scholarly journals Frames and counter-frames giving meaning to palliative care and euthanasia in the Netherlands

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Baldwin Van Gorp ◽  
Gert Olthuis ◽  
Anneleen Vandekeybus ◽  
Jelle van Gurp
Keyword(s):  
Palliative Care ◽  
The Netherlands ◽  
Public Debate ◽  
Problem Definition ◽  
Framing Analysis ◽  
Policy Makers ◽  
Medical Progress ◽  
Heavy Burden ◽  
Axial Coding ◽  
Definition Of

Abstract Background Based on the case of palliative care and euthanasia in the Netherlands, this paper presents an analysis of frames and counter-frames used in the ongoing public debate about these two intertwined topics. Each (counter)frame presents a cultural theme that can act as a prism to give meaning to palliative care and/or euthanasia. Each frame comprehends a different problem definition, consequences and policy options. Typical word choices and metaphors are identified that can evoke these frames and the underlying reasoning. The frames do not belong to a specific stakeholder but a pattern can be seen in their use that is related to interests and ideology. Methods An inductive framing analysis was conducted of 2,700 text fragments taken from various Dutch newspapers, websites of stakeholders and policy documents in the period 2016–2018. After an extensive process of thematic coding, axial coding, selective coding and peer review seven frames and seven counter-frames about palliative care and euthanasia were constructed. Fifteen experts in the field of palliative and/or end-of-life care commented on the overview during a member check. Results Two frames about palliative care were constructed: the Fear of death frame, which stresses the hopeless ‘terminality’ of palliative care and the Heavy burden frame, in which palliative care is too big a responsibility for the relatives of the patient. In addition, two counter-frames were constructed: palliative care as a contributor to Quality of life and Completion. With regard to euthanasia, five frames were identified that lead to a problematising definition: Thou shalt not kill, Slippery slope, Lack of willpower, I am not God, and Medical progress. Five counter-frames offer a non-problematising definition of euthanasia in the debate: Mercy, Prevention, Triumph of reason, Absolute autonomy, and Economic utility thinking. Conclusions The debate in the Netherlands on euthanasia and palliative care is characterized by a plurality of angles that goes beyond the bipolar distinction between the pros and cons of euthanasia and palliative care. Only with an overview of all potential frames in mind can an audience truly make informed decisions. The frame matrix is not only useful for policy makers to know all perspectives when joining public debate, but also to health care workers to get into meaningful conversations with their patients and families.

scholarly journals Frames and Counter-Frames Giving Meaning to Palliative Care and Euthanasia in the Netherlands

2020 ◽  
Author(s):  
Baldwin Van Gorp ◽  
Gert Olthuis ◽  
Anneleen Vandekeybus ◽  
Jelle van Gurp
Keyword(s):  
Palliative Care ◽  
The Netherlands ◽  
Public Debate ◽  
Problem Definition ◽  
Framing Analysis ◽  
Policy Makers ◽  
Medical Progress ◽  
Heavy Burden ◽  
Axial Coding ◽  
Definition Of

Abstract Background Based on the case of palliative care and euthanasia in the Netherlands, this paper presents an analysis of frames and counter-frames used in the ongoing public debate about these two intertwined topics. Each (counter)frame presents a cultural theme that can act as a prism to give meaning to palliative care and/or euthanasia. Each frame comprehends a different problem definition, consequences and policy options. Typical word choices and metaphors are identified that can evoke these frames and the underlying reasoning. The frames do not belong to a specific stakeholder but a pattern can be seen in their use that is related to interests and ideology.Methods An inductive framing analysis was conducted of 2,700 text fragments taken from various Dutch newspapers, websites of stakeholders and policy documents in the period 2016-2018. After an extensive process of thematic coding, axial coding, selective coding and peer review seven frames and seven counter-frames about palliative care and euthanasia were constructed. Fifteen experts in the field of palliative and/or end-of-life care commented on the overview during a member check. Results Two frames about palliative care were constructed: the Fear of death frame, which stresses the hopeless ‘terminality’ of palliative care and the Heavy burden frame, in which palliative care is too big a responsibility for the relatives of the patient. In addition, two counter-frames were constructed: palliative care as a contributor to Quality of life and Completion. With regard to euthanasia, five frames were identified that lead to a problematising definition: Thou shalt not kill, Slippery slope, Lack of willpower, I am not God, and Medical progress. Five counter-frames offer a non-problematising definition of euthanasia in the debate: Mercy, Prevention, Triumph of reason, Absolute autonomy, and Economic utility thinking.Conclusions The debate in the Netherlands on euthanasia and palliative care is characterized by a plurality of angles that goes beyond the bipolar distinction between the pros and cons of euthanasia and palliative care. Only with an overview of all potential frames in mind can an audience truly make informed decisions. The frame matrix is not only useful for policy makers to know all perspectives when joining public debate, but also to health care workers to get into meaningful conversations with their patients and families.

scholarly journals Defining wicked problems for public policy: The case of Mexico’s disappearances

2020 ◽  
pp. 64-80
Author(s):  
Monica Naime
Keyword(s):  
Public Policy ◽  
Empirical Studies ◽  
Wicked Problems ◽  
Problem Definition ◽  
Decision Makers ◽  
Wicked Problem ◽  
Problematic Situation ◽  
Policy Makers ◽  
Definition Of ◽  
Heuristic Devices

Wicked problem literature is increasingly popular, but empirical studies about its relation to public policy are scarce. Additionally, there is no consensus on the convenience of Public Administration as policy makers addressing wicked problems by artificially defining and structuring them. The purpose of the paper is to address these gaps, specifically how, in practice, governments handle wicked problems. Two possible alternatives are discussed: either policy makers are rational, or rather they use heuristics for problem definition. The research focuses on problem definition as part of the policy process. In particular, how the definition of the particular wicked problematic situation was reflected in legislation: disappearances in Mexico. The case shows that forced disappearances is an heterogeneous phenomenon that can be considered a wicked problem, which further increases the complexity of policies that aim to tackle it. Also, results of applying congruence tests show that policy-makers structure wicked problems when defining them, but after a certain amount of energy has been spent on this task, policy makers employ heuristic devices. This contributes to understand how flesh and bone decision-makers build public policies.

KEBIJAKAN POLITIK KERUKUNAN ANTARAGAMA DI INDONESIA ERA REFORMASI

2017 ◽  
Vol 9 (2) ◽  
pp. 407-424
Author(s):  
Jamaluddin Jamaluddin
Keyword(s):  
Transition Period ◽  
Religious Life ◽  
New Order ◽  
Reform Era ◽  
Policy Makers ◽  
Accommodation Space ◽  
Nation States ◽  
The Government ◽  
Definition Of ◽  
Cultural Reality

Indonesian reformation era begins with the fall of President Suharto. Political transition and democratic transition impact in the religious life. Therefore, understandably, when the politic transition is not yet fully reflects the idealized conditions. In addition to the old paradigm that is still attached to the brain of policy makers, various policies to mirror the complexity of stuttering ruler to answer the challenges of religious life. This challenge cannot be separated from the hegemonic legacy of the past, including the politicization of SARA. Hegemony that took place during the New Order period, adversely affected the subsequent transition period. It seems among other things, with airings various conflicts nuances SARA previously muted, forced repressive. SARA issues arise as a result of the narrowing of the accommodation space of the nation state during the New Order regime. The New Order regime has reduced the definition of nation-states is only part of a group of people loyal to the government to deny the diversity of socio-cultural reality in it. To handle the inheritance, every regime in the reform era responds with a pattern and a different approach. It must be realized, that the post-reform era, Indonesia has had four changes of government. The leaders of every regime in the reform era have a different background and thus also have a vision that is different in treating the problem of racial intolerance, particularly against religious aspect. This treatment causes the accomplishment difference each different regimes of dealing with the diversity of race, religion and class that has become the hallmark of Indonesian society.

Empowering Women Entrepreneurs Through Microfinance - A Case of Rural Bangladesh

2017 ◽  
Vol 3 (2) ◽  
pp. 7
Author(s):  
Saida Parvin
Keyword(s):  
Women's Empowerment ◽  
Assessment Tools ◽  
Women’S Empowerment ◽  
Case Study Method ◽  
Policy Makers ◽  
Theoretical Contribution ◽  
Donor Agencies ◽  
Definition Of ◽  
The Impact

Women’s empowerment has been at the centre of research focus for many decades. Extant literature examined the process, outcome and various challenges. Some claimed substantial success, while others contradicted with evidence of failure. But the success remains a matter of debate due to lack of empirical evidence of actual empowerment of women around the world. The current study aimed to address this gap by taking a case study method. The study critically evaluates 20 cases carefully sampled to include representatives from the entire country of Bangladesh. The study demonstrates popular beliefs about microfinance often misguide even the borrowers and they start living in a fabricated feeling of empowerment, facing real challenges to achieve true empowerment in their lives. The impact of this finding is twofold; firstly there is a theoretical contribution, where the definition of women’s empowerment is proposed to be revisited considering findings from these cases. And lastly, the policy makers at governmental and non-governmental organisations, and multinational donor agencies need to revise their assessment tools for funding.

Bottlenecks in the Implementation of On-Site Wastewater Treatment Plants on a Large Scale in The Netherlands

1990 ◽  
Vol 22 (3-4) ◽  
pp. 291-298
Author(s):  
Frits A. Fastenau ◽  
Jaap H. J. M. van der Graaf ◽  
Gerard Martijnse
Keyword(s):  
Wastewater Treatment ◽  
The Netherlands ◽  
Large Scale ◽  
Wastewater Treatment Plants ◽  
Housing Stock ◽  
Research Work ◽  
Field Research ◽  
Domestic Wastewater ◽  
Research Programme ◽  
Definition Of

More than 95 % of the total housing stock in the Netherlands is connected to central sewerage systems and in most cases the wastewater is treated biologically. As connection to central sewerage systems has reached its economic limits, interest in on-site treatment of the domestic wastewater of the remaining premises is increasing. A large scale research programme into on-site wastewater treatment up to population equivalents of 200 persons has therefore been initiated by the Dutch Ministry of Housing, Physical Planning and Environment. Intensive field-research work did establish that the technological features of most on-site biological treatment systems were satisfactory. A large scale implementation of these systems is however obstructed in different extents by problems of an organisational, financial and/or juridical nature and management difficulties. At present research is carried out to identify these bottlenecks and to analyse possible solutions. Some preliminary results are given which involve the following ‘bottlenecks':-legislation: absence of co-ordination and absence of a definition of ‘surface water';-absence of subsidies;-ownership: divisions in task-setting of Municipalities and Waterboards; divisions involved with cost-sharing;-inspection; operational control and maintenance; organisation of management;-discharge permits;-pollution levy;-sludge disposal. Final decisions and practical elaboration of policies towards on-site treatment will have to be formulated in a broad discussion with all the authorities and interest groups involved.

The determinants of the intensity of home-based informal care among cancer patients in receipt of home-based palliative care

2020 ◽  
pp. 026921632097927
Author(s):  
Jiaoli Cai ◽  
Li Zhang ◽  
Denise Guerriere ◽  
Peter C Coyte
Keyword(s):  
Palliative Care ◽  
Marital Status ◽  
Cancer Patients ◽  
Informal Care ◽  
Instrumental Variables ◽  
Spousal Caregivers ◽  
Living Alone ◽  
Policy Makers ◽  
Cohort Design ◽  
Home Based

Background: Understanding the determinants of the intensity of informal care may assist policy makers in the identification of supports for informal caregivers. Little is known about the utilization of informal care throughout the palliative care trajectory. Aim: The purpose of this study was to analyze the intensity and determinants of the use of informal care among cancer patients over the palliative care trajectory. Design: This was a longitudinal, prospective cohort design conducted in Canada. Regression analysis using instrumental variables was applied. Setting/participants: From November 2013 to August 2017, a total of 273 caregivers of cancer patients were interviewed biweekly over the course of the care recipient’s palliative care trajectory. The outcome was the number of hours of informal care provided by unpaid caregivers, that is, hours of informal care. Results: The number of hours of informal care increased as patients approached death. Home-based nursing care complemented, and hence, increased the provision of informal care. Patients living alone and caregivers who were employed were associated with the provision of fewer hours of informal care. Spousal caregivers provided more hours of informal care. Patient’s age, sex, and marital status, and caregiver’s age, sex, marital status, and education were associated with the number of hours of informal care. Conclusions: The intensity of informal care was determined by predisposing, enabling, and needs-based factors. This study provides a reference for the planning and targeting of supports for the provision of informal care.

Value assessment of antimicrobials and the implications for development, access, and funding of effective treatments: Australian stakeholder perspective

2020 ◽  
pp. 1-7
Author(s):  
Nadine T. Hillock ◽  
Tracy L. Merlin ◽  
Jonathan Karnon ◽  
John Turnidge ◽  
Jaklin Eliott
Keyword(s):  
Cost Effectiveness ◽  
Healthcare Resource ◽  
Economic Evaluations ◽  
Value Assessment ◽  
Antimicrobial Drugs ◽  
Policy Makers ◽  
Stakeholder Perspective ◽  
Definition Of ◽  
The Impact ◽  
Potential Use

Abstract Background The frameworks used by Health Technology Assessment (HTA) agencies for value assessment of medicines aim to optimize healthcare resource allocation. However, they may not be effective at capturing the value of antimicrobial drugs. Objectives To analyze stakeholder perceptions regarding how antimicrobials are assessed for value for reimbursement purposes and how the Australian HTA framework accommodates the unique attributes of antimicrobials in cost-effectiveness evaluation. Methods Eighteen individuals representing the pharmaceutical industry or policy-makers were interviewed. Interviews were transcribed verbatim, coded, and thematically analyzed. Results Key emergent themes were that reimbursement decision-making should consider the antibiotic spectrum when assessing value, risk of shortages, the impact of procurement processes on low-priced comparators, and the need for methodological transparency when antimicrobials are incorporated into the economic evaluation of other treatments. Conclusions Participants agreed that the current HTA framework for antimicrobial value assessment is inadequate to properly inform funding decisions, as the contemporary definition of cost-effectiveness fails to explicitly incorporate the risk of future resistance. Policy-makers were uncertain about how to incorporate future resistance into economic evaluations without a systematic method to capture costs avoided due to good stewardship. Lacking financial reward for the benefits of narrower-spectrum antimicrobials, companies will likely focus on developing broad-spectrum agents with wider potential use. The perceived risks of shortages have influenced the funding of generic antimicrobials in Australia, with policy-makers suggesting a willingness to pay more for assured supply. Although antibiotics often underpin the effectiveness of other medicines, it is unclear how this is incorporated into economic models.

Sign in / Sign up

Export Citation Format

Share Document