scholarly journals Prioritarianism in Health-Care: Resisting the Reduction to Utilitarianism

Diametros ◽  
2021 ◽  
Author(s):  
Massimo Reichlin
Keyword(s):  
Health Care ◽  
Distributive Justice ◽  
Mentally Ill ◽  
Life Extension ◽  
Artificial Reproduction ◽  
Medical Resources ◽  
Present Distribution ◽  
Practical Convergence ◽  
Mood Enhancement

Tännsjö’s book Setting Health-Care Priorities defends the view that there are three main normative theories in the domain of distributive justice, and that these theories are both highly plausible in themselves, and practically convergent in their normative conclusions. All three theories (utilitarianism, the maximin/leximin theory and egalitarianism) point to a somewhat radical departure from the present distribution of medical resources: in particular, they suggest redirecting resources from marginal life extension to the care of mentally ill patients. In this paper I wish to argue, firstly, that prioritarianism should not be considered as an amendment to utilitarianism, as it is in Tännsjö’s view, but as a distinctive fourth option. This can best be appreciated if we focus on a reading of the theory that emphasizes its derivation from egalitarianism and its attempt to develop an intermediate approach between utilitarian and egalitarian intuitions. Secondly, in response to Tännsjö’s central objection to prioritarianism, I will argue that the theory does not apply in intrapersonal cases but is only relevant for decisions regarding the interpersonal distribution of benefits. Finally, I will suggest that a practical convergence of the four theories on specific issues such as artificial reproduction or mood enhancement is far less likely than Tännsjö seems to believe.

Setting Health-Care Priorities

2019 ◽  
Author(s):  
Torbjörn Tännsjö
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Real Life ◽  
Thought Experiments ◽  
Life Extension ◽  
Weighted Sum ◽  
Absolute Priority ◽  
Abstract Thought

The three most promising theories of distributive ethics are presented: Utilitarianism, with or without a prioritarian amendment. The maximin/leximin theory. Egalitarianism. Utilitarianism urges us to maximize the sum-total of happiness. When prioritarianism is added to utilitarianism we are instead urged to maximize a weighted sum of happiness, where happiness weighs less the happier you are and unhappiness weighs more the more miserable you are. The maximin/leximin theory urges us to give absolute priority to those who are worst off. Egalitarianism gives us two goals: to maximize happiness but also to level out differences with regard to happiness between persons. All of these theories are justifiable. In abstract thought experiments they conflict. When applied in real life they converge in an unexpected manner: more resources should be directed to mental health and less to marginal life extension. It is doubtful if the desired change will take place, however. What gets in its way is human irrationality.

Can employment in a café change Clientele Attitude towards the staff when they are Persons with Mental Illness?

2021 ◽  
pp. 002076402199006
Author(s):  
Sailaxmi - Gandhi ◽  
Sangeetha Jayaraman ◽  
Thanapal Sivakumar ◽  
Annie P John ◽  
Anoop Joseph ◽  
...  
Keyword(s):  
Health Care ◽  
Mental Illness ◽  
Mentally Ill ◽  
Health Care Professionals ◽  
Negative Attitude ◽  
Chi Square ◽  
Community Needs ◽  
Descriptive Research ◽  
Study Results ◽  
Self Administered Questionnaire

Background: Clientele’s attitude toward Persons with Mental Illness (PwMI) changes over a period of time. The aim of this study was to explore and understand how and whether perception about PwMI changes when they are seen working like persons without mental illness among those availing services of ROSes café at NIMHANS, Bengaluru. Methods: The descriptive research design was adopted with purposive sampling. Community Attitude toward Mentally Ill (CAMI) a self -administered questionnaire of was administered to measure the clientele attitude towards staff with mental illness in ROSes Café (Recovery Oriented Services). A total of 256 subjects availing services from the ROSes café recruited in the study. Chi-square and Mann–Whitney U test was computed to see the association and differences on selected variables. Results: The present study results showed that subjects had a positive attitude seen in health care professionals in the domains of benevolence (BE) (28.68 ± 3.00) and community mental health ideology (CMHI) (31.53 ± 3.19), whereas non-health care professionals had showed negative attitude in the domain of authoritarianism (AU) (30.54 ± 3.42) and social restrictiveness (SR) (30.18 ± 3.05). Education, employment, marital, income, and working status were significantly associated with CAMI domains. Conclusion: PwMI also can work like people without mental illness when the opportunities are provided. The community needs to regard mental illness in the same manner as chronic physical illness diabetes mellitus and allow PwMI to live a life of dignity by creating and offering opportunities to earn livelihood which would help them recover with their illnesses.

Psychiatric Advance Directives

2003 ◽  
Vol 9 (2) ◽  
pp. 55-59 ◽  
Author(s):  
Paula K. Vuckovich
Keyword(s):  
Health Care ◽  
Decision Maker ◽  
Advance Directives ◽  
Care Provider ◽  
Mentally Ill ◽  
Autonomous Control ◽  
Surrogate Decision Maker ◽  
Psychiatric Advance Directives ◽  
Mentally Ill Persons ◽  
Surrogate Decision

Psychiatric advance directives (PADs) have been legally defined in 12 states and implemented in all but 9. PADs may prevent unwanted treatment and identify preferred treatment. They may also allow mentally ill persons to exercise autonomous control over care even during periods of illness-induced incompetence. PADs can be beneficial for intermittently psychotic patients who have a trusted health care provider and a surrogate decision maker. Because of the growing interest in the use of PADs, nurses should be informed about the intended purposes, benefits, and drawbacks of them.

Conclusion

2019 ◽  
pp. 172-200
Author(s):  
Torbjörn Tännsjö
Keyword(s):  
Mental Illness ◽  
Distributive Justice ◽  
Moral Theory ◽  
Moral Realism ◽  
Life Extension ◽  
Fear Of Death ◽  
A Priority

Even if according to all plausible theories of distributive justice, spending more on the care and cure of patients suffering from mental illness should be a priority rather than on marginal life extension, this will not happen. The reason has to do with fear of death and human irrationality. Does the fact that we will not abide by any one of the theories, even if we are convinced that it is true, mean that there is something wrong with it? Does our reluctance to act on the theories mean that they must be false? I think not. Here I avail myself in my argument of moral realism. If there is a truth in the matter, there is no reason to believe that the correct moral theory must be such that we abide by it, once we accept it (theoretically speaking) as true. This means that our unwillingness to live according to the theories does not show that they are unreasonable. The problem lies not with the theories themselves but rather with our unwillingness to abide by them. We are to blame, not abstract moral theory.

Analysis of Emergency Room Visits Reveals a Seriously Mentally Ill, Medically Fragile Population Requiring Strategic Management

2019 ◽  
Vol 25 (6) ◽  
pp. 496-500
Author(s):  
Kavinder Sahota ◽  
Carole Bennett
Keyword(s):  
Health Care ◽  
Emergency Room ◽  
Mentally Ill ◽  
Health Care Services ◽  
Physical Symptoms ◽  
Medically Fragile ◽  
Integration Of Care ◽  
Improvement Project ◽  
Care Services ◽  
Seriously Mentally Ill

OBJECTIVE: This practice improvement project evaluated the cost of health care services utilized by patients with comorbid mental and physical chronic conditions who were psychiatrically hospitalized but transported for health care services of physical symptoms that developed during their psychiatric hospitalization. METHOD: A retrospective review of invoices to a regional psychiatric hospital for non-psychiatric health services utilized by inpatients revealed high costs of emergency room (ER) visits from July 2016 to June 2017. Medical records for these seriously mentally ill inpatients who visited the ER for evaluation of sudden emergent physical symptoms were reviewed. The collected data were analyzed. RESULTS: ER invoices revealed that 41 visits had been made by 28 patients with a total cost of $308,466.67, of which $258,668.15 was judged to be for the treatment of patients with symptoms of preventable side effect syndromes. This chart review and analysis suggest a need for improved strategic medication management in an integrated model of care. CONCLUSIONS: Polypharmacy was found to be responsible for increased debilitating physical symptoms requiring ER visits for this seriously mentally ill, medically fragile population. An integration of care services for comorbid conditions by advanced practice registered nurses with protocols specifically designed for this population was recommended.

Health Care Politics, Policy, and Distributive Justice: The Ironic Triumph.

1992 ◽  
Vol 107 (3) ◽  
pp. 565
Author(s):  
Anne Lenhard Reisinger ◽  
Robert P. Rhodes
Keyword(s):  
Health Care ◽  
Distributive Justice ◽  
Health Care Politics

Assessing Medical Technology in Less-Developed Countries

1997 ◽  
Vol 13 (3) ◽  
pp. 463-470
Author(s):  
Samuel Sideman ◽  
Joseph D. BenDak
Keyword(s):  
Health Care ◽  
Performance Measures ◽  
National Health ◽  
Medical Technology ◽  
Developed Countries ◽  
Assessment Process ◽  
Less Developed Countries ◽  
Medical Resources ◽  
National Health Care ◽  
Goals And Objectives

AbstractLess developed countries (LDCs) are limited in medical resources. Medical technology and the management talent required to handle it play a particularly major role in their national health care and has significant economic, political, and ethical ramifications. This study of the assessment process of medical technology in the LDCs proposes a limited framework for the analysis of the major parameters involved, i.e., stakeholders, boundaries and constraints, goals and objectives, criteria to be met, performance measures, and measurement of performance. The importance of the intangible factors is elucidated.

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