IronFleet Background and Verification History
IronFleet delves into the importance of correct software development and verification through historical insights and techniques like model checking and manual proofs. Explore its experience with ironclad application verification and the refinement process from TLA+ to Verifiable assembly. Discover the challenges it tackles and aspects it discards in pursuit of automation and modularity in Verdi.
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Health Care Ethics in the Rural Context Why It Matters James Stewart, MS
A (Quick) History of Health Care Ethics 5th Century B.C. Hippocrates 1847 American Medical Association Code of Ethics 1960s-1970s A combination of circumstances and events move health care ethics into the public view Tuskegee Syphilis Study Medical Technology and Skills
Bioethics: The integration of biology and values into a mechanism to shape the values of science in a service of human and environmental well-being.
Terminology and Concepts Morality: Shared beliefs about right and wrong conduct in a culture or society. Ethics: A systemic analysis of moral action which justifies a position through rational arguments and reflection. Ethics is how we should act in consideration of others, not how we believe or feel.
Health Care Ethics Issues: Situations or circumstances embedded with questions of morality that require attention and reflection to assure continuing on a path consistent with the correct moral direction.
Health Care Ethics Problems: There is no way to act in a situation without something of moral worth being compromised.
Ethics Conflict or Dilemma: Occurs when faced with two alternatives that are mutually exclusive; two or more ethically required courses of action diverge. Ethics Distress: The result of knowing the right course of action but feeling constrained to act by external influences often a challenge to personal or professional integrity.
Core Health Care Ethics Principles or Obligations A system of health care ethics constructed around a set of principles generally recognized and understood. Beneficence Nonmaleficence Respect for Autonomy Justice
Beneficence Benefiting others, doing good for others, preventing harm Requires action Action must be conducted with the patient s best interest as the top priority
Nonmaleficence Refraining from harming others Obligation not to harm corresponds to a right of the other person not to be harmed Exceptions for extraordinary circumstances: Self-Defense War
Respect for Autonomy Self-rule; self determination Recognizing a person s right to choose regarding healthcare Informed Consent End-of-Life Decisions
Justice Fair distribution of goods, benefits, burdens, services; ensuring fair processes in policies and laws; compensating for wrongs that have been done Rationing Socioeconomic factors of health
Ethics theories and principles provide a framework for the decision-maker to guide the resolution of medical ethics problems.
What is Rural? No consensus on an official definition. Approximately one-fifth of the overall U.S. population. Distributed over more than three-quarters of the U.S. land mass. Rural is small populations spread over vast distances (in the Western U.S. anyway).
Rural Health Only 10% of physicians practice in rural areas. Rural residents have a lower per capita income and are more likely to live below the poverty line; nearly 24% of rural children live in poverty. Between 57% and 90% of first responders in rural areas are volunteers.
Abuse of tobacco by rural adults is higher Significantly higher among rural youth; 26% of rural 8th graders v. 12.7% of urban youth. Alcohol abuse by rural inhabitants is higher 40% of rural 12th graders reported using alcohol while driving v. 25% of urban youth. Seat belt use in rural areas reported as 77.6% v. 88% nationally.
Motor vehicle related deaths in rural areas more than twice the rate in urban areas. Rural citizens are nearly twice as likely to die from unintentional injuries (other than motor vehicle accidents).
Rural Residents have higher rates of: Obesity Hypertension Diabetes Cerebrovascular disease Higher death rates from ischemic heart disease and COPD. The suicide rate among rural males is significantly higher than urban males and escalating rapidly among rural females.
Shortage of All Rural Health Care Providers Doctors RNs/NPs PAs Dentists Pharmacists Mental Health Care Services Social Workers
The Rural Good Life Peaceful Low crime Physical beauty Strong family and community ties Health care providers held in high esteem Freedom Clean air Abundance of nature
Rural Culture/Society Hardy/tough Independent Self-sufficient Stoic Strong community identification and allegiance Traditional/conservative values
Definitions of Health WHO: A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. MERRIAM-WEBSTER: the condition of being well or free from disease; the condition of being sound in body, mind, or spirit; especially: free from physical disease or pain.
Rural Definition of Health The ability to work, to do daily chores without regard to how a person feels. Health means HARDINESS.
Financial/Economic Implications Dual and Overlapping Relationships Boundary Issues Rural Health Culture Shared Decision Making Isolation Privacy and Confidentiality Cultural and Personal Values Caregiver stress Limited Resources and Access
Dual and Overlapping Relationships Multiple relationships with community members Daily contact Schools/Kids Store clerks, waitresses, town mechanic, pastor, etc. Social and civil organizations Generations of service
Privacy and Confidentiality Intentional and unintentional Patient reluctance Provider reluctance Breach can be devastating
Provider Stress and Burnout Overlapping relationships Immense clinician responsibilities Geographic and professional isolation Lack of resources
Why It Matters Likely you will have a patient or contact with rural provider. You may live or relocate to a rural area. Telemedicine or other technological interactions.
