In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good reason to (...) deny assisted suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good reason to (...) deny assisted suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

This article examines Bey v. City of New York — a recent Second Circuit case where four Black firefights suffering from Pseudofolliculitis Barbae (a skin condition causing irritation when shaving which mostly affects Black men) challenged the New York City Fire Department’s Clean Shave Policy — with an intersectional approach utilizing legal theories of racial, disability, and religious discrimination.

The status of indirect discrimination is ambiguous in the current literature. This paper addresses two contemporary and related debates. First, for some, indirect discrimination is not truly a distinct kind of discrimination, but it is simply a legal construct designed to address distributive inequalities between groups. Second, even if one accepts that indirect discrimination is a distinct type of discrimination, the connection between the two kinds of discrimination, direct and indirect, is debated. For some, they are distinct act-types, while for (...) others, indirect discrimination should be conceived as a side effect of prior cases of direct discrimination. In this paper, I argue that indirect discrimination is a distinct act-type that can take place without being connected to prior instances of direct discrimination. (shrink)

Prominent among the arguments against the legalization of assisted suicide is the contention that legalization will have a disproportionately adverse, or “disparate,” impact on various vulnerable groups. There are many versions of this argument, with different advocates of this argument focusing on different vulnerable groups, and some advocates confusedly blending slippery slope and social justice concerns. Also, the weight placed on this argument by its various advocates is not uniform, with some including the argument in a list of (...) multiple, apparently similarly persuasive, reasons for not legalizing assisted suicide, while others place significant reliance on it and yet others advance the argument without any clear indication of its importance. Nonetheless, the various versions share a common core: One reason assisted suicide should not be legalized is that members of certain vulnerable groups are more likely to be pressured into requesting it, whether directly by those hostile or indifferent to their interests, or indirectly by social circumstances, such as an inability to pursue other healthcare choices. (shrink)

Prominent among the arguments against the legalization of assisted suicide is the contention that legalization will have a disproportionately adverse, or “disparate,” impact on various vulnerable groups. There are many versions of this argument, with different advocates of this argument focusing on different vulnerable groups, and some advocates confusedly blending slippery slope and social justice concerns. Also, the weight placed on this argument by its various advocates is not uniform, with some including the argument in a list of (...) multiple, apparently similarly persuasive, reasons for not legalizing assisted suicide, while others place significant reliance on it and yet others advance the argument without any clear indication of its importance. Nonetheless, the various versions share a common core: One reason assisted suicide should not be legalized is that members of certain vulnerable groups are more likely to be pressured into requesting it, whether directly by those hostile or indifferent to their interests, or indirectly by social circumstances, such as an inability to pursue other healthcare choices. (shrink)

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based (...) on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

It is usually accepted that whether or not indirect discrimination is a form of immoral discrimination, it appears to be structurally different from direct discrimination. First, it seems that either one involves the agent focusing on different things while making a decision. Second, it seems that the victim’s group membership is relevant to the outcomes of either sort of action in different ways. In virtue of these two facts, it is usually concluded that indirect discrimination is structurally different from direct (...) discrimination. I argue against the notion that indirect discrimination and direct discrimination have significantly different structures. I first argue that both kinds of discrimination involve similar decision-making processes. Second, I analyze how being in a social group affects personal identity, and from there argue that indirect discrimination and direct discrimination are about group membership similarly. In virtue of these two arguments, I conclude that direct and indirect discrimination are structurally similar. (shrink)

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based on the well-documented (...) tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed “medically inappropriate” will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

Although the same environmental regulations apply to all regions in China, legal enforcement can be different due to local economic development priorities. There is still a lack of knowledge about how regional disparities affect the operating performance results of the implementation of corporate environmental management practices, thus providing little information for foreign companies when they invest and develop their production base in China. To fill this research gap, this paper collects data from the Fortune 500 Chinese firms to investigate the (...) moderating role of regional disparities in affecting the performance results of corporate environmental management efforts based on the institutional theory. The disclosed corporate environmental responsibility practices serve as proxy to represent corporate environmental management practices. Content analysis approach was applied to collect and analyze CER practices published in the corporate reports of Chinese manufacturers. The results show that CER has a positive impact on operating income, while regional disparities influence the relationship between CER and corporate operating income. Specifically, CER and operating income are positively related in Eastern China; on the contrary, they are negatively related in Western China. This paper adds to the body of knowledge about environmental discrepancies in the same emerging economy, and provides insights for systematic consideration in terms of the issues of government environmental regulations and corporate environmental strategies. (shrink)

Although the same environmental regulations apply to all regions in China, legal enforcement can be different due to local economic development priorities. There is still a lack of knowledge about how regional disparities affect the operating performance results of the implementation of corporate environmental management practices, thus providing little information for foreign companies when they invest and develop their production base in China. To fill this research gap, this paper collects data from the Fortune 500 Chinese firms to investigate the (...) moderating role of regional disparities in affecting the performance results of corporate environmental management efforts based on the institutional theory. The disclosed corporate environmental responsibility practices serve as proxy to represent corporate environmental management practices. Content analysis approach was applied to collect and analyze CER practices published in the corporate reports of Chinese manufacturers. The results show that CER has a positive impact on operating income, while regional disparities influence the relationship between CER and corporate operating income. Specifically, CER and operating income are positively related in Eastern China; on the contrary, they are negatively related in Western China. This paper adds to the body of knowledge about environmental discrepancies in the same emerging economy, and provides insights for systematic consideration in terms of the issues of government environmental regulations and corporate environmental strategies. (shrink)

It is well documented that the language skills of preschool children differ substantially and that these differences are highly predictive of their later academic success and achievements. Especially in the early phases of children’s lives, the importance of different structural and process characteristics of the home learning environment has been emphasized and research results have documented that process characteristics such as the quality of parental interaction behavior and the frequency of joint activities vary according to the socio-economic status of the (...) family. Further, both structural and process characteristics are associated with children’s language development. As most of the studies focus on single indicators or didn’t take the dynamics of parenting behavior across age into account, the present paper aims to investigate the associations of different characteristics of the home learning environment as well as their potentially changing impact on the language skills of 2-year-old children. Using data of 2.272 families of the infant cohort study of the German National Educational Panel Study, longitudinally assessed process characteristics and structural characteristics were considered. Language skills of the children at the age of two were measured by a standardized and validated parent report instrument. Results showed that all three process characteristics of the home learning environment are associated with the family’s SES; across three assessment waves nearly all process characteristics predicted children’s vocabulary and grammar skills with some process-specific changes across waves; despite separate direct effects of nearly all HLE-process characteristics in each wave, the amount of explained variance in a joint model including the HLE facets from each wave is hardly higher than in the separate models; and socioeconomic background predicted both language facets of the children in each model even when controlling for the assessed process characteristics of the home learning environment. (shrink)

Previous research has found that funding disparities are driven by applications’ final impact scores and that only a portion of the black/white funding gap can be explained by bibliometrics and topic choice. Using National Institutes of Health R01 applications for council years 2014–2016, we examine assigned reviewers’ preliminary overall impact and criterion scores to evaluate whether racial disparities in impact scores can be explained by application and applicant characteristics. We hypothesize that differences in commensuration—the process of combining (...) criterion scores into overall impact scores—disadvantage black applicants. Using multilevel models and matching on key variables including career stage, gender, and area of science, we find little evidence for racial disparities emerging in the process of combining preliminary criterion scores into preliminary overall impact scores. Instead, preliminary criterion scores fully account for racial disparities—yet do not explain all of the variability—in preliminary overall impact scores. (shrink)

Statistical evidence is crucial throughout disparate impact’s three-stage analysis: during (1) the plaintiff’s prima facie demonstration of a policy’s disparate impact; (2) the defendant’s job-related business necessity defense of the discriminatory policy; and (3) the plaintiff’s demonstration of an alternative policy without the same discriminatory impact. The circuit courts are split on a vital question about the “practical significance” of statistics at Stage 1: Are “small” impacts legally insignificant? For example, is an employment policy that (...) causes a one percent disparate impact an appropriate policy for redress through disparate impact litigation? This circuit split calls for a comprehensive analysis of practical significance testing across disparate impact’s stages. Importantly, courts and commentators use “practical significance” ambiguously between two aspects of practical significance: the magnitude of an effect and confidence in statistical evidence. For example, at Stage 1 courts might ask whether statistical evidence supports a disparate impact (a confidence inquiry) and whether such an impact is large enough to be legally relevant (a magnitude inquiry). Disparate impact’s texts, purposes, and controlling interpretations are consistent with confidence inquires at all three stages, but not magnitude inquiries. Specifically, magnitude inquiries are inappropriate at Stages 1 and 3—there is no discriminatory impact or reduction too small or subtle for the purposes of the disparate impact analysis. Magnitude inquiries are appropriate at Stage 2, when an employer defends a discriminatory policy on the basis of its job-related business necessity. (shrink)

This book explores the ethical problems of algorithmic bias and its potential impact on populations that experience health disparities by examining the historical underpinnings of explicit and implicit bias, the influence of the social determinants of health, and the inclusion of racial and ethnic minorities in data. Over the last twenty-five years, the diagnosis and treatment of disease have advanced at breakneck speeds. Currently, we have technologies that have revolutionized the practice of medicine, such as telemedicine, precision medicine, big (...) data, and AI. These technologies, especially AI, promise to improve the quality of patient care, lower health care costs, improve patient treatment outcomes, and decrease patient mortality. AI may also be a tool that reduces health disparities; however, algorithmic bias may impede its success. This book explores the risks of using AI in the context of health disparities. It is of interest to health services researchers, ethicists, policy analysts, social scientists, health disparities researchers, and AI policy makers. (shrink)

BackgroundThe current paper follows up on the results of an exploratory quantitative analysis that compared the publication and citation records of men and women researchers affiliated with the Faculty of Computing and Engineering at Dublin City University in Ireland. Quantitative analysis of publications between 2013 and 2018 showed that women researchers had fewer publications, received fewer citations per person, and participated less often in international collaborations. Given the significance of publications for pursuing an academic career, we used qualitative methods to (...) understand these differences and explore factors that, according to women researchers, have contributed to this disparity.MethodsSixteen women researchers from DCU’s Faculty of Computing and Engineering were interviewed using a semi-structured questionnaire. Once interviews were transcribed and anonymised, they were coded by both authors in two rounds using an inductive approach.ResultsInterviewed women believed that their opportunities for research engagement and research funding, collaborations, publications and promotions are negatively impacted by gender roles, implicit gender biases, their own high professional standards, family responsibilities, nationality and negative perceptions of their expertise and accomplishments.ConclusionsOur study has found that women in DCU’s Faculty of Computing and Engineering face challenges that, according to those interviewed, negatively affect their engagement in various research activities, and, therefore, have contributed to their lower publication record. We suggest that while affirmative programmes aiming to correct disparities are necessary, they are more likely to improve organisational culture if they are implemented in parallel with bottom-up initiatives that engage all parties, including men researchers and non-academic partners, to inform and sensitise them about the significance of gender equity. (shrink)

Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in both urban and (...) rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population. (shrink)

In ‘Does zero-COVID neglect health disparities?’ we made the case that strict zero-COVID policies implemented during the coronavirus 2019 disease (COVID-19) pandemic raise health equity concerns so serious that these policies are not ethically sustainable.1 Zero-COVID, which has dominated many Pacific Rim societies, sets zero deaths from COVID-19 as a goal, and aims to reach it by forcefully containing transmission through short-term lockdowns, followed by stringent find, test, trace and isolate methods. Since the paper appeared in 2021, the Omicron variant (...) and subvariants took hold, making a strict zero goal unattainable and leading many countries to abandon it. Careful ethical analysis of zero-COVID’s impact remains crucially important, however, not only because the novel coronavirus continues to surprise us, but also to ensure lessons learnt from this pandemic are carried forward to future pandemics. In ‘Zero-COVID and health inequities’,2 Schaefer argues that it is possible to pursue zero-COVID yet offset any negative impacts on disadvantaged groups. Citing Singapore, where zero-COVID led to outbreaks in crowded and unsanitary migrant workers dormitories, Schaefer notes the government offset these effects, setting up less densely populated ‘quick build dormitories’ that caused daily case counts to drop, even while zero-COVID remained …. (shrink)

Abstract:This paper describes how anticipated age discrimination in the form of disparate treatment induces behavior that in effect constitutes gender discrimination. Potential employers often exhibit a common pattern of behavior that acts to discriminate against older workers entering a specific workplace. Women, at a decision-making point early in their lives, are aware of this pattern of discrimination. They perceive that it is important for them to establish their careers before they have a family because it will be more difficult (...) for them to enter the work force at a later age and excel at their careers. This anticipated age discrimination disparately impacts women, resulting in gender discrimination. (shrink)

This article examines how people of color can biologically inherit the deleterious effects of white racism. Drawing primarily on the field of epigenetics, I demonstrate how transgenerational racial disparities are in fact racist disparities that can be manifest physiologically, helping constitute the chemicals, hormones, cells, and fibers of the human body. Epigenetics can be used to demonstrate how white racism can have durable effects on the biological constitution of human beings that are not limited to the specific person who is (...) the target of white racism, but instead extend to that person's offspring. In this way, the field of epigenetics can help philosophers and others understand the transgenerational biological impact of social forces such as white racism. It reveals that the damage done by white racism is more extensive than critical philosophers of race might have realized, and also that interventions against white racism must address not just the economic, geographical, social, and psychological, but also the biological aspects of human existence. In particular, the article examines racist disparities in preterm birth rates and argues that the scope and significance of prenatal care for African American women must be expanded intergenerationally and include wide-scale forms of racial justice. (shrink)

Over the past two decades, we have seen an increase in the use of medical-legal partnerships in health-care and/or legal settings to address health disparities affecting vulnerable populations. MLPs increase medical teams' capacity to address social and environmental threats to patients' health, such as unsafe housing conditions, through partnership with legal professionals. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we systematically reviewed observational studies published from January 1993-January 2016 to investigate the capacity of MLPs to address (...) legal and health disparities. We identified 13 articles for qualitative analysis from an initial pool of 355 records. The resulting pool of 13 articles revealed more information regarding the capacity of MLPs to address legal outcomes than their capacity to address health outcomes; only 4 studies directly addressed the impact of MLP intervention on patient wellbeing and/or patient utilization of healthcare services. We call for further evaluation/longitudinal studies that specifically address MLPs' short and long term effects upon patient health disparities. Finally, given the demonstrated capacity of MLPs to address unmet legal needs, and their evident potential in regards to improving health outcomes, we present the MLP model as a framework to address HIV-related legal and health disparities. (shrink)

_Purpose:_ This study examined the relationship between the near dissociated phoria and disparity vergence eye movements. Convergence insufficiency (CI) patients before vergence therapy were compared to: (1) the same patients after vergence therapy; and (2) binocularly normal controls (BNC). _Methods:_ Sixteen subjects were studied—twelve BNC and four with CI. Measurements from the CI subjects were obtained before and after 18 h of vergence eye movement therapy. The near dissociated phoria was measured using the flashed Maddox rod technique. Vergence responses were (...) stimulated from 4° symmetrical disparity vergence step stimuli. The peak velocity of the vergence response and the magnitude of the fusion initiating component (FIC) from an independent component analysis (ICA) were calculated. A linear regression analysis was conducted studying the vergence peak velocity as a function of the near dissociated phoria where the Pearson correlation coefficient was computed. _Results:_ Before vergence therapy, the average with one standard deviation FIC magnitude of convergence responses from CI subjects was 0.29° ± 0.82 and significantly less than the FIC magnitude of 1.85° ± 0.84 for BNC ( p t -test reported that the FIC and near dissociated phoria before vergence therapy for CI subjects significantly increased to 1.49° ± 0.57 ( p p r = 0.87; p _Conclusion:_ The results have clinical translational impact in understanding the mechanism by which vergence therapy may be changing the vergence system leading to a sustained reduction in visual symptoms. (shrink)

Social health disparities are increasing in most countries around the world. During the past two decades, a large amount of evidence has emerged about the health consequences of social inequalities. Despite such evidence, the concept of medical fairness, as traditionally defined by the World Medical Association, has remained unchallenged and even reinforced by some scholars who emphasize that doctors should remain neutral to the socioeconomic status of their patients when providing clinical care. The inconsistency between public health and clinical care (...) perspectives raises tension between a narrow interpretation of the ethics of justice, which stresses the importance of equality and impartiality, and the ethics of care, which highlights the importance of particularity and individuality in clinical practice. This article analyzes the concept of medical fairness using the emerging evidence that demonstrates the impact of social health disparities on clinical care. It proposes a new approach of medical fairness based on equity rather than on equality and provides a consistent ethical framework based on Paul Ricoeur’s three levels of medical judgments. This integrative framework provides a better balance between public health and clinical care in medical practice. (shrink)

Web 2.0 innovations may enhance informed patient decision-making, but also raise ethical concerns about inaccurate or misleading information, damage to the doctor-patient relationship, privacy and confidentiality, and health disparities. To increase the benefits and decrease the risks of these innovations, we recommend steps to help patients assess the quality of health information on the Internet; promote constructive doctor-patient communication about new information technologies; and set standards for privacy and data security in patient-controlled health records and for point-of-service advertising.

In the forty‐year history of U.S. bioethics commissions, these government‐sanctioned forums have often demonstrated their power to address pressing problems and to enable policy change. For example, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, established in 1974, left a legacy of reports that were translated into regulations and had an enormous practical impact. And the 1982 report Splicing Life, by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical (...) and Behavioral Research, became the basis for the National Institutes of Health's Recombinant DNA Advisory Committee as well as for the Food and Drug Administration's developing “Points to Consider” when contemplating the introduction of recombinant DNA into human beings. Some efforts of bioethics commissions, however, are not tightly connected to policy change or to outcomes directly linked to a specific report. While direct policy impact is indeed a useful metric for government bioethics commissions, it is not their only legitimate utility. For instance, bioethics commissions can also be incubators for deliberation on a hot topic, giving policy‐makers time to think through options while the political heat has some time to dissipate. Or a bioethics commission may stake out a position that enables a politician to take action while not necessarily following its recommendations. (shrink)

Several experimental studies have reported that an otherwise robust regularity—the disparity between Willingness-To-Accept and Willingness-To-Pay—tends to be greatly reduced in repeated markets, posing a serious challenge to existing reference-dependent and reference-independent models alike. This article offers a new account of the evidence, based on the assumptions that individuals are affected by good and bad deals relative to the expected transaction price (price sensitivity), with bad deals having a larger impact on their utility (`bad-deal’ aversion). These features of preferences explain (...) the existing evidence better than alternative approaches, including the most recent developments of loss aversion models. (shrink)

Rare genetic diseases collectively impact millions of individuals in the United States. These patients and their families share many challenges including delayed diagnosis, lack of knowledgeable providers, and limited economic incentives to develop new therapies for small patient groups. As such, rare disease patients and families often must rely on advocacy, including both self-advocacy to access clinical care and public advocacy to advance research. However, these demands raise serious concerns for equity, as both care and research for a given (...) disease can depend on the education, financial resources, and social capital available to the patients in a given community. In this article, we utilize three case examples to illustrate ethical challenges at the intersection of rare diseases, advocacy and justice, including how reliance on advocacy in rare disease may drive unintended consequences for equity. We conclude with a discussion of opportunities for diverse stakeholders to begin to address these challenges. (shrink)

The Dobbs decision will directly affect patients and reproductive rights; it will also impact patients indirectly in many ways, one of which will be changes in the physician workforce through its impact on graduate medical education. Current residency accreditation standards require training in all forms of contraception in addition to training in the provision of abortion. State bans on abortions may diminish access to training as approximately half of obstetrics and gynecology residency programs are in states with significant (...) abortion restrictions. The Dobbs decision creates numerous hurdles for trainees and their programs. Trainees in restrictive states will have to travel to learn in a different program in a protective state. As training opportunities diminish, potentially leading to a decline in clinical skills, knowledge, and experience in the provision of abortion, the rate of complications and maternal mortality are likely to rise. This will likely have a disproportionately negative effect on preexisting disparities in reproductive health fueled by a longstanding history of systemic racism and inequities. This work aims to both define the looming problem in abortion training created by Dobbs and propose solutions to ensure that an adequate workforce is available in the future to serve patient needs. (shrink)

The purpose of this study is to explore the impact of constraining class-specific residual variances to be equal by examining and comparing the parameter estimation of a free model and a constrained model under various conditions. A Monte Carlo simulation study was conducted under several conditions, including the number of predictors, class-specific intercepts, sample size, class-specific regression weights, and class proportion to evaluate the results for parameter estimation of the free model and the restricted model. The free model yielded (...) a more accurate estimation than the restricted model for most of the conditions, but the accuracy of the free model estimation was impacted by the number of predictors, sample size, the disparity in the magnitude of class-specific slopes and intercepts, and class proportion. When equality constraints were imposed in residual variance discrepant conditions, the parameter estimates showed substantial inaccuracy for slopes, intercepts, and residual variances, especially for those in Class 2. When the residual variances were equal between the classes, the restricted model showed better performance under some conditions. (shrink)

This introduction supplies further bearing points for the conceptual map, which the introduction to the previous issue on European bioethics (2008/1) had provided for sorting out the various dimension in which the essays collected in these issues resemble and differ from each other. Special attention is devoted to communication, as diverse Christianities attend to different purposes, problems, and opportunities for normatively engaging (persuading, influencing, ruling, opposing, and converting) their surrounding secularized cultures. These differences reflect incompatible ways of conceiving Christ's acts (...) of healing, as these provide a model for His disciples' bioethics. These differences also reflect diversely rationalist and noetic epistemologies. The subtext concerns the haunting question about the enduring sustainability of a specifically Christian bioethics in Europe. As Schotsmans opts for a Roman Catholicism that is not recognized as such by his Magisterium, as Muller transforms Protestantism into a religiously nonhostile laicity, as Messer and Silva da Barbosa hope for the prophetic impact of communal “cities on the hill,” and as the Orthodox pursue the conversion of Western Europe in Greek, Russian, and Rumanian, ongoing Divine miracles present the most realistic hope. (shrink)

Synthetic biologists design and engineer organisms for a better and more sustainable future. While the manifold prospects are encouraging, concerns about the uncertain risks of genome editing affect public opinion as well as local regulations. As a consequence, biosafety and associated concepts, such as the Safe-by-design framework and genetic safeguard technologies, have gained notoriety and occupy a central position in the conversation about genetically modified organisms. Yet, as regulatory interest and academic research in genetic safeguard technologies advance, the implementation in (...) industrial biotechnology, a sector that is already employing engineered microorganisms, lags behind. The main goal of this work is to explore the utilization of genetic safeguard technologies for designing biosafety in industrial biotechnology. Based on our results, we posit that biosafety is a case of a changing value, by means of further specification of how to realize biosafety. Our investigation is inspired by the Value Sensitive Design framework, to investigate scientific and technological choices in their appropriate social context. Our findings discuss stakeholder norms for biosafety, reasonings about genetic safeguards, and how these impact the practice of designing for biosafety. We show that tensions between stakeholders occur at the level of norms, and that prior stakeholder alignment is crucial for value specification to happen in practice. Finally, we elaborate in different reasonings about genetic safeguards for biosafety and conclude that, in absence of a common multi-stakeholder effort, the differences in informal biosafety norms and the disparity in biosafety thinking could end up leading to design requirements for compliance instead of for safety. (shrink)

Recent research in epidemiology has identified a number of factors beyond access to medical care that contribute to health disparities. Among the so-called socioeconomic determinants of health are income, education, and the distribution of social capital. One factor that has been overlooked in this discussion is the effect that stigmatization can have on health. In this paper, I identify two ways that social stigma can create health disparities: directly by impacting health-care seeking behaviour and indirectly through the internalization of negative (...) interpersonal judgments. I then argue that social arrangements that foster self-respect can reduce the impact of stigmatization on health disparities. I conclude by showing how John Rawls' conception of justice can be used to address the intersection of stigma, health, and self-respect, in contrast to critics of his position, who have seen him as excessively focused on the allocation of material goods. (shrink)

Pediatric palliative care is specialized medical care for children who live with serious and life-limiting illnesses, with the central goal to improve quality of life for both children and their families. Presently, a majority of pediatric palliative care referrals are based on the traditional consultative model, in which primary providers serve as the gatekeepers to palliative care access. It is well-known that racial and ethnic healthcare disparities exist across the continuum of care, fraught with healthcare providers’ biases that impact (...) the care delivered. This includes the referral practices, allocation and utilization of palliative care services, and leaving vulnerable children and families with potentially unmet palliative care needs. We make the moral argument that the establishment of standard referral criteria for pediatric palliative care services is one simple step that must be taken to begin to address and hopefully ameliorate the impact of providers’ biases and disparities that exist within pediatric palliative care. (shrink)

The COVID-19 pandemic’s effects on mental health interact with preexisting health risks and disparities to impact varying populations differently. This study explored the relationship between demographic variables, distress and mental health, and vulnerability factors for COVID-19. An online cross-sectional study was conducted from 18 June to 17 July 2020, reflecting the impact of early phase COVID-19 pandemic and related shelter-in-place measures in the United States. Participants were adults residing in the United States, with substantial subsamples of American Indian, (...) Asian American, African-American, and Hispanic and/or Latinx participants, as well as people with disabilities and sexual minorities. Outcomes measured were depression, hopelessness, somatic complaints, anxiety-related disorders, locus of control, and a novel measure of pandemic-related distress. Data were analyzed using analyses of covariance, chi-square test, and correlation coefficients. Generally, younger individuals, and those with less financial power—across all identities—suffered more distress. When controlling for age, lower financial power was associated with higher scores on the Center for Epidemiologic Studies Depression Scale-Revised, Beck Hopelessness Scale, Patient Health Questionnaire-15, Screen for Child Anxiety Related Emotional Disorders for Adults Panic Disorder, SCARED-A generalized anxiety disorder, SCARED-A obsessive–compulsive disorder, and the COVID-19 Pandemic Distress restriction/disconnection scale. In addition, disparities were found, in general, for marginalized identities by gender, sexual orientation, and disability status. Importantly, each ethnicity subsample showed a unique pattern of relationships between COVID-19 risk variables and mental health symptoms. The results support the hypothesis that any pandemic may amplify preexisting social and financial disparities. Overall, interventions at the clinical, governmental, or health equity level should take into consideration the needs of vulnerable groups. (shrink)

This paper compares the socio-economic impact of warfare on two frontier zones of the sixth-century eastern Roman empire: the central and northern Balkans; and the northern Syrian-Mesopotamian and Armenian borderlands in the East. The theme of war damage is central to historical and archaeological work on the Balkans but plays a comparatively marginal role in research on the East. And yet the eastern provinces were affected by more intensive raiding by larger armies, and at least as regularly as the (...) Balkans. Much of the difference in perception is related to contemporary sources’ exaggerated coverage of ‘barbarian’ raiding on the Balkans, a region traditionally viewed as a neglected backwater by authors such as Procopius. Conversely, such sources portray warfare with the Sassanid Persians in the East through a ‘classicising’ lens, describing at greater length generals’ speeches, battles, campaigns and sieges. Another reason for the disparity in modern discussions of the two regions is the socio-economic recession in the northern Balkans toward the end of the sixth century. This can be at least indirectly linked to the effects of warfare between the empire and the Avar Khaganate and Slavic groups. Recovery from the devastation caused by these groups’ invasions could no longer be funded by the imperial authorities, who, by this stage, were struggling to finance wars on multiple fronts and were feeling the fiscal effects of repeated bouts of bubonic plague. Despite also suffering from this absence of central investment, eastern societies and economies enjoyed a greater degree of continuity in the final decades of the sixth century. This was because non-imperial sources of agricultural and commercial wealth in these areas encouraged elites to invest in recovery projects. Local elites’ and wider populations’ deep-rooted feelings of cultural, linguistic and religious attachment also played a role in their survival. These economic and cultural ties can in part be explained by the fact that, unlike the Balkans, these eastern provinces had enjoyed a long period of peace and stability in the fourth and fifth centuries. (shrink)

As COVID-19 keeps impacting the world, its impact is felt differently by people of different sexes and genders. International guidelines and research on gender inequalities and women’s rights during the pandemic have been published. However, data from Taiwan is lacking. This study aims to fill the gap to increase our knowledge regarding this issue and provide policy recommendations. This study is part of a more extensive project in response to the fourth state report concerning the implementation of the Convention (...) on the Elimination of All Forms of Discrimination against Women in Taiwan in 2022. We have drawn on the guidelines and documents published by the United Nations human rights bodies, conducted interviews with advocacy and professional practitioners, and hosted a study group comprising students and teachers from the National Taiwan University College of Public Health to supplement the interview data. The data were analyzed thematically. The results include five themes: (1) particular health risks to carers (primarily women); (2) COVID-related measures’ impact on women’s health and health behaviors; (3) highly gendered psychological maladjustment; (4) increase in gender-based violence and domestic violence; and (5) mental health inequities and intersectionality. The study has global implications for societies of similar sociopolitical contexts and developmental statuses. To truly live up to the standard of CEDAW and other international human rights principles, we ask that central and local government be more aware of these lived experiences and adjust their policies accordingly, accounting for gender sensitivity. (shrink)

This book provides a novel framework for understanding and revising labor markets and education policies in an era of machine learning. It posits that while learning and knowing both require thinking, learning is fundamentally different than knowing because it results in cognitive processes that change over time. Learning, in contrast to knowing, requires time and agency. Therefore, “learning algorithms”—that enable machines to modify their actions based on real-world experiences—are a fundamentally new form of artificial intelligence that have potential to be (...) even more disruptive to labor markets than prior introductions of digital technology. To explore the difference between knowing and learning, Turing’s “Imitation Game,”—that he proposed as a test for machine thinking—is expanded to include time dependence. The arguments presented in the book introduce three novel concepts: (1) Comparative learning advantage: This is a concept analogous to comparative labor advantage but arises from the disparate times required to learn new knowledge bases/skillsets. It is argued that in the future, comparative learning advantages between humans and machines will determine their division of labor. (2) Two dimensions of job performance—expertise and interpersonal: Job tasks can be sorted into two broad categories. Tasks that require expertise have stable endpoints, which makes these tasks inherently repetitive and subject to automation. Tasks that are interpersonal are highly context-dependent and lack stable endpoints, which makes these tasks inherently non-routine. Humans compared to machines have a comparative learning advantage along the interpersonal dimension, which is increasing in value economically. (3) The Learning Game is a time-dependent version of Turing’s “Imitation Game.” It is more than a thought experiment. The “Learning Game” provides a mathematical framework with quantitative criteria for training and assessing comparative learning advantages. The book is highly interdisciplinary—presenting philosophical arguments in economics, artificial intelligence, and education. It also provides data, mathematical analysis, and testable criteria that researchers in these fields will find of practical use. The book calls for a rethinking of how labor markets operate and how the education system should prepare students for future jobs. It concludes with a list of counterintuitive recommendations for future education and labor policies that all stakeholders—employers, employees, educators, students, and political leaders—should heed. (shrink)

In this article, we consider a recent trend whereby private equity available from venture capital firms is being deployed toward mission-driven initiatives in the form of impact investing. Acting as hybrid organizations, these impact investors aim to achieve financial results while also targeting companies and funds to achieve social impact. However, potential mission drift in these VCs, which we define as a decoupling between the investments made and intended aims, might become detrimental to the simultaneous financial and (...) social goals of such firms. Based on a content analysis of mission statements, we assess mission drift and the hybridization level of VC impact investors by examining their missions and their investment practices through the criteria of social and financial logic. After examining eight impact-oriented VC investors and their investments in 164 companies, we find mission drift manifest as a disparity between the means and ends in half of the VC impact investors in our sample. We discuss these findings and make suggestions for further studies. (shrink)

Fulfilling consumer expectations of corporate social responsibility can bring strategic advantage to firms. However, research on the topic is fragmented across disparate disciplines, and a comprehensive framework to connect CSR supply and demand is missing. As a result, firms often supply CSR that does not attract demand, as signified by pessimism about ethical consumerism in recent years and the inconclusive link between corporate financial and social performance. In this study, we propose a framework of strategic CSR management to define (...) how a company’s supply of CSR could meet consumer demand for ethical products by aligning managerial and consumer perspectives. We then investigate empirically whether such a strategic approach, which integrates potential demand in CSR management, would influence consumer choice of products with CSR components. Our hybrid choice modeling allows the inclusion of psychological biases caused by social desirability and cynicism to increase result validity. The findings support the explanatory power of the framework and reveal that consumers prefer some CSR elements while others adversely affect choices. This study advances the understanding of strategic CSR management and its impact on consumer choice and helps managers include the right mix of CSR characteristics in their products to satisfy ethical consumers. (shrink)

This article focuses on the early years of children from immigrant families in Germany. Research has documented disparities in young children’s development correlating with their family background, making clear the importance of early intervention. Institutional childcare—as an early intervention for children at risk—plays an important role in Germany, as 34.3% of children below the age of three and 93% of children above that age are in external childcare. This paper focuses on the extent to which children from families with a (...) background of migration differ in their social development when considering their age of entry into early external childcare. Data from the infant cohort study of the German National Educational Panel Study is used to analyze the impact of early institutional childcare before the age of 3 years on children’s social competence at the age of 5 years, controlling for gender, siblings, temperament, home learning activities, and socioeconomic status. Results show the effects of duration of early external childcare on peer problems for children from families with a background of migration, in such a way that children who attend early external childcare for more than 1 year before the age of three show less problem behavior with peers than those who attend for less than a year. These findings have equity implications for children with a migration background living in Germany, especially as the proportion of these children is trending upwards. (shrink)

The concept of Health in All Policies aims to improve the health outcomes associated with policies in an attempt to mitigate health disparities and provide optimal environments for healthier living. This multidisciplinary framework seeks to improve health through effective assessment and reformation of policy for organizations of any level and stature. The importance of integrating health in policy assessment and decision making is a key concept in the growing field of Health Impact Assessment.The World Health Organization defines Health (...) class='Hi'>Impact Assessment as “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” HIA provides a mechanism for collaboration between various sectors and disciplines bridging the gap between research, policymaking, and implementation of policies, programs, and projects affecting health outcomes. In the United States, while some HIA efforts have focused on proposed public policies, HIA has been used primarily to analyze the health effects of proposed development projects and plans related to community design and transportation. (shrink)

The concept of Health in All Policies aims to improve the health outcomes associated with policies in an attempt to mitigate health disparities and provide optimal environments for healthier living. This multidisciplinary framework seeks to improve health through effective assessment and reformation of policy for organizations of any level and stature. The importance of integrating health in policy assessment and decision making is a key concept in the growing field of Health Impact Assessment.The World Health Organization defines Health (...) class='Hi'>Impact Assessment as “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” HIA provides a mechanism for collaboration between various sectors and disciplines bridging the gap between research, policymaking, and implementation of policies, programs, and projects affecting health outcomes. In the United States, while some HIA efforts have focused on proposed public policies, HIA has been used primarily to analyze the health effects of proposed development projects and plans related to community design and transportation. (shrink)

This paper argues that the concept and role of ‘institutional racism’ in contemporary discussions of race should be reconsidered. It starts by distinguishing between ‘intrinsic institutional racism’, which holds that institutions are racist in virtue of their constitutive features, and ‘extrinsic institutional racism’, which holds that institutions are racist in virtue of their negative effects. It accepts intrinsic institutional racism, but argues that a ‘disparate impact’ conception of extrinsic conception faces a number of objections, the most serious being (...) that it has no plausible account of what it is that makes extrinsically racist institutions racist. It also argues that claims about the explanatory indispensability of institutional racism are overstated (individual racism is at least as important), critiques structural approaches to racial inequality, and suggests that there is reason to doubt whether institutional reform can provide us with all that morality may require in the racial domain. (shrink)

Responsible management competences are the skills of managers to deal with the triple bottom line, stakeholder value and moral dilemmas. In this paper, we analyse how managers develop responsible management competences and how the competences interact with capabilities at the organisational level. The paper contributes to the responsible management literature by integrating research on absorptive capacity and organisational learning. By creating intersections between these disparate research streams, this study enables a better understanding of the development of responsible management competences. (...) The paper is a systematic literature review on environmental competences, which are a type of responsible management competences referring to the managerial skills aimed at improving environmental sustainability. The findings demonstrate that managers who are able to recognize and acquire external knowledge develop environmental competences, and organisations capable of assimilating, transforming and exploiting knowledge develop environmental capabilities. The paper establishes that a dynamic and recursive relation exists between environmental competences and capabilities. Antecedents and contextual conditions specific to a sustainability context, such as eco-centric values and stakeholder pressures, influence the development of environmental competences. The study shows that environmental competences have a positive direct effect on environmental performance, and an indirect effect as a mediator between environmental capabilities and performance. (shrink)

The contribution of women to China’s economic growth and development cannot be overemphasized. Women play important social, economic, and productive roles in any economy. China remains one of the countries in the world with severe gender inequality and sex ratio at birth (SRB) imbalance. Severe gender inequality and disenfranchisement of girls with abnormally high sex ratios at birth reflect deep-rooted sexism and adversely affect girls’ development. For China to achieve economic growth, women should not be ignored and marginalized so that (...) they can contribute to the country’s growth, but the sex ratio at birth needs to be lowered because only women can contribute to growth. Thus, this study empirically predicts an asymmetric relationship between gender inequality, sex ratio at birth and economic growth, using NARDL model over the period 1980–2020. The NARDL results show that increases in gender inequality and sex ratio at birth significantly reduce economic growth in both the short and long term, while reductions in gender inequality and sex ratio at birth significantly boost economic growth in both the short and long term. Moreover, the results show the significant contribution of female labor force participation and female education (secondary and higher education) to economic growth. However, infant mortality rate significantly reduced economic growth. Strategically, the study recommends equal opportunities for women in employment, education, health, economics, and politics to reduce gender disparities and thereby promote sustainable economic growth in China. Moreover, policymakers should introduce new population policy to stabilize the sex ratio at birth, thereby promoting China’s long-term economic growth. (shrink)