title: The Ethical Imperative to Move to a Seven-Day Care Model.
abstract: Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery.
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, MetroNorth Hospital and Health Service, Butterfield St, Herston, 4029, Australia.|School of Medicine, University of Queensland, Brisbane, Australia.|School of Public Health, Queensland University of Technology, Brisbane, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Bell
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia. fiona.mcdonald@qut.edu.au.|Department of Bioethics, Dalhousie University, Halifax, NS, Canada. fiona.mcdonald@qut.edu.au.
authors.forename: Fiona
authors.initials: F
authors.lastname: McDonald
authors.affiliation: QEII Jubilee Hospital and Community Based Services, Metro South Health Level 5, QEII Jubilee Hospital, 360 Troughton Road Coopers Plains, Brisbane, Queensland, Australia, 4108.
authors.forename: Tania
authors.initials: T
authors.lastname: Hobson
mesh_terms: D039602:After-Hours Care / Q000941:ethics / Q000592:standards*; D000553:Ambulatory Care / Q000941:ethics / Q000592:standards*; D003695:Delivery of Health Care / Q000941:ethics* / Q000592:standards; D006291:Health Policy; D006301:Health Services Needs and Demand; D006754:Hospital Restructuring / Q000941:ethics*; D006801:Humans; D017146:Models, Organizational; D010561:Personnel Staffing and Scheduling; D011785:Quality Assurance, Health Care; D013222:State Medicine / Q000941:ethics* / Q000592:standards; D006113:United Kingdom
keywords: Delivery of healthcare; Ethics, institutional; Healthcare ethics; Healthcare reform