In a globalizing world, governments are not always able or willing to regulate the social and environmental externalities of global business activities. Multi-stakeholder initiatives (MSI), defined as global institutions involving mainly corporations and civil society organizations, are one type of regulatory mechanism that tries to fill this gap by issuing soft law regulation. This conceptual paper examines the conditions of a legitimate transfer of regulatory power from traditional democratic nation-state processes to private regulatory schemes, such as MSIs. Democratic legitimacy (...) is typically concerned with input legitimacy (rule credibility, or the extent to which the regulations are perceived as justified) and output legitimacy (rule effectiveness, or the extent to which the rules effectively solve the issues). In this study, we identify MSI input legitimacy criteria (inclusion, procedural fairness, consensual orientation, and transparency) and those of MSI output legitimacy (rule coverage, efficacy, and enforcement), and discuss their implications for MSI democratic legitimacy. (shrink)

In a globalizing world, governments are not always able or willing to regulate the social and environmental externalities of global business activities. Multi-stakeholder initiatives (MSI), defined as global institutions involving mainly corporations and civil society organizations, are one type of regulatory mechanism that tries to fill this gap by issuing soft law regulation. This conceptual paper examines the conditions of a legitimate transfer of regulatory power from traditional democratic nation-state processes to private regulatory schemes, such as MSIs. Democratic legitimacy (...) is typically concerned with input legitimacy (rule credibility, or the extent to which the regulations are perceived as justified) and output legitimacy (rule effectiveness, or the extent to which the rules effectively solve the issues). In this study, we identify MSI input legitimacy criteria (inclusion, procedural fairness, consensual orientation, and transparency) and those of MSI output legitimacy (rule coverage, efficacy, and enforcement), and discuss their implications for MSI democratic legitimacy. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

A commitment to receive input from stakeholders is often obligatory in the crafting of environmental policies. This requirement is presumed to satisfy certain conditions of democracy. In this article, by drawing from pragmatism, we examine the logic of participation and prerequisites of the meaningful game of asking for and giving reasons. We elaborate the nature and significance of three components—the game, the pleadings, and the reasons. We conclude by offering the conditions under which the stakeholder game might be (...) considered legitimate. (shrink)

Stakeholder theory calls for decision makers to balance stakeholder interests, but before this can happen, management must understand how other parties view its decisions. Effective stakeholder dialogues convened to reach this understanding require management to appreciate how others perceive the risks posed by their decision. Although understanding others’ risk perception is crucial for effective communications, we do not have a clear idea of how viewing a situation from multiple stakeholder perspectives affects risk perception. Based on a (...) technique derived from risk perception studies of health and environmental issues, an experiment with 224 business students examined how an individual’s risk perception can account for both managerial and customer perspectives. Factors described as customer participation, extent of the effect, and management input, together with the respondent’s self-assessed understanding of the decision process, help categorize overall risk perceptions and are shown to be associated with behaviors based on the decision’s riskiness. Discussion includes implications for designs of business communications, including their content and transparency, and for understanding the audience for these communications. (shrink)

Although stakeholder theory is concerned with stakeholder engagement, substantive operational barometers of engagement are lacking in the literature. This theoretical paper attempts to strengthen the accountability aspect of normative stakeholder theory with a more robust notion of stakeholder engagement derived from the concept of good faith. Specifically, it draws from the labor relations field to argue that altered power dynamics are essential underpinnings of a viable stakeholder engagement mechanism. After describing the tenets of substantive engagement, (...) the paper draws from the labor relations and commercial law literatures to describe the characteristics of good faith as dialogue, negotiation, transparency, and totality of conduct; explains how they can be adapted and applied to the stakeholder context; and suggests the use of mediation and non-binding arbitration. The paper concludes by addressing anticipated objections and shortcomings and discussing implications for theory and research. (shrink)

A commitment to receive input from stakeholders is often obligatory in the crafting of environmental policies. This requirement is presumed to satisfy certain conditions of democracy. The need for stakeholder input is quite intuitive; public decision makers want to know what their constituents—or at least a limited number of them—think about certain issues. At the same time, individuals, groups, communities, and various interest groups want to learn about the plans that authoritative agencies have concerning those things that (...) affect their daily lives. In light of this widespread commitment to stakeholder input, it is surprising that little attention has been paid to the necessary conditions under which .. (shrink)

Large tracts of European rural land, mostly in the less favored areas (LFA), are devoted to low-inputs and large scale grazing systems (LSGS) with potential environmental and social functions. Although these LSGS may provide harbor for a good part of European nature values, their continuity is facing contrasting threats of intensification and abandonment. These areas, however, may be characterized by particular grazing structures and social dynamics of change that should be unveiled prior to attempts to devise rural development strategies or (...) to adapt policy frameworks in general. To wit, stakeholder interactions and legal and institutional processes are described and analyzed for the cereal-sheep system of Castile-La Mancha (CLM) in the central Iberian plain. Farmers and pastoralists still share the use of the land, but their roles and interests have changed over time, and particularly in the last 50 years. Arable farming, mainly cereal cropping, has followed an intensification path, partially tempered by the environmental constraints of the Castilian plain. Extensive pastoralism is still a secondary option of land use; in the main, sheep farmers depend on, and look to, the management practices of arable farmers. A mixed cereal and sheep operation may deliver environmental and economic benefits, but successful implementation of this strategy is only possible when the system serves the needs of both types of stakeholders. Paradoxically, the main drivers of change in the countryside overall are arrayed against this sensible and traditional agricultural system. We argue that the recent legal and institutional frameworks do not favor social cohesion and that policy-support schemes of the European Union (EU) have been, and continue to be, devised without taking into account the particular structures and social dynamic of the farming system. (shrink)

Stakeholder involvement in design is desirable from both a practical and an ethical point of view. It is difficult to do well, however, and some problems recur again and again, both of a practical nature, e.g. stakeholders acting strategically rather than openly, and of an ethical nature, e.g. power imbalances unduly affecting the outcome of the process. Hidden Design has been proposed as a method to deal with the practical problems of stakeholder involvement. It aims to do so (...) by taking the observation of stakeholder actions, rather than the outcomes of a deliberative process, as its input. Furthermore, it hides from stakeholders the fact that a design process is taking place so that they will not behave differently than they otherwise would. Both aspects of Hidden Design have raised ethical worries. In this paper I make an ethical analysis of what it means for a design process to leave participants uninformed or deceived rather than acquiring their informed consent beforehand, and to use observation of actions rather than deliberation as input for design, using Hidden Design as a case study. This analysis is based on two sets of normative guidelines: the ethical guidelines for psychological research involving deception or uninformed participants from two professional psychological organisations, and Habermasian norms for a fair and just process. It supports the conclusion that stakeholder involvement in design organised in this way can be ethically acceptable, though under a number of conditions and constraints. (shrink)

Portraying the firm as a ‘black box’, as traditional conceptions of the firm tend to do, has been strongly criticised by stakeholder theorists. This article claims, however, that the ‘black box problem’ has not been satisfactorily resolved by stakeholder theory itself. The failure to bring clarity to the internal realities of the firm has led to unacceptable conceptions of the firm from a moral agency point of view. For example, stakeholder theory tends to portray the firm as (...) an exchange system with an input-output thought model as a basis. Such a conception does not provide a credible account of moral agency and results in problematic consequences for stakeholder theory, for example when it comes to motivating the existence of corporate moral purposes and ethically acceptable foundations of stakeholder interests. (shrink)

The neglect of marginalized stakeholders is a colossal problem in both stakeholder and entrepreneurship streams of literature. To address this problem, we offer a theory of marginalized stakeholder-centric entrepreneurship. We conceptualize how firms can utilize marginalized stakeholder input actualization through which firms should process a variety of ideas, resources, and interactions with marginalized stakeholders and then filter, internalize, and, finally, realize important elements that improve a variety of related socioeconomic, ethical, racial, contextual, political, and identity issues. (...) This input actualization process enables firms to innovate with marginalized stakeholders and develop marginalized stakeholder capabilities. To this end, firms fulfill both their moral and entrepreneurial claims to marginalized stakeholders. (shrink)

This paper analyses the arguments for two competing ethical models of business. On the one hand there are theorists like Milton Friedman who claim that the sole social responsibility of business leaders is to maximise stockholder profits. On the other, there are those who argue that a business has ethical responsibilities to many stakeholders: employees, stockholders, retailers, customers, and so on. I argue that a business has ethical responsibility over those functions and purposes over which it has the most autonomous (...) control. The production and selling of products and services for customers is the primary purpose of a business. The generation of profit is a contingent purpose dependent on the exchange between the business and the customer. I define excellent functioning businesses as those that synergise the purposes of stakeholders to provide products and services with ethical outcomes. When ethical considerations and business interests between stakeholders conflict, the responsibility of a business to its customers has primacy over those related to business input stakeholders such as employees, stockholders and suppliers. (shrink)

The informal business sector has made enormous contributions to Nigeria's economic growth and development, but this sector is not given the necessary attention to transforming these businesses toward sustainability. This study explores the depth of informal business sector practices in Nigeria. It underscores the inputs of stakeholders in the transformation of businesses in the Nigerian informal sector to increase tax remittances and employment generation for job security in the Nigerian economy. Also, it underpins value chain performances to transform the informal (...) sector and rescue it from liquidation through voluntary company arrangements, administration, merger, takeover, and acquisition schemes. The study adopts a conceptual review. The research relies on extant literature relating to the antecedence of informal business sector activities in Nigeria. It relies on reports from tertiary data sources such as academic articles, books, newspapers, the Internet, and website sources. It further explores the views of researchers, covering the informal sector development and the support of the provisions of the social services in Nigeria. There is the absence of a model for the transformation and sustainability of the informal sector enterprises in Nigeria. This study recommends a model approach to address informal sector enterprises' issues and challenges necessary to transform the businesses into a formal status while supporting their sustainability and resilience. (shrink)

The idea of public or stakeholder engagement in governance of science and technology is widely accepted in many policy and academic research settings. However, this enthusiasm for stakeholder engagement has not necessarily resulted in changes of attitudes toward the role of stakeholders in the dialogue nor to the value of public knowledge, practical experience, and other inputs (like salient questions) vis-à-vis expert knowledge. The formal systems of evaluation of the stakeholder engagement activities are often focused on showing (...) that the method is efficient and works. In this article, we argue that every stakeholder engagement process should be evaluated beyond a simple assessment of the methodology and that the wider context of the stakeholder engagement activity should also be addressed. We evaluate two different stakeholder engagement activities against the existing method evaluation criteria and demonstrate their limitations for assessing the quality of a stakeholder engagement. We argue that these criteria need to be extended so that engagement processes will have a chance to improve not only policies but also their democratic legitimacy. (shrink)

Private governance raises important questions about democratic representation. Rule making is rarely based on electoral authorisation by those in whose name rules are made—typically a requirement for democratic legitimacy. This requires revisiting the role of representation in input legitimacy in transnational governance, which remains underdeveloped. Focussing on private labour governance, we contrast two approaches to the transnational representation of worker interests in global supply chains: non-governmental organisations providing representative claims versus trade unions providing representative structures. Studying the Bangladesh Accord (...) for Fire and Building Safety, we examine their interaction along three dimensions of democratic representation: 1) creating presence, 2) authorisation, and 3) accountability to affected constituents. We develop a framework that explains when representative claims and structures become complementary but also how the politics of input legitimacy shapewhoseinterests get represented. We conclude by deriving theoretical and normative implications for transnational representation and input legitimacy in global governance. (shrink)

In the December 2006 edition of Harvard Business Review, Michael Porter and Mark Kramer argue that by approaching corporate social responsibility (CSR) based on corporate priorities, strengths and abilities, firms can develop socially and fiscally responsible solutions to current CSR issues, which will provide operational and competitive advantages. We agree that an effective approach to CSR includes a mapping of strategy, risk and opportunity. However, we also caution that the identification of these to the exclusion of societal input may (...) not be to the corporation's advantage. Instead, an investment in both strategic analysis and social capital can pay off from a social and an organizational standpoint. Compared with their larger counterparts, small‐ and medium‐sized enterprises (SMEs) frequently have stronger relationships with their internal and external stakeholders that foster the development of social capital. As such, we believe that the sector offers a unique opportunity to identify additional models and frameworks in order to approach a strategic CSR model as espoused by Porter and Kramer. This paper explores a case study of one Canadian SME that uses a community development framework called Asset Based Community Development (ABCD) for its CSR programming. Because ABCD relies heavily on the development and maintenance of social capital and can be utilized to attain set objectives, we propose that it provides a supplementary framework through which the arguments of Porter and Kramer can be expanded. In applying the ABCD framework for CSR, we can begin to establish a programme that supports strategy, integrates employees and stakeholders towards a common vision, and creates unique and sustainable alternatives towards the resolution of social and corporate goals. (shrink)

This work defines various stakeholder roles to overcome the barriers to implementing Education 4.0, which were recently identified in the domain literature. The stakeholder roles are evaluated against these barriers, and such evaluation is structured as a multicriteria sorting problem. To this end, an integrated entropy-based CRITIC-CODAS-SORT under a Fermatean fuzzy environment addresses epistemic uncertainties inherent in decision-making. The FF CRITIC assigns the priority weights of the barriers, while the FF CODAS-SORT determines the high-priority stakeholder roles. A (...) case of an HEI evaluating 57 possible roles of 5 stakeholders is demonstrated here. Findings suggest the lack of collaboration, apprehensive stakeholders, cybersecurity threats, health issues, and cost as crucial barriers to the HEI. The sorting process yields 13 high-priority roles, encompassing those within the influence of the government, university management, human resource function, and educators. Various managerial insights are offered as inputs to the design of initiatives in EDUC4 implementation. (shrink)

In the December 2006 edition of Harvard Business Review , Michael Porter and Mark Kramer argue that by approaching corporate social responsibility (CSR) based on corporate priorities, strengths and abilities, firms can develop socially and fiscally responsible solutions to current CSR issues, which will provide operational and competitive advantages. We agree that an effective approach to CSR includes a mapping of strategy, risk and opportunity. However, we also caution that the identification of these to the exclusion of societal input (...) may not be to the corporation's advantage. Instead, an investment in both strategic analysis and social capital can pay off from a social and an organizational standpoint. Compared with their larger counterparts, small- and medium-sized enterprises (SMEs) frequently have stronger relationships with their internal and external stakeholders that foster the development of social capital. As such, we believe that the sector offers a unique opportunity to identify additional models and frameworks in order to approach a strategic CSR model as espoused by Porter and Kramer. This paper explores a case study of one Canadian SME that uses a community development framework called Asset Based Community Development (ABCD) for its CSR programming. Because ABCD relies heavily on the development and maintenance of social capital and can be utilized to attain set objectives, we propose that it provides a supplementary framework through which the arguments of Porter and Kramer can be expanded. In applying the ABCD framework for CSR, we can begin to establish a programme that supports strategy, integrates employees and stakeholders towards a common vision, and creates unique and sustainable alternatives towards the resolution of social and corporate goals. (shrink)

After decades of absence, the federal legalization of hemp in the U.S. positions the crop as an innovative, plant-based input for conventional products. Through an application of the diffusion of innovations theory, this study responds to identified research needs made by hemp stakeholders and the existing literature by modeling the influence of innovation characteristics on propensity to use hemp products among Vermont consumers. Findings reveal that attributes associated with relative advantage and trialability significantly influence propensity to use at least (...) one type of hemp product, as well as use multiple types of hemp products. This highlights particularly salient points for hemp stakeholders engaged in the marketing and communication of hemp products. Findings contribute to informed strategy creation for producers, institutions, and other stakeholders operating in this nascent industry, where data and research continue to be limited. (shrink)

Appraising public policies about using technoscientific innovations requires attending to the values reflected in the interests expected to be served by them. It also requires addressing questions about the efficacy of using the innovations, and about whether or not using them may occasion harmful effects ; moreover, judgments about these matters should be soundly backed by empirical evidence. Clearly, then, scientists have an important role to play in formulating and appraising these public policies. However, ethical and social values affect decisions (...) made about the criteria for identifying the range of risks, and of relevant empirical data needed for making judgments about them, that should be considered in public policy deliberations, and for determining how well claims concerning risks should be supported by the available data in order to warrant that they have a decisive role in the deliberations. Consider the case of public policies about using GMOs. Concerning the range of data: is it sufficient for risk assessment only to be informed by data relevant to investigating the risks of using GMOs that may be occasioned by way of physical/chemical/biological mechanisms directly triggered by events within their modified genomes? Or: should data pertaining to the full range of ecological and socioeconomic effects of using them, in the environments in which they are used and under the socioeconomic conditions of their use, also inform this assessment? Those interested in producing and using GMOs, in the light of their adhering to values of capital and the market, are likely to give a positive answer to the first question; those holding competing values, e.g., connected with respect for human rights and environmental sustainability, to the second. And, concerning the degree of support: the former – citing the ethical gravity of losses that would be incurred by failing to use GMOs on a wide scale – are likely to require less stringent standards of evidential appraisal than the latter. Scientists, qua scientists, however, do not have special authority in the realm of values. Thus, their judgments, about the evidential support that claims about risks have, may sometimes be reasonably contested partly on value-laden grounds – as they have been in the GMO case, where the contestation has generated considerable controversy, and continues to do so. It follows that, in the context of deliberations about public policy, unless scientists engage with representatives of all stakeholders in the outcomes of the policies – taking into account that their competing values may lead to making different decisions about what are the relevant data, as well as about the degree of support required for their claims about risks to gain the required credibility to inform the deliberations; and respecting "tempered equality" of participants in the dialogue – their trustworthiness is put into question and their authority diminished. (shrink)

This article asserts the need for the ethical analysis of regulatory policy. The article explores the conventional wisdom surrounding the proper role of government, the function of law, the role of lawmakers, the nature of business, and the relationship between business and government. It is the traditional thinking regarding these fundamental aspects of our social life which creates barriers to the ethical analysis of regulatory policy. It is argued that, in spite of the persistence of agency theories of the firm, (...) a stakeholder theory of the firm best approximates a true descriptive and normative view of business organizations. If the role of government is to maximize the full range of public — private relationships for any given series of inputs, and the role of the firms is to maximize the balance of diverse stakeholders' interests, then a stakeholders' interests paradigm becomes the natural foundation for the ethical analysis of policies which regulate business. (shrink)

Recent advancements in neuroengineering research have prompted neuroethicists to propose a variety of “ethical guidance” frameworks (e.g., principles, guidelines, framing questions, responsible research innovation frameworks, and ethical priorities) to inform this work. In this chapter, we offer a comparative analysis of five recently proposed ethical guidance frameworks (NIH neuroethics guiding principles, Nuffield Council on Bioethics, Global Neuroethics Summit Delegates, the Center for Neurotechnology’s neuroethical principles and guidelines, and the Neurotechnology Ethics Taskforce’s ethical priorities). We identify some common themes among these (...) frameworks, making explicit significant areas of convergence. We also highlight three areas of ethical consideration that have not received sufficient attention across these frameworks (extended care for research participants, cultural salience, and stakeholder input). Further attention and analysis of these three areas would improve the breadth and scope of ethical considerations for neuroengineering research. (shrink)

Attempts to employ discourse ethics for assessing communication and information technologies have tended to focus on managerial and policy-oriented contexts. These initiatives presuppose institutional resources for organizing sophisticated consultation processes that elicit stakeholder input. Drawing on Jürgen Habermas’s discourse ethics, this paper supplements those initiatives by developing a more widely usable framework for moral inquiry and reflection on problematic cyberpractices. Given the highly idealized character of discourse ethics, a usable framework must answer two questions: How should those who (...) lack organizational power conduct their moral inquiry under non-ideal conditions of discourse? How ought they to understand the moral force of the judgments they reach under such conditions? In response, I develop the heuristic implications of Habermas’s principle of universalization. To render that principle usable for non-ideal discourse, I propose a modification that yields a scalar measure of “dialogically robust” judgments that are responsive to the actual state of discussion. To illustrate the use of these principles, I sketch two case studies, which examine the moral acceptability of violent video gaming and government cyber-surveillance. (shrink)

The purpose of this paper is to explore corporate perspectives on the development and use of sustainability reports. Interviews with experts from 35 Canadian corporations were conducted. The research showed that the content of the reports was determined by following standards, conducting an internal evaluation, and other methods. Five corporations were found to develop fully integrated reports, while another 15 included some sustainability aspects in their annual reports. The extent of external stakeholder involvement in the development of the report (...) varied widely, but the majority of the corporations considered stakeholder input. Data collection was handled by a number of different individuals and groups, with sustainability departments often taking a lead role. Twenty-five corporations relied exclusively on internal personnel to write the report, with the remaining corporations using a combination of internal and external writers. A number of key challenges in developing sustainability reports were identified, including timelines, data collection, selecting content, and striking an appropriate balance in reporting. The reports were used internally in a number of different ways, including enhancing employee awareness and engagement and as an internal reference tool. A number of potential future uses of sustainability reports were also mentioned, such as improving the ability to track real-time performance. (shrink)

For a long time, researchers in the fields of psychology and neuroscience have been interested in discovering ways to boost productivity in traditionally "healthy," "clinical," and "military" populations. However, one of the biggest challenges in reaching this objective is developing personalised performance phenotypes that can be used to build interventions that are specifically catered to each individual's needs. Impact: Thanks to AI's recent advancements, we can now create individualised training, preparation, and recovery plans that are tailored to each person's unique (...) cognitive and biological profile. Concurrent AI advancements, especially in the psychological and neurological sciences, have demonstrated the importance of incorporating domain expertise and stakeholder inputs into the development of trustworthy AI. Value: This Patterns themed issue seeks original empirical work, literature reviews, and methodological papers that establish and validate precision artificial intelligence methods for human performance optimization, with a focus on modelling individual differences via state-of-the-art computational methods. (shrink)

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that (...) any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new “spaces” for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for “clinical ethics conflict coaching” can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes. (shrink)

The draft Common Frame of Reference is likely to play a prominent role in the further development of European contract law. Therefore, with a view to its acceptability it is crucial to assess the draft from the point of view of social justice.The DCFR has all the characteristics of a typical European compromise. Ideological and esthetical purists will certainly be disappointed. This is not necessarily something to be worried about. A common frame of reference is not drafted, in the first (...) place (if at all), for esthetical or ideological reasons; it is meant to provide some normative guidance in the further development of European contract law. European citizens have very different interests, preferences and opinions in relation to almost all the subjects dealt with in the DCFR. A DCFR consistently based on only one conception about the right choices would inevitably have disappointed all European citizens with a different idea of social justice in European private law. Therefore, if we really want the further Europeanization of private law we will have to accept that it will probably look rather different from both the particular Member State law that each of us is familiar with and our personal ideas of social justice. The publication of the interim outline edition of the draft CFR, which is the result of a close collaboration between hundreds of legal scholars from all Member States, has brought that message home. The characterisations of the DCFR as 'a law for big business and competent consumers' or, alternatively, as a 'massive reduction of private autonomy' are both unfounded. Overall, from the point of view of social justice, the DCFR is fairly balanced. Nevertheless, there is certainly room for improvement.Even if the DCFR is going to remain only a soft law instrument it is still likely to have a considerable influence on the further development of private law in Europe and will therefore also affect, directly or indirectly, the lives of all European citizens. For this reason it is crucial that European citizens will not only be the addressees of the CFR, or of the legislative measures based thereon, but can also rightly consider themselves as its authors. After the drafting by legal experts and the rather one-sided 'stakeholders'' input that were both organised by the European Commission it is now time for the citizens' voice. Only a meaningful input from the European and national Parliaments can provide the final CFR with the regulatory legitimacy that it needs.The level of consumer protection in the DCFR is sufficiently high for it to be acceptable as the content of an optional instrument, which could be made applicable, for example, by clicking on a 'blue button'. However, as an absolute maximum beyond which the Member States would not be allowed to go in the case of full harmonisation, it is submitted, the level of protection in the DCFR is insufficient. Moreover, the DCFR draws a sharp distinction between B2C and B2B contracts. It categorically excludes from the protection that it grants to consumers all businesses, even the smallest ones that may be as vulnerable as consumers (or even more so) when it comes to a lack of information, inexperience and dependence. This sharp distinction deviates from the law in many Member States, is not required by the EC Treaty (which is relevant with a view to the CFR's role as a toolbox for revising the acquis and for drafting new acquis), and is potentially contrary to the fundamental principle of justice that any distinction between groups of people should favour the least privileged.General private law - the bulk of the model rules contained in the DCFR - cannot be said to be 'neoliberal' as the Social Justice Group feared it would. Nor is it 'socialist' as some business stake holders warned for. It strikes a balance between autonomy and solidarity that is quite similar to the ones drawn in the modern private laws (including the case law, i.e. not merely the civil codes) of the Member States. However, where the DCFR deviates from the Principles of European Contract Law (PECL) it is always in the liberal direction.Throughout the last Century general clauses, such as good faith, have played a prominent role in promoting social justice in private law in the Member States. In fact they became delegations of law-making power to the courts in order to allow them to find just and fair solutions in new cases. This tradition was codified in the PECL. However, in the DCFR the role of good faith is narrower and deliberately so. From the point of view of social justice it is important that in the final CFR the role of good faith as an undisputed legal basis for judge-made law should be restored.The catalogue of underlying values and principles, that is meant to become the preamble to the final CFR and is likely to play a crucial role in the interpretation and further development of the CFR, brings back to the foreground some fundamental values that have played a prominent role in private law making in the Member States but that have been overshadowed, on the European level, by the narrow focus on market building. Having said that, the list of values in the DCFR could be framed so as to be more balanced. In particular, the privileged position of party autonomy as the only principle that is also contained in the black-letter model rules seems unjustified. (shrink)

This article examines the legitimacy attached to different types of multi-stakeholder data partnerships occurring in the context of sustainable development. We develop a framework to assess the democratic legitimacy of two types of data partnerships: open data partnerships and closed data partnerships. Our framework specifies criteria for assessing the legitimacy of relevant partnerships with regard to their input legitimacy as well as their output legitimacy. We demonstrate which particular characteristics of open and closed partnerships can be expected to (...) influence an analysis of their input and output legitimacy. (shrink)

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that (...) any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new spaces for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for clinical ethics conflict coaching can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes. (shrink)

Engaging stakeholders in policy making and supporting policy development with advanced information and communication technologies including policy simulation is currently high on the agenda of research. In order to involve stakeholders in providing their input to policy modeling via online means, simple techniques need to be employed such as scenario technique. Scenarios enable stakeholders to express their views in narrative text. At the other end of policy development, a frequently used approach to policy modeling is agent-based simulation. So far, (...) effective support to transform narrative text input to formal simulation statements is not widely available. In this paper, we present a novel approach to support the transformation of narrative texts via conceptual modeling into formal simulation models. The approach also stores provenance information which is conveyed via annotations of texts to the conceptual model and further on to the simulation model. This way, traceability of information is provided, which contributes to better understanding and transparency, and therewith enables stakeholders and policy modelers to return to the sources that informed the conceptual and simulation model. In this paper, we present the consistent conceptual description (CCD) as conceptual modeling approach to bridge the gap between narrative texts and formal policy models. The CCD meta-model with the underlying vocabulary for describing policy contexts is detailed. A case study introduces the application of the approach in the Open Collaboration for Policy Modeling project. (shrink)

Social norms are an important input for ethical decisions in any business context. However, the cross-cultural discovery of extant social norms presents a special challenge to international management because norms may be inscrutable to outsiders. This article considers the contribution of Integrative Social Contracts Theory (ISCT) to the analysis of social norms in business ethics. It questions the origins and dynamics of norms from a sociological perspective, and identifies a tension between prescriptive efforts to make norms obligatory and positivist (...) accounts that describe norms as evolving and unstable. In the presence of dynamic and incomplete norms, managers can either deliberate with stakeholders to make norms flexible or codify norms to make them rigid. This essay argues that deliberation is the only reliable method for anticipating emergent norms. (shrink)

In light of the many corporate scandals, social and ethical commitment of society has increased considerably, which puts pressure on companies to communicate information related to corporate social responsibility (CSR). The reasons underlying the decision by management teams to engage in ethical communication are scarcely focussed on. Thus, grounded on legitimacy and stakeholder theory, this study analyses the views management teams in large listed companies have on communication of CSR. The focus is on aspects on interest, motives/reasons, users and (...) problems related to corporate communication of CSR information. A questionnaire survey and in-depth interviews confirm that there is a distinct trend shift: towards more focus on CSR in corporate communication. Whilst this trend shift started as a reactive approach initiated by the many corporate scandals, the trend shift is now argued to be of a proactive nature focussed at preventing legitimacy concerns to arise. These findings are significant and interesting, implying that we are witnessing a transit period between two legitimacy strategies. Furthermore, the findings suggest that the way respondents argue when it comes to CSR activities coincides with consequentialism or utilitarianism, i. e. companies engage in CSR activities to avoid negative impacts instead of being driven by a will to make a social betterment or acting in accordance with what is fundamentally believed to be right to do. This provides new input to the ongoing debate about business ethics. The findings should alert national and international policy makers to the need both to increase the vigilance and capacity of the regulatory and judicial systems in the CSR context and to increase institutional pressure to enhance CSR adoption and CSR communication. Furthermore, stakeholders need to be careful in assuming that CSR communication is an evidence of a CSR commitment influencing corporate behaviour and increasing business ethics. (shrink)

The Adverse Outcome Pathway (AOP) concept is a knowledge assembly and communication tool to facilitate the transparent translation of mechanistic information into outcomes meaningful to the regulatory assessment of chemicals. The AOP framework and associated knowledgebases (KBs) have received significant attention and use in the regulatory toxicology community. However, it is increasingly apparent that the potential stakeholder community for the AOP concept and AOP KBs is broader than scientists and regulators directly involved in chemical safety assessment. In this paper (...) we identify and describe those stakeholders who currently—or in the future—could benefit from the application of the AOP framework and knowledge to specific problems. We also summarize the challenges faced in implementing pathway-based approaches such as the AOP framework in biological sciences, and provide a series of recommendations to meet critical needs to ensure further progression of the framework as a useful, sustainable and dependable tool supporting assessments of both human health and the environment. Although the AOP concept has the potential to significantly impact the organization and interpretation of biological information in a variety of disciplines/applications, this promise can only be fully realized through the active engagement of, and input from multiple stakeholders, requiring multi-pronged substantive long-term planning and strategies. (shrink)

Many of the computing systems programmed using Machine Learning are opaque: it is difficult to know why they do what they do or how they work. Explainable Artificial Intelligence aims to develop analytic techniques that render opaque computing systems transparent, but lacks a normative framework with which to evaluate these techniques’ explanatory successes. The aim of the present discussion is to develop such a framework, paying particular attention to different stakeholders’ distinct explanatory requirements. Building on an analysis of “opacity” from (...) philosophy of science, this framework is modeled after accounts of explanation in cognitive science. The framework distinguishes between the explanation-seeking questions that are likely to be asked by different stakeholders, and specifies the general ways in which these questions should be answered so as to allow these stakeholders to perform their roles in the Machine Learning ecosystem. By applying the normative framework to recently developed techniques such as input heatmapping, feature-detector visualization, and diagnostic classification, it is possible to determine whether and to what extent techniques from Explainable Artificial Intelligence can be used to render opaque computing systems transparent and, thus, whether they can be used to solve the Black Box Problem. (shrink)

We suggest that a restorative justice critique of current retributive policy and practice may well be a starting point for the development of more just and more effective approaches to sentencing, both formal and informal, and to a more effective approach to reentry for currently incarcerated persons. While restorative justice principles acknowledge the debt owed by offenders to their victims and victimized communities, this is a debt met neither by inflicting harm on the offender nor by removing the offender's rights (...) as a citizen. As a different normative theory, the measure of justice in a restorative approach is the extent to which harm caused by crime is repaired. While restorative justice may therefore demand a lot of offenders, their supporters, and community members, it also provides for the opportunity for victim input and reparation. Most importantly, the normative theory of restorative justice provides a different currency of repair and healing that could begin to displace the currency of punishment that knows no limits. While a restorative metric would certainly have its own limits and guidelines, the metric of uniformity as the primary gauge of justice process could at least be supplemented with a metric of stakeholder participation, satisfaction, accountability, reparation, and peacemaking. (shrink)

In the age of Big Data, companies and governments are increasingly using algorithms to inform hiring decisions, employee management, policing, credit scoring, insurance pricing, and many more aspects of our lives. Artificial intelligence systems can help us make evidence-driven, efficient decisions, but can also confront us with unjustified, discriminatory decisions wrongly assumed to be accurate because they are made automatically and quantitatively. It is becoming evident that these technological developments are consequential to people’s fundamental human rights. Despite increasing attention to (...) these urgent challenges in recent years, technical solutions to these complex socio-ethical problems are often developed without empirical study of societal context and the critical input of societal stakeholders who are impacted by the technology. On the other hand, calls for more ethically and socially aware AI often fail to provide answers for how to proceed beyond stressing the importance of transparency, explainability, and fairness. Bridging these socio-technical gaps and the deep divide between abstract value language and design requirements is essential to facilitate nuanced, context-dependent design choices that will support moral and social values. In this paper, we bridge this divide through the framework of Design for Values, drawing on methodologies of Value Sensitive Design and Participatory Design to present a roadmap for proactively engaging societal stakeholders to translate fundamental human rights into context-dependent design requirements through a structured, inclusive, and transparent process. (shrink)

Background This paper describes the design, implementation, and process outcomes from three public deliberations held in three tribal communities. Although increasingly used around the globe to address collective challenges, our study is among the first to adapt public deliberation for use with exclusively Indigenous populations. In question was how to design deliberations for tribal communities and whether this adapted model would achieve key deliberative goals and be well received.Methods We adapted democratic deliberation, an approach to stakeholder engagement, for use (...) with three tribal communities to respect tribal values and customs. Public deliberation convenes people from diverse backgrounds in reasoned reflection and dialogue in search of collective solutions. The deliberation planning process and design were informed by frameworks of enclave deliberation and community-based participatory research, which share key egalitarian values. The deliberations were collaboratively designed with tribal leadership and extensive partner input and involvement in the deliberations. Each deliberation posed different, locally relevant questions about genomic research, but used the same deliberation structure and measures to gauge the quality and experience of deliberation.Results A total of 52 individuals participated in the deliberations across all three sites. Deliberants were balanced in gender, spanned decades in age, and were diverse in educational attainment and exposure to health research. Overall, the deliberations were positively evaluated. Participant perceptions and external observer datasets depict three deliberations that offered intensive conversation experiences in which participants learned from one another, reported feeling respected and connected to one another, and endorsed this intensive form of engagement.Conclusion The adapted deliberations achieved key deliberative goals and were generally well received. Limitations of the study are described. (shrink)

The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive ‘high tech’ medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource (...) allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals. (shrink)

The concept of death and its relationship to organ transplantation continue to be sources of debate and confusion among academics, clinicians, and the public. Recently, an international group of scholars and clinicians, in collaboration with the World Health Organization, met in the first phase of an effort to develop international guidelines for determination of death. The goal of this first phase was to focus on the biology of death and the dying process while bracketing legal, ethical, cultural, and religious perspectives. (...) The next phase of the project will include a broader group of stakeholders in the development of clinical practice guidelines and will use expert consensus on biomedical criteria for death from the first phase as scientific input into normative deliberation about appropriate policies and practices. Surely, science alone cannot resolve the normative and philosophical questions intertwined in debates about moral status, legal and moral rights, the ethics of killing, and personhood and the nature of the self; however, scientific input is necessary for informed moral deliberation. An objective and unbiased investigation of the biology of death is independent of, and should be undertaken prior to, an analysis of the normative questions engendered by debate about determination of death. This strategy is explicitly endorsed by the International Guidelines for Determination of Death and reflects the prevailing view of these issues in the mainstream medical literature. However, this mainstream literature, exemplified by the IGDD group's recent report, does not exhibit any of the characteristics usually associated with a scientifically rigorous investigation, such as making empirically testable and falsifiable claims, a commitment to evidence and logic over authoritative assertion, or a willingness to revise hypotheses and theories in light of new evidence. Indeed, the core claims and methodologies of the mainstream medical literature on death, both of which are represented by the IGDD report, are not merely scientifically unjustified; they are not science at all. This situation creates a problem for the integrity of science and the academy, and it unjustly obscures and prevents legitimate democratic and moral deliberation about issues that, at bottom, are normative, not scientific. (shrink)

In this paper, we explore and describe what is needed to allow connected and automated vehicles to break traffic rules in order to minimise road safety risk and to operate with appropriate transparency. Reviewing current traffic rules with particular reference to two driving situations, we illustrate why current traffic rules are not suitable for CAVs and why making new traffic rules specifically for CAVs would be inappropriate. In defining an alternative approach to achieving safe CAV driving behaviours, we describe the (...) use of ethical goal functions as part of hybrid AI systems, suggesting that functions should be defined by governmental bodies with input from citizens and stakeholders. Ethical goal functions for CAVs would enable developers to optimise driving behaviours for safety under conditions of uncertainty whilst allowing for differentiation of products according to brand values. Such functions can differ between regions according to preferences for safety behaviours within that region and can be updated over time, responding to continual socio-technological feedback loops. We conclude that defining ethical goal functions is an urgent and necessary step from governmental bodies to enable the safe and transparent operation of CAVs and accelerate the reduction in road casualties they promise to achieve. (shrink)

The promotion of conservation agriculture for smallholders in sub-Saharan Africa is subject to ongoing scholarly and public debate regarding the evidence-base and the agenda-setting power of involved stakeholders. We undertake a political analysis of CA in Zambia that combines a qualitative case study of a flagship CA initiative with a quantitative analysis of a nationally representative dataset on agricultural practices. This analysis moves from an investigation of the knowledge politics to a study of how the political agendas of the actors (...) involved are shaping agrarian practices. From its initial focus on CA as soil conservation and sustainable agriculture, the framing of the initiative has evolved to accommodate shifting trends in the policy arena. In tandem with the increased focus on climate adaptation, we see an increased emphasis on private sector-led modernisation. The initiative has shifted its target group from the poorest smallholders to prospective commercial farmers, and has forged connections between its farmer-to-farmer extension network and private input suppliers and service providers. The link between CA and input intensification is reflected in national statistics as a significantly higher usage of herbicides, pesticides and mineral fertilizer on fields under CA tillage compared to other fields. We argue that the environmental and participation agendas are used to buttress CA as an environmentally and socially sustainable agricultural development strategy, while the prevailing practice is the result of a common vision for a private sector-led agricultural development shared between the implementing organisation, the donor and international organisations promoting a new green revolution in Africa. (shrink)

The energy sector contributes approximately two-thirds of global greenhouse gas emissions. In this context, the sector must adapt to new supply and demand networks for all future energy sources. The ongoing transformation in the European energy field is driven by the ambition of the European Union to reach the climate objectives set for 2030. The main actions are increasing renewable energy production, adapting transition fuels like natural gas to reduce emissions, improving energy efficiency across all economic sectors, prioritizing building, transportation, (...) and industry, developing Carbon Capture and Storage technologies, and ensuring universal access to clean and affordable energy. The significant changes envisaged in the energy sector to increase renewable energy production and consumption require improved integration and more use of predictive tools to support stakeholders' decision-making processes. This article presents a case study to assess the performance of predictive models based on a Feed-Forward Neural Network architecture that employ Root Mean Squared Propagation as their optimization function in terms of choosing the most appropriate activation function for this kind of data input and output. The training and testing phases of the models use data about building energy consumption. The lowest training time and Root Mean Square Error values were similar for Rectified Linear Unit and Tanh activation functions. The model with the Rectified linear Unit activation function performed best. (shrink)

Background In the wake of mandates for biomedical research to increase participation by members of historically underrepresented populations, community engagement (CE) has emerged as a key intervention to help achieve this goal.Methods Using interviews, observations, and document analysis, we examine how stakeholders in precision medicine research understand and seek to put into practice ideas about who to engage, how engagement should be conducted, and what engagement is for.Results We find that ad hoc, opportunistic, and instrumental approaches to CE exacted significant (...) consequences for the time and resources devoted to engagement and the ultimate impacts it has on research. Critical differences emerged when engagement and research decisionmaking were integrated with each other versus occurring in parallel, separate parts of the study organization, and whether community members had the ability to determine which issues would be brought to them for consideration or to revise or even veto proposals made upstream based on criteria that mattered to them. CE was understood to have a range of purposes, from instrumentally facilitating recruitment and data collection, to advancing community priorities and concerns, to furthering long-term investments in relationships with and changes in communities. These choices about who to engage, what engagement activities to support, how to solicit and integrate community input into the workflow of the study, and what CE was for were often conditioned upon preexisting perceptions and upstream decisions about study goals, competing priorities, and resource availability.Conclusions Upstream choices about CE and constraints of time and resources cascade into tradeoffs that often culminated in “pantomime community engagement.” This approach can create downstream costs when engagement is experienced as improvised and sporadic. Transformations are needed for CE to be seen as a necessary scientific investment and part of the scientific process. (shrink)

The expansion of research on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises important neuroethics and policy questions related to data sharing. However, there has been little empirical research on the perspectives of experts developing these technologies. We conducted semi-structured, open-ended interviews with aDBS researchers regarding their data sharing practices and their perspectives on ethical and policy issues related to sharing. Researchers expressed support for and a commitment to sharing, with most saying that they were either sharing their data (...) or would share in the future and that doing so was important for advancing the field. However, those who are sharing reported a variety of sharing partners, suggesting heterogeneity in sharing practices and lack of the broad sharing that would reflect principles of open science. Researchers described several concerns and barriers related to sharing, including privacy and confidentiality, the usability of shared data by others, ownership and control of data (including potential commercialization), and limited resources for sharing. They also suggested potential solutions to these challenges, including additional safeguards to address privacy issues, standardization and transparency in analysis to address issues of data usability, professional norms and heightened cooperation to address issues of ownership and control, and streamlining of data transmission to address resource limitations. Researchers also offered a range of views on the sensitivity of neural activity data (NAD) and data related to mental health in the context of sharing. These findings are an important input to deliberations by researchers, policymakers, neuroethicists, and other stakeholders as they navigate ethics and policy questions related to aDBS research. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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BackgroundBesides balancing burdens and benefits of intensive care, ethical conflicts in the process of decision-making should also be recognised. This calls for an ethical analysis relevant to clinicians. The aim was to analyse ethically difficult situations in the process of deciding whether a patient is admitted to intensive care unit.MethodsAnalysis using the ‘Dilemma method’ and ‘wide reflective equilibrium’, on ethnographic data of 45 patient cases and 96 stakeholder interviews in six UK hospitals.Ethical analysisFour moral questions and associated value conflicts (...) were identified. Who should have the right to decide whether a patient needs to be reviewed? Conflicting perspectives on safety/security. Does the benefit to the patient of getting the decision right justify the cost to the patient of a delay in making the decision? Preventing longer-term suffering and understanding patient’s values conflicted with preventing short-term suffering and provision of security. To what extent should the intensivist gain others’ input? Professional independence versus a holistic approach to decision-making. Should the intensivist have an ongoing duty of care to patients not admitted to ICU? Short-term versus longer-term duty to protect patient safety. Safety and security were key values at stake in the ethical conflicts identified. The life-threatening nature of the situation meant that the principle of autonomy was overshadowed by the duty to protect patients from harm. The need to fairly balance obligations to the referred patient and to other patients was also recognised.ConclusionProactive decision-making including advance care planning and escalation of treatment decisions may support the inclusion of patient autonomy. However, our analysis invites binary choices, which may not sufficiently reflect reality. This calls for a complementary relational ethics analysis. (shrink)

BackgroundCarefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/aids, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/aids (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency (...) as ‘interacting layers’.MethodsUsing a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulnerability and resilience of young people living with HIV/aids, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability.ResultsALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.ConclusionsThe most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities. (shrink)

Urban agriculture has, forcenturies, served as a vital input in thelivelihood strategies of urban households inthe developing countries. As a response to theeconomic crises exacerbated by the structuraladjustment programs and increasing migration,urban agriculture has expanded rapidly withinthe last 20 years. An examination of thegeneral trends in urban agriculture reveals anumber of issues policy-makers in developingcountries should address to provide services toensure a sustainable behavior towards urbancultivation. Most important is the legalizationof urban agriculture as a step towards securinglands for the (...) urban poor. The illegal statushas left a governance vacuum, which should befilled through policy formulation and regularinstitutionalized management in a participatorymanner including all relevant stakeholders iffood security has to be increased andenvironment improved in an urban developmentcontext. (shrink)

To be successful, policy must anticipate a broad range of constituents. Yet, all too often, technology policy is written with primarily mainstream populations in mind. In this article, drawing on Value Sensitive Design and discount evaluation methods, we introduce a new method—Diverse Voices—for strengthening pre-publication technology policy documents from the perspective of underrepresented groups. Cost effective and high impact, the Diverse Voices method intervenes by soliciting input from “experiential” expert panels. We first describe the method. Then we report on (...) two case studies demonstrating its use: one with a white paper on augmented reality technology with expert panels on people with disabilities, people who were formerly or currently incarcerated, and women; and the other with a strategy document on automated driving vehicle technologies with expert panels on youth, non-car drivers, and extremely low-income people. In both case studies, panels identified significant shortcomings in the pre-publication documents which, if addressed, would mitigate some of the disparate impact of the proposed policy recommendations on these particular stakeholder groups. Our discussion includes reflection on the method, evidence for its success, its limitations, and future directions. (shrink)