Prior work shows limited success in retail firms’ efforts to create socially responsible supply chains by enforcing suppliers’ compliance with labor standards, partly due to conflicting sourcing demands exerted on the supplier by siloed functional units within the retail firm. To ensure the substantive adoption of labor standards throughout its supply chain, we argue that the retail firm must improve their degree of “supply chain labor compliance integration” by minimizing cross-functional tensions in human capital, identities, processes and goals. We define (...) supply chain labor compliance integration, identify its determinant organizational practices that reduce cross-functional tensions, and explain the mechanisms by which it improves the retail firm’s supply chain labor standards performance. This work offers theoretical and practical insights on the retail firm’s capacity for managing socially responsible supply chains, and more broadly, on how systematically minimizing intra-organizational tensions arising in the pursuit of competing organizational priorities is a prerequisite for their simultaneous execution in inter-organizational business exchanges. (shrink)

An increasing number of non-governmental organisations provide humanitarian assistance, including healthcare. Some faith-based NGOs combine proselytising work with humanitarian aid. This can result in ethical dilemmas that are rarely discussed in the literature. The article explores several ethical issues, using four generic activities of faith-based NGOs: It is discriminatory to deny aid to a needy community because it provides less opportunity for proselytising work. Allocating aid to a community with fewer health needs but potential for proselytising work is unjust, since (...) it neither maximises welfare nor assists the most needy . Faith-based-NGOs may state that proselytising work combined with humanitarian assistance improves spiritual wellbeing and overall benefit. However, proselytising work creates religious doubts, which could transiently decrease wellbeing. Proselytising work is unlikely to be a perceived need of the population and, if carried out without consent, breaches the principle of autonomy. Such work also exploits the vulnerability of disaster victims. Governments that decline the assistance of a faith-based NGO involved in proselytising work may deprive the needy of aid. Three strategies are proposed: Increase knowledge to empower communities, individuals and governments; information on NGOs could be provided through an accessible register that discloses objectives, funding sources and intended spiritual activities. Clearly demarcate between humanitarian aid from proselytising work, by setting explicit guidelines for humanitarian assistance. Strengthen self-regulation by modifying the Code of Conduct of the Red Cross to state criteria for selecting communities for assistance and procedures for proselytising work. (shrink)

Sri Lanka, once a colony of Britain, gained independence in 1948. However, especially the health sector continues to use English as its main medium of communication. Such language bias leads to marginalization of those less fluent in English, and hinders achieving a higher level of health literacy. Discrimination of people or social groups based on their language is termed linguicism. Tackling linguicism requires an understanding of its historic roots and an exploration of potential links to colonial racial prejudices. Published literature (...) presents evidence that traces linguicism to language policies of the British colonial government. Though an exhaustive survey of historical records is not presented, there is reasonable evidence to suggest a close link. British colonial rule derived its justification from supremacist and racist ideology. As a result, English became the medium in all forms of official communications, a situation that persisted after independence. A similar situation exists in many parts of the worlds. We should recognize language-based discrimination and linguicism as public health issues. They are detrimental to health of vulnerable groups and have the potential to worsen health disparities. (shrink)

Engagement with genomic medicine and research has increased globally during the past few decades, including rapid developments in Sri Lanka. Genomic research is carried out in Sri Lanka on a variety of scales and with different aims and perspectives. However, there are concerns about participants' understanding of genomic research, including the validity of informed consent. This article reports a qualitative study aiming to explore the understanding, knowledge, and attitudes of the Sri Lankan public towards genomic medicine and to inform the (...) development of an effective and appropriate process for informed consent in that setting. Purposive sampling was employed. Participants were recruited from a sub-group of the public in Colombo, Sri Lanka who had either consented or refused to donate genetic material for a biobank. Data were collected using face-to-face semi-structured interviews. Interview data were transcribed verbatim and translated into English. Conventional content analysis was used. The analysis developed three key themes: a) ‘Scientific literacy’ describes an apparent lack of scientific knowledge that seems to affect a participant’s ability to understand the research, b) ‘Motivation’ describes narratives about why participants chose (not) to take part in the research, despite not understanding it, and c) ‘Trust’ describes how trust served to mitigate the apparent ethical deficit created by not being fully informed. In this article, we argue that informed trust is likely an acceptable basis for consent, particularly in settings where scientific literacy might be low. However, researchers must work to be worthy of that trust and ensure that misconceptions are actively addressed. (shrink)

Fragile states and developing countries increasingly contract out health services to non-state providers (NSPs) (such as non-governmental organisations, voluntary sector and private sector). The paper identifies ethical issues when contracts involve devolution of health services to NSPs and proposes procedures to prevent or resolve these ethical dilemmas. Ethical issues were identified by examining processes of contracting out. Health needs could be used to select areas to be contracted out and to identify service needs. Health needs comprise “disease-burden-related needs”, “health-service needs”, (...) and “urgency of health-service needs”. The mix of services should include an analysis of cost-effectiveness. NSPs should be selected fairly, without bias, and conflicts of interest during their work must be avoided. The population’s views must be respected and accountability structures established. Devolved health services should ensure equity of access to healthcare. The services ought to be sustainable and evaluated objectively. Of these issues, conflicts of interest among NSPs and sustainability of health services have not attracted attention in the literature on ethics of health policy. Fair procedures could address these ethical issues—for example, public consultation on issues; decisions based on the public consultation and made on evidence; principles of decisions stated and reasonable; decisions given adequate publicity; a mechanism established to challenge decisions; assurance that mechanisms meet the above conditions; and regular review of the policies. These procedures are complemented by improving self-governance of NSPs, countries’ development of guidelines for devolving health services, and measures to educate the public of the client countries on these issues. (shrink)

Racial bias and language discrimination are recognized in the health sector in countries such as Sri Lanka. This may extend to images used in health communication and educational literature. We analyzed the racial and ethnic representation in a sample of newspapers and websites related to health obtained over a period. Most of the human figures in health-related messages in newspapers had an overrepresentation of Caucasians. This trend was absent in websites where 73% of the images of Sri Lankans. The reasons (...) for this pattern could be due to the availability of image-quality photographs and exposure to a norm that is racially biased. For example, a majority of images in medical textbooks and prestigious journals are of white Caucasians. A predominance of such images could have two impacts. At an individual level, it would affect acquiring skills of visual diagnoses. At a societal level, it may reinforce a view that most forms of health-related knowledge are created in the West and could add to existing discrimination based on skin color (i.e., colorism). The latter is a known psychosocial stressor that contributes to psychological distress among socially disadvantaged populations and promotes behaviors adverse to health and residential segregation. These may contribute to poorer physical, mental, and infant health outcomes in dark-skinned individuals compared to lighter-skinned in the USA and Canada. Such discrimination within the health system would compromise basic human dignity, disempower patients, and violate the principle of autonomy. Sri Lankan media, the healthcare profession, and educationists need to recognize the relevance and importance of using images that appropriately reflect the realities of their own environment, its people, and patients. (shrink)

Chronic stroke survivors with severe contralesional arm paresis face numerous challenges to performing activities of daily living, which largely rely on the use of the less-affected ipsilesional arm. While use of the ipsilesional arm is often encouraged as a compensatory strategy in rehabilitation, substantial evidence indicates that motor control deficits in this arm can be functionally limiting, suggesting a role for remediation of this arm. Previous research has indicated that the nature of ipsilesional motor control deficits vary with hemisphere of (...) damage and with the severity of contralesional paresis. Thus, in order to design rehabilitation that accounts for these deficits in promoting function, it is critical to understand the relative contributions of both ipsilesional and contralesional arm motor deficits to functional independence in stroke survivors with severe contralesional paresis. We now examine motor deficits in each arm of severely paretic chronic stroke survivors with unilateral damage to determine whether hemisphere-dependent deficits are correlated with functional independence. Clinical evaluation of contralesional, paretic arm impairment was conducted with the upper extremity portion of the Fugl-Meyer assessment. Ipsilesional arm motor performance was evaluated using the Jebsen-Taylor Hand Function Test, grip strength, and ipsilesional high-resolution kinematic analysis during a visually targeted reaching task. Functional independence was measured with the Barthel Index. Functional independence was better correlated with ipsilesional than contralesional arm motor performance in the left hemisphere damage group [JTHFT: [r = −0.73, p = 0.017]; grip strength: [r = 0.64, p = 0.047]], and by contralesional arm impairment in the right hemisphere damage group [UEFM: [r = 0.66, p = 0.040]]. Ipsilesional arm kinematics were correlated with functional independence in the left hemisphere damage group only. Examination of hemisphere-dependent motor correlates of functional independence showed that ipsilesional arm deficits were important in determining functional outcomes in individuals with left hemisphere damage only, suggesting that functional independence in right hemisphere damaged participants was affected by other factors. (shrink)

Sponsorship of medical conferences by the pharmaceutical industry has led to many ethical issues, especially in resource-poor developing countries. The core issue in these instances is to reduce or avoid conflicts of interests. COI is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by secondary interests. Disruption of social trust should also be considered. This deontological approach should be complemented by a consequentialist approach. Towards this, the concept (...) ofdistal interests is introduced. DI lies beyond the immediately visible COIs and the consequences of immediate decisions. They are ‘distal’ in time or place: ‘DI in time’ means consequence of the decision in future scenarios, while ‘DI in space’ means those that impinge on other institutions or bodies. In judging the consequences, it is also necessary to consider the reality of the existing relationship between the pharmaceutical industry and organisers of conferences. In more developed countries, these relationships are governed by stricter regulations, adherence to codes of conduct by both parties and stronger institutional oversights. In contrast, developing countries such as Sri Lanka the regulatory environment is lax and the demarcation of interests between the pharmaceutical industry and the medical profession is considerably blurred. Therefore, establishing clear rules of engagement between the stakeholders should be considered as an attempt to clear the muddy waters. The paper proposes a set of guidelines to capture these approaches. (shrink)

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion (...) about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. (shrink)

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion (...) about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. (shrink)

The COVID-19 pandemic has undoubtedly become an era-defining challenge for the entire world. It has implications not only in the public health sector but also in the global economy and political landscape. The prevention strategy that has been followed in Sri Lanka is unique. Early action taken by the government and the ministry of health, being one of pre-emptive quarantining and isolation of suspected contacts even before they developed symptoms, was vital to contain the spread of the disease. During the (...) early phase, a nationwide lockdown in the form of a curfew was imposed which helped mitigate the spread of the virus. However, due to several lapses, there was a threat of community transmission; this was swiftly brought under control through ongoing government interventions. Thus, strict social/physical distancing measures enforced by the government, together with an increase in testing capacity, prevented widespread community transmission. Strictly containing the outbreaks as and when they were identified made it easier to bring the spread under control through contact tracing. In this article, we give an account of the strategy taken by Sri Lanka to mitigate the pandemic and comment on the lessons learned concerning the ethical responses to the COVID-19 crisis. (shrink)