scholarly journals The ethical implications of verbal autopsy: responding to emotional and moral distress

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alex Hinga ◽  
Vicki Marsh ◽  
Amek Nyaguara ◽  
Marylene Wamukoya ◽  
Sassy Molyneux
Keyword(s):  
Public Health ◽  
Emotional Distress ◽  
Verbal Autopsy ◽  
Moral Distress ◽  
Ethical Issues ◽  
Community Members ◽  
Research Staff ◽  
Autopsy Data ◽  
The Right ◽  
Death Data

Abstract Background Verbal autopsy is a pragmatic approach for generating cause-of-death data in contexts without well-functioning civil registration and vital statistics systems. It has primarily been conducted in health and demographic surveillance systems (HDSS) in Africa and Asia. Although significant resources have been invested to develop the technical aspects of verbal autopsy, ethical issues have received little attention. We explored the benefits and burdens of verbal autopsy in HDSS settings and identified potential strategies to respond to the ethical issues identified. Methods This research was based on a case study approach centred on two contrasting HDSS in Kenya and followed the Mapping-Framing-Shaping Framework for empirical bioethics research. Data were collected through individual interviews, focus group discussions, document reviews and non-participant observations. 115 participants were involved, including 86 community members (HDSS residents and community representatives), and 29 research staff (HDSS managers, researchers, census field workers and verbal autopsy interviewers). Results The use of verbal autopsy data for research and public health was described as the most common potential benefit of verbal autopsy in HDSS. Community members mentioned the potential uses of verbal autopsy data in addressing immediate public health problems for the local population while research staff emphasized the benefits of verbal autopsy to research and the wider public. The most prominent burden associated with the verbal autopsy was emotional distress for verbal autopsy interviewers and respondents. Moral events linked to the interview, such as being unsure of the right thing to do (moral uncertainty) or knowing the right thing to do and being constrained from acting (moral constraint), emerged as key causes of emotional distress for verbal autopsy interviewers. Conclusions The collection of cause-of-death data through verbal autopsy in HDSS settings presents important ethical and emotional challenges for verbal autopsy interviewers and respondents. These challenges include emotional distress for respondents and moral distress for interviewers. This empirical ethics study provides detailed accounts of the distress caused by verbal autopsy and highlights ethical tensions between potential population benefits and risks to individuals. It includes recommendations for policy and practice to address emotional and moral distress in verbal autopsy.

Essay I Primary Care and Public Health

2015 ◽  
pp. 26-27
Author(s):  
Julie K. Wood
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Professionals ◽  
The United States ◽  
Federal Agencies ◽  
Community Members ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

Data and the Future of Public Health

2015 ◽  
pp. 305-310
Author(s):  
Jeffrey Engel
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Professionals ◽  
The United States ◽  
Federal Agencies ◽  
Community Members ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

Partnering With Medicaid, Medicare, Public Health, and Primary Care to Improve Health Outcomes

2015 ◽  
pp. 195-206
Author(s):  
Sharon G. Moffatt ◽  
Monica Valdes Lupi ◽  
Kathleen Nolan
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Professionals ◽  
The United States ◽  
Federal Agencies ◽  
Community Members ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

Community Health Assessments: Past, Present, and Future

2015 ◽  
pp. 167-179 ◽  
Author(s):  
Kevin Barnett ◽  
Sara Rosenbaum
Keyword(s):  
Public Health ◽  
Health Professionals ◽  
The United States ◽  
Federal Agencies ◽  
Community Members ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Health Assessments ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

Challenges of Working Together

2015 ◽  
pp. 105-110
Author(s):  
Lara Snyder
Keyword(s):  
Public Health ◽  
Health Professionals ◽  
The United States ◽  
Federal Agencies ◽  
Community Members ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Working Together ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

scholarly journals Working With Data

2015 ◽  
pp. 243-256
Author(s):  
Mina Silberberg ◽  
Denise Koo ◽  
Raymond J. King
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Professionals ◽  
The United States ◽  
Federal Agencies ◽  
Community Members ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

Ethics in Palliative Care

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Moral Distress ◽  
Clinical Medicine ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Age Groups ◽  
Life Threatening Illness ◽  
Unique Nature ◽  
The Right

No specialty faces more diverse and challenging ethical dilemmas than palliative medicine. What is the best way to plan ahead for the end of life? How should physicians respond when patients refuse treatments likely to be beneficial or demand treatments not likely to be? Who makes medical decisions for patients who are too ill to decide for themselves? Do patients have the “right to die” (and, if so, what exactly does that mean)? Other ethics texts have explored these issues but often from an academic perspective that overlooks the practical realities of clinical medicine. Conversely, medical textbooks frequently lack sufficient philosophical depth to fully explore the complexities of these issues. This complete guide to the ethics of palliative care combines clinical experience with philosophical rigor to provide a comprehensive analysis of this fascinating field. Using relevant case studies, core subjects such as intensive symptom management at the end of life, physician-assisted dying, and palliative sedation are examined from historical, legal, clinical, and ethical perspectives. Whereas pediatric issues are often an afterthought in palliative care textbooks, this guide explores the unique nature of ethical dilemmas in the prenatal, neonatal, and adolescent age groups. Other important topics such as neuro-palliative care, organ donation, research, and moral distress are also covered in detail. Written with clinical nuance for medical professionals—and clear language as well as a glossary for lay readers—this guide offers all readers an opportunity to explore and understand the fascinating ethical issues facing patients suffering from life-threatening illness.

scholarly journals Minimizing the Moral Remainder

2018 ◽  
Vol 8 (3) ◽  
pp. 270
Author(s):  
Ariel Arguelles ◽  
John McCaskill
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Moral Dilemmas ◽  
Health Issues ◽  
Moral Decision Making ◽  
Moral Issues ◽  
Careful Scrutiny ◽  
Sacred Values ◽  
Entire Society ◽  
The Right

Public health issues can have devastating consequences on sub-groups of societies. But larger moral issues that face the entire society frequently frame these issues. Our deepest held moral values are frequently in conflict, and cannot withstand careful scrutiny, so we shield them by making them moral imperatives. This is how humans find themselves in moral dilemmas; torn regarding the right thing to do because we are unable to sacrifice sacred values that are in conflict (Tessman 2017).In this paper, we examine the ethical issues that have been inserted into the funding efforts taken to combat Zika in 2016, with some of the ethical dilemmas scientists and physicians have found themselves in through recent history serving as a comparison. We then examine the parallels (and inconsistencies) of public judgment passed on the choices made by these individuals and how these same stark judgments may be influencing public health outcomes today. The primary tool we use throughout this analysis is the “Ethics Triangle” as described by James Svara (2015). The goal of the paper is to examine how our sacred values can become ethical traps (or dilemmas) in moral decision-making. Basically, how do we minimize the moral remainder?

Essay The Value of Early Wins in Be Well Lake County

2015 ◽  
pp. 100-104
Author(s):  
Christina Arnold
Keyword(s):  
Public Health ◽  
Health Professionals ◽  
The United States ◽  
Federal Agencies ◽  
Community Members ◽  
Lake County ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

Essay I Local Health Departments and a Primary Care Safety Net

2015 ◽  
pp. 216-221
Author(s):  
Robert M. Pestronk
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Safety Net ◽  
The United States ◽  
Local Health ◽  
Community Members ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

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