is one of concentric circles. ASB training fosters the development of an internal dialogue in individuals (center of the model) which has effects on their personal life and by ricochet, their professional activities (periphery of the model). Their expanded sense of self-awareness and quality of “savoir-être” brought on by the training contributes to their impression of “feeling whole” and provides them with a quality of presence that influences the type of care they can provide to their patients by considering the individual as a whole. Conclusion: Behind a physician, there is a human being with human qualities enabling them to be a better physician. Our model underlines the importance of developing the inner self as a background to becoming a better health professional. 


2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Josée Lachance ◽  
Richard B. Hovey ◽  
Jean-François Desbiens

 Health does not arise from health care. Perhaps we are facing an impasse and should we reconsider and reconceptualize the mandate of the health system. In order to improve our influence on the culture that often prevails in our institutions as well as the health of those institutions. This article examines the changes to the mandate of the health system seen in the light of self-transformations. This vision is based on a model that illustrates the transformations experienced by physicians following a mind-body training, i.e. Awakening the Sensible Being (ASB). The model shows the transformation process reported by physicians, after experiencing self-awareness of what they are doing, through experiencing the ASB, while developing a closer relationship with themselves. As it turned out, the training was beneficial for their health. Their expanded sense of self-awareness and quality of “savoir-être” brought on by the training contributes to their impression of “feeling whole” and provides them with a quality of presence that influences the type of care they can provide to their patients by considering the individual as a whole. This point of view could bring about a shift in the mandate of the health system and improve the health of caregivers and care-receivers as well, while contributing to widen the concept of health.


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