Access, equity and the role of rights in health care

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally. In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values-liberty and equity-can be evaluated and assessed.

Refinement of the Clinical Scenario Evaluation Framework for Assessment of Competing Development Strategies with an Application to Multiple Sclerosis

When competing strategies for development programs, clinical trial designs, or data analysis methods exist, the alternatives need to be evaluated in a systematic way to facilitate informed decision making. Here we describe a refinement of the recently proposed clinical scenario evaluation framework for the assessment of competing strategies. The refinement is achieved by subdividing key elements previously proposed into new categories, distinguishing between quantities that can be estimated from preexisting data and those that cannot and between aspects under the control of the decision maker from those that are determined by external constraints. The refined framework is illustrated by an application to a design project for an adaptive seamless design for a clinical trial in progressive multiple sclerosis.

Spiritual capital: the co-evolution of an ethical framework based on Abrahamic religious values in the Islamic tradition

Purpose – The aim of this paper is to investigate how values from within Abrahamic religions could be adopted to improve liberal market economies’ (LMEs’) corporate governance business practices. Design/methodology/approach – The concept of spiritual capitalism is explained from an Islamic perspective by adopting three universal Abrahamic values to critically analyse LMEs and offer an ethical alternative to current capitalism concerns. Findings – It is found that LMEs can be improved by considering all stakeholders, putting ethics before economics, and introducing shared risk/reward plus lower debt. Originality/value – The paper compares LMEs/Co-ordinated market economies (CMEs)/Islamic countries economies (ICEs) within an ethical framework for LMEs.

Out of the ivory tower: the impact of wider social contact on the values, religious beliefs and identities of Chinese postgraduate students in the UK

This article explores the impact of wider social contact on the experience of Chinese postgraduate students of adaptation to life in the UK. Focus group and individual interviews were conducted with a group of 11 Chinese students on an MA programme at a university in southern England and individual interviews with three representatives of a local volunteer group (LVG) offering support to the Chinese students. Although it was perceived that the students’ support needs were not adequately met by the University, the additional support offered outside the University was unanimously valued and considered as enriching their cultural and linguistic experiences and meeting their expectations. However, frequent social contact with the LVG, whose members were mostly Christians, also had an impact on their values, religious beliefs and identities. In a discussion framed within the sociological perspective of proselytization or religious conversion and the broad framework of international education and globalization, the different responses to this contact are described in terms of believers, doubters, empathisers and commentators. Implications are considered for universities, people involved in providing social support for international students, and sponsors of international students.

Online data processing consent under EU law: a theoretical framework and empirical evidence from the UK

This article analyses the results of an empirical study on the 200 most popular UK-based websites in various sectors of e-commerce services. The study provides empirical evidence on unlawful processing of personal data. It comprises a survey on the methods used to seek and obtain consent to process personal data for direct marketing and advertisement, and a test on the frequency of unsolicited commercial emails (UCE) received by customers as a consequence of their registration and submission of personal information to a website. Part One of the article presents a conceptual and normative account of data protection, with a discussion of the ethical values on which EU data protection law is grounded and an outline of the elements that must be in place to seek and obtain valid consent to process personal data. Part Two discusses the outcomes of the empirical study, which unveils a significant departure between EU legal theory and practice in data protection. Although a wide majority of the websites in the sample (69%) has in place a system to ask separate consent for engaging in marketing activities, it is only 16.2% of them that obtain a consent which is valid under the standards set by EU law. The test with UCE shows that only one out of three websites (30.5%) respects the will of the data subject not to receive commercial communications. It also shows that, when submitting personal data in online transactions, there is a high probability (50%) of incurring in a website that will ignore the refusal of consent and will send UCE. The article concludes that there is severe lack of compliance of UK online service providers with essential requirements of data protection law. In this respect, it suggests that there is inappropriate standard of implementation, information and supervision by the UK authorities, especially in light of the clarifications provided at EU level.

Biodiversity, cultural pathways, and human health: a framework

Direct contact with biodiversity is culturally important in a range of contexts. Many people even join conservation organisations to protect biodiversity that they will never encounter first-hand. Despite this, we have little idea how biodiversity affects people's well-being and health through these cultural pathways. Human health is sensitive to apparently trivial psychological stimuli, negatively affected by the risk of environmental degradation, and positively affected by contact with natural spaces. This suggests that well-being and health should be affected by biodiversity change, but few studies have begun to explore these relationships. Here, we develop a framework for linking biodiversity change with human cultural values, well-being, and health. We argue that better understanding these relations might be profoundly important for biodiversity conservation and public health.

Assessing the ability of rural agrarian areas to provide Cultural Ecosystem Services (CES): a Multi Scale Social Indicator Framework (MSIF)

Assessing the ways in which rural agrarian areas provide Cultural Ecosystem Services (CES) is proving difficult to achieve. This research has developed an innovative methodological approach named as Multi Scale Indicator Framework (MSIF) for capturing the CES embedded into the rural agrarian areas. This framework reconciles a literature review with a trans-disciplinary participatory workshop. Both of these sources reveal that societal preferences diverge upon judgemental criteria which in turn relate to different visual concepts that can be drawn from analysing attributes, elements, features and characteristics of rural areas. We contend that it is now possible to list a group of possible multi scale indicators for stewardship, diversity and aesthetics. These results might also be of use for improving any existing European indicators frameworks by also including CES. This research carries major implications for policy at different levels of governance, as it makes possible to target and monitor policy instruments to the physical rural settings so that cultural dimensions are adequately considered. There is still work to be developed on regional specific values and thresholds for each criteria and its indicator set. In practical terms, by developing the conceptual design within a common framework as described in this paper, a considerable step forward towards the inclusion of the cultural dimension in European wide assessments can be made.

Striking a balance: cultural conflicts or cultural adaptation

This paper explores the cultural representations embedded in the EFL textbooks for Primary English language education in China. In particular, it examines how cultural globalisation and localisation are competing with each other as the educational policy in English attempts to strike a balance between the local culture and ‘western’ culture. Using discourse analysis as an analytical framework, this paper argues that culture as a social construct is constantly evolving and traditions are fused with new cultural values and worldviews brought about by globalisation. As such, the analysis of the textbooks illustrates that culture as a social phenomenon has changed over the decades and glocalisation is gaining new perspectives in English language education in China. Importantly, the analysis shows that new cultural elements have been established and cultural globalisation has taken place when local culture adapt ‘foreign’ cultures to suit local needs. Acknowledging that there are cultural conflicts and competing ideologies in the texts, the paper argues that these conflicts and contradictories can be used to develop students’ critical language awareness and foster their critical analytical abilities. Importantly, the analysis can facilitate the students’ English language learning by providing them with opportunities to read beyond texts per se to cultural politics and practices. Juxtaposing different cultural and ideological perspectives can help students understand that cultural values are socially and politically constructed when they are confronted with complex linguistic and cultural environments in reality.

The dark side of brand attachment: a conceptual framework of brand attachment's detrimental outcomes

Brand attachment recently has received great attention among practitioners and academics alike. Scholars consider brand attachment a key requisite in consumer-brand relationships that create favourable consumer behaviours such as positive brand attitudes and brand loyalty. Few studies, however, examine the detrimental outcomes of brand attachment. In this paper, we develop a conceptual framework that explores how brand attachment may explain detrimental consumer behaviours, such as oppositional brand loyalty and antibrand actions. We investigate consumers' trash-talking and schadenfreude in brand communities and their subsequent outcomes. Our framework reveals that the link between brand attachment and oppositional brand loyalty is driven by consumers' social identity and sense of rivalry. Furthermore, we put forward that brand attachment leads to anti-brand actions when relationships deteriorate. We identify two factors behind the deterioration: (1) companies' opportunism activities, and (2) incongruity between consumers' values and the brand's values. Theoretical and managerial implications are discussed arising from our emerging 'dark side' brand attachment framework.

Resilience in crisis reconsidered: the need for values against relativist ethics

The need for a reconsideration of resilience from both a positive and a normative point of view can be discussed using some of the lessons and conclusions drawn from individual resilience studied by psychologists in an educational context. The main point made in this article is that unless we want to approach resilience as a feature which is exogenously given in each population and society and whose dynamics, if any, are not subject to deliberate actions and policies, we need a framework for the evaluation of resilience as a social good. Relying on the hope that resilience is necessarily built in our societies as a force guaranteeing convergence to a socially desirable point of social evolution may be too optimistic and even counterproductive, because it may lead us to an inefficient or biased political and regulatory decision making. When the effect of policies and actions at a national or international level take into account the dynamic effect of such actions on resilience itself, one cannot blindly rely on the goodness of the process any more. This is mainly because resilience is not uniformly embodied in all societies and it does not have a globally positive social value by itself. The issue of socially valuing the options available beyond market-price valuations becomes fundamental in this context.