Justice Health Dictionary

(Greek) In mythology, the goddess of justice... dike

The basic evaluative principles which (should) guide “good” care. Principles typically refer to respect for, and the dignity of, human beings. Basic dimensions are “autonomy” (respect for self determination), “well-being” (respect for happiness, health and mental integrity) and “social justice” (justifiable distribution of scarce goods and services). More specifically, ethics of care refer to ethical standards developed for the care professions which are designed to implement ethical principles in the practice of care provision.... ethics (of care)

Hanging is a form of death due to suspension of the body from the neck – either suddenly, as in judicial hanging (although not in the United Kingdom, as the death penalty is not used in the UK justice system), so as to damage the spinal column and cord, or in such a way as to constrict the AIR PASSAGES and the blood vessels to the brain. Death is, in any case, speedy, resulting in 2–3 minutes if not instantaneously. Apart from judicial hanging, and in the absence of any signs of a struggle, hanging is usually due to SUICIDE. The resuscitation of people found hanging is similar to that for drowning. (See APPENDIX 1: BASIC FIRST AID – Cardiac/respiratory arrest.)... hanging

(Egyptian) In mythology, the goddess of truth, order, and justice... maat

(Japanese) Child of justice... masako

EDUCATIONAL PSYCHOLOGISTS Working in schools and in local education authorities, they are concerned with children’s learning and development. They carry out tasks aimed at improving children’s learning and helping teachers to become more aware of social factors that affect teaching and learning. Chartered educational psychlogists have a graduate degree in psychology and also a teaching quali?cation, with experience; in addition they have completed a one-year postgraduate course in educational psychology with supervised experience. COUNSELLING PSYCHOLOGISTS apply psychology to working in collaboration with people across a range of human problems. For example, helping people to manage di?cult life events, relationship issues, BEREAVEMENT and issues raised by mental-health problems. Their usual route to qualify is completing a three-year postgraduate training in counselling psychotherapy. CLINICAL PSYCHOLOGISTS have completed a three-year doctorate training course as well as having their ?rst degree in psychology. They work in health and care settings. Their aim is to reduce psychological distress and to promote psychological well-being. They work with individuals, families, groups and organisations: the individuals are people who have problems such as anxiety, DEPRESSION, serious and enduring MENTAL ILLNESS, brain injuries, addiction, child and family problems, LEARNING DISABILITY and the after-effects of trauma. They provide various types of treatment, for example COGNITIVE BEHAVIOUR THERAPY and family therapy, based on psychological theories and research. They also carry out research, training, consultation with other professionals involved with clients, and supervision of colleagues.

(See also NEUROSIS; PSYCHOTHERAPY.) FORENSIC PSYCHOLOGISTS work in the

criminal and justice ?elds, applying psychological theory to aspects of legal processes in courts, criminal investigation, and understanding and treating psychological problems associated with criminal behaviour. They will have completed an accredited training course in forensic psychology. HEALTH PSYCHOLOGISTS apply psychological methods to studying behaviour relevant to health, illness and care including health promotion and education. OCCUPATIONAL PSYCHOLOGISTS are concerned with how people perform at work and how organisations function. They work in management, personnel, selection and careers advice. They have a postgraduate degee in occupational psychology and will have had to undertake three years’ supervised practice.... types of psychologist

(Scandinavian) Feminine form of Tyr, the god of war and justice Tyrah, Tyrra, Tyrrah... tyra

n. treating individuals differently on the basis of morally insignificant characteristics, such as race, sex, or religion. In medicine, any discrimination of this kind (e.g. when deciding on treatments or allocating resources) offends against the ethical principle of *justice. Legally, discrimination can be direct (i.e. overtly differentiating between people and groups) or indirect (i.e. behaviour that will disproportionately affect particular people or some groups more than others). See also equality; stigma.... discrimination

n. in medical ethics, the principle that cases with an equal moral status should be treated equally. This means, most obviously, that patients with the same clinical needs should not be treated differently on morally irrelevant grounds, such as race (see discrimination), and are afforded identical rights, respect, and value. However, there is much debate over what characteristics are morally important when medical resources need to be rationed; for example, whether a patient’s age or *quality of life is morally important. See justice.... equality

n. see equality; justice.... fairness

an approach to medical ethics, proposed by Tom Beauchamp and James F. Childress, that identifies four basic tenets of ethical practice, namely: respect for *autonomy, *beneficence, *nonmaleficence, and *justice. Although the four principles are often used as a framework for decision-making in Western medical ethics, there may be problems when principles conflict or their application is contested in practice.... four principles

an approach to moral problems acknowledging that ethical analysis is frequently culture-specific and geographically limited. The international and worldwide experience of health care is the subject of study and there is commonly close attention to inequities in health and health-care provision, with frequent emphasis on *human rights, *justice, and *equality.... global ethics

Within most cultures, care of the sick is seen as entailing special duties, codi?ed as a set of moral standards governing professional practice. Although these duties have been stated and interpreted in di?ering ways, a common factor is the awareness of an imbalance of power between doctor and patient and an acknowledgement of the vulnerability of the sick person. A function of medical ethics is to counteract this inevitable power imbalance by encouraging doctors to act in the best interests of their patients, refrain from taking advantage of those in their care, and use their skills in a manner which preserves the honour of their profession. It has always been accepted, however, that doctors cannot use their knowledge indiscriminately to ful?l patients’ wishes. The deliberate ending of life, for example, even at a patient’s request, has usually been seen as alien to the shared values inherent in medical ethics. It is, however, symptomatic of changing concepts of ethics and of the growing power of patient choice that legal challenges have been mounted in several countries to the prohibition of EUTHANASIA. Thus ethics can be seen as regulating individual doctor-patient relationships, integrating doctors within a moral community of their professional peers and re?ecting societal demands for change.

Medical ethics are embedded in cultural values which evolve. Acceptance of abortion within well-de?ned legal parameters in some jurisdictions is an example of how society in?uences the way in which perceptions about ethical obligations change. Because they are often linked to the moral views predominating in society, medical ethics cannot be seen as embodying uniform standards independent of cultural context. Some countries which permit capital punishment or female genital mutilation (FGM – see CIRCUMCISION), for example, expect doctors to carry out such procedures. Some doctors would argue that their ethical obligation to minimise pain and suffering obliges them to comply, whereas others would deem their ethical obligations to be the complete opposite. The medical community attempts to address such variations by establish-ing globally applicable ethical principles through debate within bodies such as the World Medical Association (WMA) or World Psychiatric Association (WPA). Norm-setting bodies increasingly re?ect accepted concepts of human rights and patient rights within professional ethical codes.

Practical changes within society may affect the perceived balance of power within the doctor-patient relationship, and therefore have an impact on ethics. In developed societies, for example, patients are increasingly well informed about treatment options: media such as the Internet provide them with access to specialised knowledge. Social measures such as a well-established complaints system, procedures for legal redress, and guarantees of rights such as those set out in the NHS’s Patient’s Charter appear to reduce the perceived imbalance in the relationship. Law as well as ethics emphasises the importance of informed patient consent and the often legally binding nature of informed patient refusal of treatment. Ethics re?ect the changing relationship by emphasising skills such as e?ective communication and generation of mutual trust within a doctor-patient partnership.

A widely known modern code is the WMA’s International Code of Medical Ethics which seeks to provide a modern restatement of the Hippocratic principles.

Traditionally, ethical codes have sought to establish absolutist positions. The WMA code, for example, imposes an apparently absolute duty of con?dentiality which extends beyond the patient’s death. Increasingly, however, ethics are perceived as a tool for making morally appropriate decisions in a sphere where there is rarely one ‘right’ answer. Many factors – such as current emphasis on autonomy and the individual values of patients; awareness of social and cultural diversity; and the phenomenal advance of new technology which has blurred some moral distinctions about what constitutes a ‘person’ – have contributed to the perception that ethical dilemmas have to be resolved on a case-by-case basis.

An approach adopted by American ethicists has been moral analysis of cases using four fundamental principles: autonomy, bene?cence, non-male?cence and justice. The ‘four principles’ provide a useful framework within which ethical dilemmas can be teased out, but they are criticised for their apparent simplicity in the face of complex problems and for the fact that the moral imperatives implicit in each principle often con?ict with some or all of the other three. As with any other approach to problem-solving, the ‘four principles’ require interpretation. Enduring ethical precepts such as the obligation to bene?t patients and avoid harm (bene?cence and non-male?cence) may be differently interpreted in cases where prolongation of life is contrary to a patient’s wishes or where sentience has been irrevocably lost. In such cases, treatment may be seen as constituting a ‘harm’ rather than a ‘bene?t’.

The importance accorded to ethics in daily practice has undergone considerable development in the latter half of the 20th century. From being seen mainly as a set of values passed on from experienced practitioners to their students at the bedside, medical ethics have increasingly become the domain of lawyers, academic philosophers and professional ethicists, although the role of experienced practitioners is still considered central. In the UK, law and medical ethics increasingly interact. Judges resolve cases on the basis of established medical ethical guidance, and new ethical guidance draws in turn on common-law judgements in individual cases. The rapid increase in specialised journals, conferences and postgraduate courses focused on ethics is testimony to the ever-increasing emphasis accorded to this area of study. Multidisciplinary practice has stimulated the growth of the new discipline of ‘health-care ethics’ which seeks to provide uniformity across long-established professional boundaries. The trend is to set common standards for a range of health professionals and others who may have a duty of care, such as hospital chaplains and ancillary workers. Since a primary function of ethics is to ?nd reasonable answers in situations where di?erent interests or priorities con?ict, managers and health-care purchasers are increasingly seen as potential partners in the e?ort to establish a common approach. Widely accepted ethical values are increasingly applied to the previously unacknowledged dilemmas of rationing scarce resources.

In modern debate about ethics, two important trends can be identi?ed. As a result of the increasingly high pro?le accorded to applied ethics, there is a trend for professions not previously subject to widely agreed standards of behaviour to adopt codes of ethical practice. Business ethics or the ethics of management are comparatively new. At the same time, there is some debate about whether professionals, such as doctors, traditionally subject to special ethical duties, should be seen as simply doing a job for payment like any other worker. As some doctors perceive their power and prestige eroded by health-care managers deciding on how and when to ration care and pressure for patients to exercise autonomy about treatment decisions, it is sometimes argued that realistic limits must be set on medical obligations. A logical implication of patient choice and rejection of medical paternalism would appear to be a concomitant reduction in the freedom of doctors to carry out their own ethical obligations. The concept of conscientious objection, incorporated to some extent in law (e.g. in relation to abortion) ensures that doctors are not obliged to act contrary to their own personal or professional values.... ethics

an ironic ‘law’ stating that where good health care is most needed, it is usually least available. It was first stated by the Welsh GP Tudor Hart to underline the great difficulty in bringing areas of health-care poverty up to acceptable levels. See health inequalities; justice; need; rationing.... inverse care law

the ethics of population (as opposed to individual) health, including issues related to epidemiology, disease prevention, health promotion, *justice, and *equality. Public health ethics is commonly concerned with the tensions between individual *autonomy and *communitarianism and/or *utilitarianism.... public health ethics

n. the process of allocating health-care resources among a population when demand outstrips supply. Where “first come first served” is not considered an appropriate policy, access to treatment may be rationed on a basis of *need, effectiveness, or *quality of life. See equality; justice; NICE.... rationing

advice and practical help with problems associated with social circumstances. Every local authority is responsible for establishing and staffing a social service department. Basic training for social work involves completing an approved degree in social work; there are also social workers with medical and psychiatric training who are seconded for work in hospitals (see hospital social worker) and specialist social workers in areas such as criminal justice. Social workers assess the eligibility of clients for such social services as care assistants and meals on wheels or refer them to the appropriate statutory or voluntary services; difficulties may sometimes arise when the hospital *catchment area is not coterminous with the local authority. In relation to mental health, social workers may obtain court orders for *compulsory admission where necessary and provide surveillance and support for those being treated at home or in designated hostel accommodation, including those discharged from hospital. (See also aftercare.) Case work involves identifying the causes of the client’s problem and, where appropriate, advising how best to correct them and/or adapt to the circumstances.... social services

a hypothetical state, advanced by the US political philosopher John Rawls, in which decisions about social justice and the allocation of resources would be made fairly, as if by a person who must decide on society’s rules and economic structures without knowing what position he or she will occupy in that society. By removing knowledge of status, abilities, and interests, Rawls argued, one could eliminate the usual effects of egotism and personal circumstances on such decisions. Rawls maintained that any society designed on this basis would adhere to two principles: the principle of equal liberty, which gives each person the right to as much freedom as is compatible with the freedom of others, and the maximin principle, which allocates resources so that the benefit of the least advantaged people is maximized as far as possible. Rawls’s exposition, and the maximin principle in particular, have proved widely influential in discussions of welfare provision and, especially, the allocation of medical resources.... veil of ignorance