Networks and the World Wide Web seem to provide an answer to efficiently creating and disseminating knowledge resources. Knowledge, however, is ambiguous in character, and contains both explicit (information) and tacit dimensions - the latter being difficult to value as well as to transfer. Participant identity, commitment and behaviour within the network also affect the sharing of knowledge. Hence, existing laws and norms (including property rights) which have been established on the basis of discrete transactions and monetary value-oriented exchange may (...) not be adequate to deal with the whole spectrum of knowledge transfer. A model is needed to address transfer across a large heterogeneous network. We introduce the concept of sub-networks where tacit knowledge resides and argue that considering social norms underlying trust and other informal mechanisms provides a more suitable basis for understanding the exchange of tacit knowledge. Norm establishment is complicated by the fact that values differ across cultures; however, the social norms that underpin sub-networks can sustain knowledge transfer within them. The purpose of this conceptual article is to introduce the concept of sub-networks and to identify the sub-network/network relationship as an area in which it is necessary to look beyond property rights and raise the issue of norms. We believe that an analysis of the role of social norms in knowledge sub-networks and their interaction with global networks points to a key element in understanding networks and any emerging theory of network ethics in the twenty-first century. (shrink)

Despite the importance of the co-evolution approach in various branches of research, such as strategy, organisation theory, complexity, population ecology, technology and innovation (Lewin et al., 1999; March, 1991), co-evolution has been relatively neglected in international business and ethics research (Madhok and Phene, 2001). The purpose of this article is to show how co-evolution theory provides a theoretical framework within which some issues of ethics research are addressed. Our analysis is in the context of the contrasts between business systems (North, (...) 1990), and in particular the distinction between informal systems and those systems where institutions are formalised in law. This complements the growing research on comparative corporate governance and capitalisms (Chandler and Hikino, 1990; Choi et al., 1999; Whitley, 1994). The synthesis of co-evolution and analysis of divergent institutional environments in ethics research can also complement the globalisation and MNE approaches to international business research. (shrink)

This article analyses MNCs, worker identity and the ethical vulnerability caused by over-reliance on expatriate managers and under-reliance on local managers, who are often undervalued. It is argued that MNCs not only need but also have an obligation to assess local managers’ knowledge and contributions as having not only operational and market values, but also institutional value. Local managers both give access to and form part of local social capital and the treatment they receive is an element in the CSR (...) performance of the MNCs. Recognition of the value of equal treatment creates an ethical imperative that the barriers of cultural difference be overcome. We see such an approach towards local managers as more fully taking into account the human rights of these local managers. Such a holistic approach is increasingly relevant for MNCs in the 21st century, as MNCs increasing globalize into new large emerging markets such as Brazil, Russia, India and China. (shrink)

In today''s business environment, the knowledge-based society, globalisation, and information and communication technologies (ICT) have increased the role of "intangible" values of assets and resources for all industries. As a result there is an increased role for knowledge intermediaries; one of these, advertising, plays an important role in affecting consumer choice and knowledge. Ethical issues which arise for traditional purveyors of intangibility – cultural industries such as art, music, or film, spread to advertising. Building on our perspective of the measurement (...) of intangibles we propose a new categorisation of types of goods or services, and a framework for identifying some future ethical challenges in today''s global knowledge based society. (shrink)

This paper reviews a number of huge challenges to ethical leadership in the twenty-first century and concludes that the need for global ethical leadership is not merely a desirable option, but rather – and quite literally – a matter of survival. The crises of the recent past reveal huge, and in some cases criminal, failures of both ethics and leadership in finance, business and government. We posit that mainstream economic theory’s construct of ‘homo economicus’ and its faith in the ‘invisible (...) hand’ of the market constitute deeply flawed foundations upon which alone policy may be built and, farthermore, that these problematic foundations exert substantial shaping power over the institutional and discursive landscapes in which international business is transacted. Analogously, we argue that dominant approaches to business ethics and corporate social responsibility are, if not incorrect, at least in need of revisiting in terms of questioning their basic assumptions. Instead of the smugness of Western (especially Anglo-American) attitudes towards other ways of thinking, valuing and organising, it appears clear that openness, cooperation and co-creation between the developed and developing worlds is a basic prerequisite for dealing with the global challenges facing not just leaders, but humanity as a whole. This objective of stimulating discussion between dominant and marginal voices has guided our selection of papers for this Special Issue. We have thus included not only representatives of research from within the parameters of mainstream business ethics, IB or leadership scholarship, but also innovative contributions from fields such as military history, information technology, regulation, spirituality and sociology. (shrink)

This paper posits that differences in corporate governance structure partly result from differences in institutional arrangements linked to business systems. We developed a new international triad of business systems: the Anglo-American, the Communitarian and the Emerging system, building on the frameworks of Choi et al. (British Academy of Management (Kynoch Birmingham) 1996, Management International Review 39, 257–279, 1999). A common factor determining the success of a corporate governance structure is the extent to which it is transparent to market forces. (...) Such transparency is more than pure financial transparency; as it can also be based on factors such as governmental, banking and other types of institutional transparency mechanism. There may also be a choice for firms to adopt voluntary corporate disclosure in situations where mandatory disclosure is not established. The Asian financial crisis of 1997–1999 and the more recent corporate governance scandals such as Enron, Andersen and Worldcom in the United States and Ahold and Parmalat in Europe show that corporate governance and business ethics issues exist throughout the world. As an illustration we focus on Asia’s emerging1 markets, as, both in view of the pressure of globalization and taking into account the institutional arrangements peculiar to the emerging business system, these issues are important there. Particularly for those who have to find an accommodation between the corporate governance structures and disclosure standards of the Emerging system and those of the Anglo-American and Communitarian systems. (shrink)

The influence of celebrities in the 21st century extends far beyond the traditional domain of the entertainment sector of society. During the recent Palestinian presidential elections, the Hollywood actor Richard Gere broadcast a televised message to voters in the region and stated, “Hi, I’m Richard Gere, and I’m speaking for the entire world”. Celebrities in the 21st century have expanded from simple product endorsements to global political and international diplomacy. The celebrities industry is undergoing, “mission creep”, or the expansion of (...) an enterprise beyond its original goals (Hyde, 2009 ). The global internet is one of the major drivers of this phenomenon. The contribution of this paper is to analyse this global phenomenon and the potential implications for business ethics research. (shrink)

The gulf between multinational enterprises’ focus on high income countries and the reality of 80% of the world living in developing, bottom of pyramid (Hahn, J Bus Ethics 84:313–324, 2009 ) economies could magnify the anti-globalisation movement and political backlashes in the twenty-first century. The global financial crisis of 2008 and 2009 has increased such social tensions throughout the world and creates greater challenges for, responsible leadership. In this conceptual article, the authors analyse the value and identity of local managers, (...) and the liability of foreignness caused by over-reliance on expatriate managers and under-reliance on local managers in bottom of pyramid countries (Hahn, 2009 ). It is argued that multinational enterprises need to assess local managers’ knowledge and contributions as having not only operational and market value, but also institutional value, such as access to local knowledge and local social capital; such a holistic approach will ensure fairer, equal treatment of all managers in the multinational enterprise. Responsible leadership in the twenty-first century requires a greater appreciation of local managers’ institutional value and the overcoming of any psychological distance towards local managers of bottom of pyramid countries. (shrink)

During a pandemic, where there is widespread human infection, various and varying measures are taken that are targeted at public health objectives. During the early stages of a pandemic, these objectives may focus on containing the disease and minimizing its spread, but they may switch to mitigation as the emergent infectious disease takes hold in a population. There has been considerable debate and elucidation of the ethical principles and framework for the various responses including the need to fast track research (...) and vaccine development. However, the measures imposed during a pandemic would have unintended and untoward effect on ongoing clinical research. For example, precautionary measures, such as social distancing, may hamper ongoing clinical research, because recruitment and participation of patients and healthy volunteers is a potential source of virus spread. In this paper, we argue that a framework is needed to ensure the continuity of such research. Such a framework that considers the pertinent issues would need the ‘buy in’ of the key stakeholders (policy makers, funding agencies, institutional authorities, researchers and subjects) to ensure that the issues that are ethically relevant to pandemic planning would not be neglected or overlooked. (shrink)

Background: Pulsed dye laser is the gold standard for treatment of port-wine stain birthmarks but multiple treatments are required and complete resolution is often not achieved. Posttreatment vessel recurrence is thought to be a factor that limits efficacy of PDL treatment of PWS. Imiquimod 5% cream is an immunomodulator with antiangiogenic effects. Objective: We sought to determine if application of imiquimod 5% cream after PDL improves treatment outcome. Methods: Healthy individuals with PWS were treated with PDL and then randomized to (...) apply posttreatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements for 57 PWS sites were taken at baseline and compared with measurements taken 8 weeks posttreatment. The Δa and ΔE were measured to quantify treatment outcome. Results: Two patients developed minor skin irritation. Other adverse effects were not noted. Average a was 0.43 for PDL + placebo sites and 1.27 for PDL + imiquimod sites indicating a greater reduction in erythema with imiquimod. Average E was 2.59 for PDL + placebo and 4.08 for PDL + imiquimod, again indicating a greater color improvement with imiquimod. Limitations: Effects were evaluated after a single treatment and duration of effect is unknown. Conclusion: Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy. © 2011 by the American Academy of Dermatology, Inc. (shrink)

The complex hexaploid wheat genome offers many challenges for genomics research. Expressed sequence tags facilitate the analysis of gene-coding regions and provide a rich source of molecular markers for mapping and comparison with model organisms. The objectives of this study were to construct a high-density EST chromosome bin map of wheat homoeologous group 2 chromosomes to determine the distribution of ESTs, construct a consensus map of group 2 ESTs, investigate synteny, examine patterns of duplication, and assess the colinearity with rice (...) of ESTs assigned to the group 2 consensus bin map. A total of 2600 loci generated from 1110 ESTs were mapped to group 2 chromosomes by Southern hybridization onto wheat aneuploid chromosome and deletion stocks. A consensus map was constructed of 552 ESTs mapping to more than one group 2 chromosome. Regions of high gene density in distal bins and low gene density in proximal bins were found. Two interstitial gene-rich islands flanked by relatively gene-poor regions on both the short and long arms and having good synteny with rice were discovered. The map locations of two ESTs indicated the possible presence of a small pericentric inversion on chromosome 2B. Wheat chromosome group 2 was shown to share syntenous blocks with rice chromosomes 4 and 7. (shrink)

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

A total of 1918 loci, detected by the hybridization of 938 expressed sequence tag unigenes from 26 Triticeae cDNA libraries, were mapped to wheat homoeologous group 4 chromosomes using a set of deletion, ditelosomic, and nulli-tetrasomic lines. The 1918 EST loci were not distributed uniformly among the three group 4 chromosomes; 41, 28, and 31% mapped to chromosomes 4A, 4B, and 4D, respectively. This pattern is in contrast to the cumulative results of EST mapping in all homoeologous groups, as reported (...) elsewhere, that found the highest proportion of loci mapped to the B genome. Sixty-five percent of these 1918 loci mapped to the long arms of homoeologous group 4 chromosomes, while 35% mapped to the short arms. The distal regions of chromosome arms showed higher numbers of loci than the proximal regions, with the exception of 4DL. This study confirmed the complex structure of chromosome 4A that contains two reciprocal translocations and two inversions, previously identified. An additional inversion in the centromeric region of 4A was revealed. A consensus map for homoeologous group 4 was developed from 119 ESTs unique to group 4. Forty-nine percent of these ESTs were found to be homoologous to sequences on rice chromosome 3, 12% had matches with sequences on other rice chromosomes, and 39% had no matches with rice sequences at all. Limited homology was found between wheat ESTs on homoeologous group 4 and the Arabidopsis genome. Forty-two percent of the homoeologous group 4 ESTs could be classified into functional categories on the basis of blastX searches against all protein databases. (shrink)

The objectives of this study were to develop a high-density chromosome bin map of homoeologous group 7 in hexaploid wheat, to identify gene distribution in these chromosomes, and to perform comparative studies of wheat with rice and barley. We mapped 2148 loci from 919 EST clones onto group 7 chromosomes of wheat. In the majority of cases the numbers of loci were significantly lower in the centromeric regions and tended to increase in the distal regions. The level of duplicated loci (...) in this group was 24% with most of these loci being localized toward the distal regions. One hundred nineteen EST probes that hybridized to three fragments and mapped to the three group 7 chromosomes were designated landmark probes and were used to construct a consensus homoeologous group 7 map. An additional 49 probes that mapped to 7AS, 7DS, and the ancestral translocated segment involving 7BS also were designated landmarks. Landmark probe orders and comparative maps of wheat, rice, and barley were produced on the basis of corresponding rice BAC/PAC and genetic markers that mapped on chromosomes 6 and 8 of rice. Identification of landmark ESTs and development of consensus maps may provide a framework of conserved coding regions predating the evolution of wheat genomes. (shrink)

The global corporate scandals such as Enron, Worldcom and Global Crossing have raised fundamental issues of business ethics as well as economic, social and anthropological questions concerning the nature of business competition and global capitalism. The purpose of this conceptual paper is to introduce the concept of "welfare exchange" to the existing notions of economic, social and anthropological notions of business and exchange in markets and society in the 21st century. Global competition and business success in the 21st century continue (...) to raise the nature of economic value and the interaction among diverse actors in international markets, institutions and society. We believe that the nature of such exchange between consumers and organizations, which can also be termed social marketing, need to increasingly take into account a welfare and ethical component. In this paper, we introduce our concept of welfare exchange to emphasize the importance of such welfare and ethical issues in the global business environment of the 21st century. (shrink)

One of the greatest problems facing luxury goods firms in a globalizing market is that of counterfeiting. The purpose of this paper is to analyze the different types of counterfeiting that take place in thefashion industry and the ethical issues raised. We argue that the problem partly lies in the industry itself. Copying of designs is endemic and condoned, which raises several ethical dilemmas in passing judgment on the practice of counterfeiting. We analyze the ethical issues in a number of (...) different types of counterfeiting encountered in the fashion industry. We conclude with some observations on the general implications for ethics in intellectual property rights. (shrink)

This book celebrates the work of Patricia Werhane, an iconic figure in business ethics. This festschrift is a collection of articles that build on Werhane’s contributions to business ethics in such areas as Employee Rights, the Legacy of Adam Smith, Moral Imagination, Women in Business, the development of the field of business ethics, and her contributions to such fields as Health Care, Education, Teaching, and Philosophy. All papers are new contributions to the management literature written by well-known business ethicists, such (...) as Norman Bowie, Richard De George, Ronald Duska, Edwin Hartman, Michael Hoffman, Mollie Painter-Morland, Mark Schwartz, Andrew Wicks, and others. The volume is comprised of articles that reflect on Werhane’s work as well as build on it as a way to advance further research. At the end of the festschrift, Pat Werhane provides responses to each chapter. The first chapter of the book also includes the overview of Patricia Werhane’s work and her academic career. The book is written to appeal to management scholars and graduate students interested in the areas of Business Ethics, Modern Capitalism, and Human Rights. Patricia Werhane is one of the most distinguished figures in the field of business ethics. She was a founder of the field, she is one of its leading scholars, and she has had a profound impact on the world of business practice. Among her many accomplishments, Pat is known for her original work on moral imagination, she is an acclaimed authority on employee rights in the workplace, and she is one of the leading scholars on Adam Smith. Having been active in Academia for over 50 years, Werhane is a prolific author of over a hundred articles and book chapters, and the author or editor of twenty-seven books, including Adam Smith and his Legacy for Modern Capitalism, Moral Imagination and Management Decision-Making, and co-authored books Organization Ethics in Health Care, Alleviating Poverty Through Profitable Partnerships, Obstacles to Ethical Decision-Making, Corporate Responsibility: The American Experience, and Research Approaches to Business Ethics and Corporate Responsibility. (shrink)

The ethical governance of the global Internet is an accelerating global phenomenon. A key paradox of the global Internet is that it allows individual and collective decision making to co-exist with each other. Open source software (OSS) communities are a globally accelerating phenomenon. OSS refers to groups of programs that allow the free use of the software and further the code sharing to the general and corporate users of the software. The combination of private provision and public knowledge and software, (...) and the seeming paradox of economic versus social motivations have stimulated a wide debate between researchers and policymakers. In this article, we analyze OSS communities from the viewpoint of "intrinsic motivation," knowledge creation, and collective Internet governance. We believe that the growth of global OSS has fundamental implications for business ethics and the governance of the global Internet in the twenty-first century. (shrink)

Robert Putnam in his book Bowling Alone and subsequent works has analysed the phenomenon that American society increasingly avoids various community driven activities, such as civic associations, activities with friends and family (Putnam, Bowling Alone. Simon and Schuster, New York; 2006). In this paper we introduce the idea that a counterpart to this social trend is a global addiction to fame and celebrity. We believe that the global internet is one of the major drivers of this search for fame for (...) the sake of being famous. However, most people aspiring to be famous celebrities will not succeed in this quest, and become disappointed. The purpose of this paper is to analyse the ethical implications of such social contagion, bandwagon effects in today's global business environment towards fame and celebrity. The contribution of this paper is to provide a future direction for research on business ethics in terms of this growing global phenomenon of fame and celebrity addiction. (shrink)

The topic of women and globalization raises fundamental questions on the impact of globalization on women, ethnic minorities and other socio-demographically under-represented actors in global organizations. This article seeks to integrate theories of procedural justice, psychological contracts, motivation and psychological ownership in knowledge transfer in global organizations, and the implications for women, and other under-represented actors. Our analysis concurs with current research on the need for a relativist perspective in business ethics research and one that encompasses the critical processes of (...) exchange from a cognitive perspective. Our contribution is to show that globalization is a complex process, that has different impacts on actors, an impact that can vary widely depending on, whether the actors are in a dominant situation, or as in the case of women and ethnic minorities, in a relatively socio-demographic and geo-politically under represented situation. (shrink)

Deze korte studie biedt niet de zoveelste inleiding in het denken van Spinoza, maar doet verslag van de persoonlijke, vijfentwintig jaar durende zoektocht om de vaak moeilijke thema's van Spinoza onder de knie te krijgen. Om via Spinoza's filosofie meer te begrijpen van de wereld en van het eigen leven. Om de vreugde te ervaren die dit verbeterde inzicht, in oorzaken en gevolgen, en ook in de eigen beperktheid, ons biedt. Elk hoofdstuk gaat over een onderwerp dat de auteur bijzonder (...) aanspreekt. Bestaat er een levenswil, Spinoza's conatus, die mensen voort doet leven ook onder de meest bittere omstandigheden? Is kennis en inzicht gradueel van aard? Wat is het verschil tussen adequate en inadequate kennis van de oorzaken van ons handelen? Hoe ontwikkelt een machtsstaat zich tot een rechtsstaat? (shrink)

Artikelen en lezingen uit de periode 1970-1982.

A majority of the countries in the world are still considered "developing," with a per capita income of less than U$1,000. Hahn (2008, Journal of Business Ethics 78, 711–721) recently proposed an ambitious business ethics research agenda for integrating the "bottom-of-the-pyramid" countries (Prahalad and Hart, 2002, Strategy and Competition 20, 22–14) through sustainable development and corporate citizenship. Hahn's work is among the growing field of research in comparative business ethics including the global business ethics index (Michalos, 2008, Journal of Business (...) Ethics 79(1), 9–19; Scholtens and Dam, 2008, Journal of Business Ethics 75(3), 273–284; Tsalikis and Seaton, 2008, Journal of Business Ethics 75(3), 229–238). This article is complementary to Hahn's work and it advocates an urgent need for business ethics researchers to globally integrate the bottom-of-thepyramid countries through a fundamental re-definition of the global economic triad, including the United States, Western Europe, and Japan [Ohmae, 1985, Triad Power: The Coming Shape of Global Competition (New York: Free Press)]. The definition that we propose is based on business systems and institutional perspectives that include the bottom-of-the-pyramid countries. We also propose to broaden the research in business ethics to enable comparisons across business systems indifferent income levels. (shrink)

There has been an intellectual debate at least since the 1960s in business ethics on the role of the media in relation to consumer choice driven by either habits or rationality. If consumers are totally rational, then the global media and global corporations provide just information and knowledge. If consumers are influenced by habit then large corporations and global media can greatly influence consumer choice and create problems of self-control (Ainslie, 1992, Pico Economics: The Strategic Interaction of Successive Motivational States (...) Within the Person, Cambridge University press, Cambridge). In this article, we provide a synthesis and integrated approach to this continuing debate. We provide a more institutional approach to consumer choice based on social conventions, rather than just on individual habits and lapses in self-control. (shrink)

An extensive body of literature in sociology and anthropology has shown that different societies have developed different structures for exchange of items such as goods, status and information. The purpose of this paper is to demonstrate how social exchange theory can help illuminate many of the underlying bases of different ethical perspectives in debates about social exchanges. Social exchange theory is applied to three common types of knowledge exchange – R&D joint ventures, commercial intellectual property exchange and academic exchange. Two (...) key factors that underlie different ethical perspectives are shown to be differences in structures for social exchange and differences in views of the alienability of knowledge from its originator. (shrink)

One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to reduce the indeterminacy surrounding medical decisions. (...) In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy. (shrink)

Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors’ views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents were included. (...) Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor’s considerations, the severity of the possible complications and patients’ wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage. (shrink)

OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

In a reflective and richly entertaining piece from 1979, Doug Hofstadter playfully imagined a conversation between ‘Achilles’ and an anthill (the eponymous ‘Aunt Hillary’), in which he famously explored many ideas and themes related to cognition and consciousness. For Hofstadter, the anthill is able to carry on a conversation because the ants that compose it play roughly the same role that neurons play in human languaging; unfortunately, Hofstadter’s work is notably short on detail suggesting how this magic might be achieved1. (...) Conversely in this paper - finally reifying Hofstadter’s imagination - we demonstrate how populations of simple ant-like creatures can be organised to solve complex problems; problems that involve the use of forward planning and strategy. Specifically we will demonstrate that populations of such creatures can be configured to play a strategically strong - though tactically weak - game of HeX (a complex strategic game).We subsequently demonstrate how tactical play can be improved by introducing a form of forward planning instantiated via multiple populations of agents; a technique that can be compared to the dynamics of interacting populations of social insects via the concept of meta-population. In this way although, pace Hofstadter, we do not establish that a meta-population of ants could actually hold a conversation with Achilles, we do successfully introduce Aunt Hillary to the complex, seductive charms of HeX. (shrink)