Research Awards for Health Professionals: people we've funded
This list includes current and past grantholders.
Dr Guy Schofield
University of Bristol
Understanding the ethical challenges in the practice of palliative care in Uganda
Palliative care services are being set up in locations across the world using models originally developed in the UK. Differences in cultural values must be considered when setting up these services, and models should be adapted accordingly. I will explore the ethical challenges faced by palliative care professionals in these contexts so I can understand the nature of these differences and how they affect care and training in the specialty.
I will conduct semi-structured interviews with Ugandan palliative care professionals and regional trainees studying at Hospice Africa Uganda to explore the ethical challenges they face day to day. I will also set up an online survey to examine how ethical challenges and concepts vary in content in different places. I will then use empirical bioethics to formulate recommendations for palliative care practice and education, holding stakeholder workshops in Kampala and London to review the draft recommendations for changes in curricula in both countries.
The findings will directly affect healthcare training in Africa and further afield, benefiting those who provided the data. This study will also provide research training to support a career-long body of work examining these issues.
Dr Susira Suranga Dolamulla
University of York
Middle-income country solutions for a global AMR problem: innovative health financing and the regulation of ‘essential antibiotics’ in Sri Lanka
I will study the effect of antimicrobial resistance (AMR) on healthcare in Sri Lanka. Using a critical historical approach, I will examine the evolution of import and distribution policies for antibiotics, the politics of primary healthcare and universal health coverage, and the interactions between these trends and the work of the United Nations (UN) and WHO in South Asia. I will look at arguments about AMR and critically analyse current policy trends.
Using systematic reviews and health economics to develop an understanding of antibiotic use and AMR incidence in hospitals in the country, I will create pragmatic health financing models for the regulation of so-called ‘essential antibiotics’.
My findings will be discussed at two WHO Global Health Histories seminars in Colombo and Copenhagen, organised with the WHO regional office for Europe and the Sri Lankan government.
Dr Piyush Pushkar
University of Manchester
Moral and civic reasoning in the NHS
I will ask why the NHS is so important to so many people by looking at protest movements that have emerged from the service. I am interested in the moral grounds for the creation of the NHS and the opposition to reforms which do not comply with activists’ expectations of what the state should provide for its citizens. I will also ask how state altruism interacts with notions of justice.
This is a particularly apposite time to be investigating citizenship and health in Greater Manchester, since the agreement between state and citizen is being rewritten as the local authority takes control of its health and social care budget under the auspices of Devo Manc.
I intend to use an ethnographic approach, working with activists who use moral arguments in their campaigns. I will investigate their ideas about citizenship and the social contract in the UK, and how health and ill health are used by citizens to conceptualise the role of the good state in creating the conditions for a good life.
King's College London
Form, function and fashion: health, disease and pedigree dog breeding in the 20th century
Pedigree dogs are controversial; there are tight-knit breeding and showing communities who admire their appearance and preserve their lineages, but others think the dogs are man-made freaks, crippled by diseases linked to their exaggerated features and plagued by inherited conditions exacerbated by inbreeding.
I will ask how this situation arose, how vets and breeders have responded, what influenced their actions, and what the implications were for the purebred dog. I will use underexplored source material to uncover the formational and reciprocal influence of eugenics, the changing ideas of canine health, and the social and scientific contexts. I will look at the way new epistemologies, prestige and affection have influenced the bonds between fanciers and their dogs, and how these factors came together in the management of pedigree dog disease, drawing connections between historical scholarship in medicine, veterinary medicine and animal studies.
My findings will inform current debate and cover the consequences and impact of pedigree dog breeding.
Dr Ingrid Slade
University of Oxford
Clinical genomic medicine and the need for a public health ethics account
Clinical genomic medicine increasingly employs a population perspective in the use of data, but contemporary accounts of ethics and genomics tend to focus on the best interests of individuals. This does not address the new ethical problems that arise from the population approach in clinical genomic medicine, such as the use of population level datasets to interpret variants of unknown significance. An approach built upon public health ethics, which emphasises the balance between protecting and promoting the health of populations while avoiding individual harm, might be more suited to the assessment of clinical genomic practice.
I will use conceptual ethical analysis and qualitative interviews with key stakeholder groups in the UK to explore whether public health ethics can offer a more fitting account for the ethics of clinical genomic medicine. I will combine empirical and normative analysis of public health ethical values for application in clinical genomic medicine and then design practical guidance for policy regarding clinical genomic medicine.
Dr Claire Hilton
Central and North West London NHS Trust
Barbara Robb, her book ‘Sans Everything: a case to answer’, and her campaign to improve hospital care for older people (1965-1976)
I will investigate the first of many widely publicised, detailed reports concerning inadequate standards of care for older people in institutions in England. In 1967 allegations in ‘Sans Everything’ by Barbara Robb led to inquiries into NHS care. Preliminary archival searches about the book and the ensuing events have revealed a wealth of unpublished material, including: letters from the public, politicians, civil servants and lawyers; speeches; drafts of articles; notes; diaries; transcripts of phone calls and meetings; and other published material. Documents cover the period from 1965 when Robb became aware of the conditions for many older people in mental hospitals, until her untimely death in 1976, aged 62.
This study uses standard historical methodology to explore archives, documents and oral history accounts.
I will publish academic and informal papers for a range of audiences, give presentations to academic, governmental and professional organisations, and contribute to policy debate on improving care to avoid future episodes of abuse.
University of Birmingham
What is ‘moral distress’ in nursing and how should we respond to it?
I will explore the concept of moral distress among nurses in the UK and how it might be prevented and managed. This will be done in several stages using various methodologies and empirical and philosophical methods to explore experiences of moral distress and its meaning in the healthcare context. In medical ethics, moral distress is examined in a philosophical light, whereas the nursing literature takes a practical stance. Both these bodies of literature will be used to formulate a working definition of moral distress. The overarching methodology will be drawn from 'reflexive balancing', in which the ethical analysis of how we ought to conceptualise and respond to moral distress is guided and supported by interdisciplinary engagement with empirical findings.
Nurses will be interviewed about their experiences and understanding of moral distress, and the interviews will be analysed and the common themes will contribute to a refined definition of moral distress. I will then turn to what we should do to reduce moral distress among nurses.
Recommendations for future nursing practice will be made along with suggestions for ways to recognise and respond to moral distress.
Professor Dominic Wilkinson
University of Oxford
Rational decisions: the ethics of rationing in newborn intensive care
I will examine the controversial questions that arise in the care of seriously ill infants whose lives might be saved, but only at great expense. Public health systems can’t provide every treatment that parents might want for their child and I will ask if there is a way to fairly decide which infants should be treated.
I will draw on both medical ethics and medical science and address questions that doctors in newborn intensive care units (NICU) face regularly, such as how expensive is too expensive, how effective does a treatment need to be to justify the cost of treatment, should intensive care treatment be assessed on the same basis as new medicines, and how society should deal with conflicts between parents and doctors about providing treatment.
The project will aim to help NICU doctors think clearly about the ethical questions involved in rationing treatment, both in wealthy countries and low-income countries. It will provide guidelines for policies relating to costly treatment and for people who have to make these decisions.
Dr Alan Bates
University College London
London’s anti-vivisection hospitals 1896–1935
A key argument that led to the creation of anti-vivisection hospitals in London was that doctors who were involved with vivisection lacked compassion and were on a slippery slope towards human experimentation. The careers of staff and the experiences of patients at these hospitals are little known.
I aim to discover how well these hospitals met patients’ expectations and why, after several decades, they were forced to abandon their principles owing to lack of funds. Meanwhile, mainstream medical practitioners accused anti-vivisection hospitals of poor treatment due to ideological preoccupations.
This study will investigate whether professional opposition was at the root of moves to block the hospitals’ funding. Hospital archives and other sources will be used to build up a picture of the work of London’s anti-vivisection hospitals and the financial difficulties that forced them to change. I will examine the conflict between utilitarianism and virtue ethics to ask whether the morally virtuous doctor was no longer a significant concept in the early-20th century.
Professor Roger Kneebone
Imperial College London
Using simulation to document the operating theatre as a social, material and educational space
Major changes are affecting current surgical practice. Internal forces, such as new surgical techniques and changes to the processes of care, and external forces such as reduced working times and fragmented working relationships, are disrupting former patterns. But what happens in the operating theatre is shaped by practices rooted in the early 20th century. The operating theatre is a highly complex environment. Communication between professional tribes is multimodal, depending on subtle non-verbal communication and a shared interaction with materials (human tissue and instruments). Much of this activity is tacit, and written accounts or film cannot do justice to its dynamic, experiential nature.
This project aims to render such practices visible. I will use physical simulation to ‘recreate’ a typical open operation from 1985 as a dynamic 3-D enaction. The hypothesis is that bringing together surgical team members from the 1980s and using authentic instruments and equipment will prompt and capture recollections of past practices.
This could offer a valuable addition to methods of historical documentation.
Dr Andrew Morley
Guy's & St Thomas' Hospital Trust
A ‘critical history’ of anaesthesia: anaesthetic critical incidents at Guy’s Hospital in 1955-75 and the present day
A critical incident is an event which led to harm or could have led to harm if it had been allowed to progress. Systematic recording of critical incidents in hospital has only recently become standard.
I will compare historical and contemporary critical incident reports from Guy’s Hospital, the reporting systems that generated them and their potential for education. The historical set comprises 116 anaesthetic incidents occurring at Guy’s in 1955-1975.
I will use recollections of doctors and staff involved, departmental documents, contemporaneous academic literature and analyse them with assistance of experienced anaesthetic historians. I will also select suitable incidents from the current electronic reporting system at Guy’s. I will work with hospital administrative staff, anaesthetists and an experimental psychologist specialising in healthcare decision-making. I will consider the educational potential of the two sets and systems in the light of current published opinion.
I anticipate outcomes including papers in history and anaesthetic journals as well as presentations at international conferences.
Professor John Foot
University of Bristol
Franco Basaglia and Mental Health Reform in Italy, 1960–2009
In the 1960s and 1970s a movement for radical mental healthcare reform developed in Italy led by the psychiatrist Franco Basaglia. Large asylums were compared to concentration camps and Basaglia gathered support for a law passed in 1978 that shut down existing asylums and prevented others from being constructed. Although it was state law, the act’s impact was very different between regions and cities.
I will write a history of this movement and examine its legacy. I will map out the effects of the movement by looking at individual asylums. I am interested in memory – of patients, doctors and volunteers – linked to the physical sites themselves. I will use interviews, documents and detailed local studies to tell the story, examining case, theories, international links and debates, as well as the political context. I will also look into developments in mental health reform since the 1970s, the representation of the Basaglia movement in film, literature and art, and the fate of the ex-mental health asylums (as ruins, as memory, as sites of forgetting).
Dr Peter Haddad
Greater Manchester West Mental Health NHS Foundation Trust
Understanding the introduction and use of the first generation antipsychotic (FGA) drugs in the management of schizophrenia in England, 1955-1980: the clinicians’ perspective
I will examine primary sources from 1955-1980, including journal articles, letters, drug adverts and unpublished material from the archives of the British Association for Psychopharmacology and the Royal College of Psychiatrists. These sources will illustrate clinicians’ use and views of first generation antipsychotics (FGAs) to manage schizophrenia and how they altered patient management, services and doctor-patient relationships. It will also examine the role of pharmaceutical companies and the way the new treatment was discussed at education events and conferences.
Previous psychopharmacological research has focused on the views of academics and researchers who had no direct clinical experience. I will interview 12 clinical psychiatrists who worked in the NHS in England and managed people with schizophrenia between 1955 and 1980.
Interviews will be recorded and transcripts made available for future researchers, and the work will be published so that it is available for professional historians, clinical psychiatrists and the public.
Dr Katherine Burke
Consent in (dis)array? Genome-wide testing in the paediatric setting: bioethical and clinical perspectives on informed consent in practice
Until recently, genetic investigations involved microscopic examination of chromosomes or a particular section of DNA sequence. New methods look across all genes and chromosomes simultaneously which means that abnormalities may be spotted that are unrelated to the reason the test is being carried out.. Doctors might find things that are unusual, but not know what they mean, which may include potential problems for patients and their relatives.
I will examine how doctors and families of children undergoing tests talk about the possibility of these unexpected outcomes. I will look at conversations between doctors and families when gaining permission to test and when sharing the results. By talking to doctors and parents separately, I can explore what they understand about the results of these tests and how this information should be shared.
The goal of the work is to define how health professionals and parents understand the results of investigations which look across the whole genome, producing guidance, a consent form and a patient information leaflet to support this process.
Dr Joanne Gordon
The management of alcohol dependence syndrome: autonomy, compulsion and Ulysses contracts
I will explore whether people with Alcohol Dependence Syndrome (ADS, sometimes called 'alcoholism') are capable of making voluntary decisions, especially with regards to their own medical treatment. I will examine the ethical issue of when, if ever, compulsory treatment or detention of people with ADS is justified.
In particular, I will particularly look into the use (and enforcement) of Ulysses Contracts and ask whether it isthese are preferable to the main alternatives. Ulysses Contracts contain advance instructions to a third party (eg an addiction service) to force (or prevent) someone from doing something in future, even in the face of anticipated resistance (ie resistance from the person issuing the advance instruction).
This will help both individual doctors and health policy makers to make better (or at least better-informed) judgements about how to treat people with ADS.
Dr Eleni Michalopoulou
University of Liverpool
Linking past and present: the evolution of sanitary meat inspection in the UK, 1945-2013
I will study how regulations controlling the sanitary production of meat have changed in Britain since 1945. I will examine how the risks associated with meat production have been understood and managed by examining regulations and the discussions around them. This period saw the movement of responsibility for sanitary meat inspection from the British government to the European Union and the formal introduction of risk management as a concept and practical element in the design and application of regulations.
I will look at the drivers of change, which may include risks to public health and the requirements of international trade and professional interests. This review will be of interest to the meat industry, other relevant professions such as veterinarians and meat inspectors, and policy makers.
Changes to legislation have consequences for public health. By examining the historical context, this project has the potential to inform the debates that will accompany future legislative changes in the sanitary inspection of meat.
University of Nottingham
Using animals to benefit animals: how should the UK veterinary profession manage the social and ethical implications of the clinical use of donated companion animal blood and tissue?
The use of donated blood and tissue is commonplace in medicine and there is significant debate about the ethics of these practices. Changes in legislation mean that it is becoming more common in the veterinary profession. However, we are yet to see a comparable debate about the ethics of this practice. Issues include the lack of donor consent and whether animal owners understand the costs and benefits of blood and tissue banking. Developments in human medicine and innovation in animal donation are likely to also have an effect. We predict an increase in frequency, complexity and range of species involved in the UK.
We will examine the ethical basis of such practices and generate novel empirical data on the values and expectations of animal owners, vets and other stakeholders. We will identify ethical similarities and differences between the medical and veterinary fields by reviewing existing literature.
We aim to produce policy recommendations about regulation of these techniques.
Dr Zoe Fritz
University of Warwick
Fostering appropriate questioning and well-placed trust in the acute care setting: developing an ethical framework and practical policy
Patients need to trust their doctor, particularly when they are acutely ill and need hospital care. Too much, or poorly-placed trust, however, might not be beneficial.
I will explore what well-placed trust is in the acute setting, and consider the links between information sharing, communication, trust, and asking questions. I will explore if asking relevant questions and written communication might improve trust and care in the acute setting. There will be three interlinked research strands: a critical review of academic papers on trust and communication with an ethical analysis; interviews with patients, doctors, and nurses; and questionnaires using case scenarios, which will be sent to clinicians.
I will use this information to develop a practical policy for patient-doctor communication with a pro forma for sharing written information with patients in the acute medical setting.