1. Foreword. Man's every act is an act of faith; generally, an unconscious faith; seldom, an examined faith; never, a faith that by taking thought could have been replaced by assured certainties. All this appears whenever we stop to “rationalize” our conduct. Whatever that conduct may have been, it can be made to appear reasonable only if some propositions are taken to be true, others false. Or, perhaps the more experienced and less exacting mind would feel the reasonableness of its (...) actions to have been as well established as might be, if it could show the premises with which its acts were consistent to be more likely true than false; those with whose truth they were inconsistent, more likely false than true. Either way of putting it points to the one moral; namely, that, apart from incalculable chance, there is nothing but one's judgment in the matter of premises to determine all that one's life can come to know of fruition or frustration. Nothing, then, can be more important to any man than to do all he can to assure the soundness of his reasons for the faith that is in him; i.e. to test the weight of evidence supporting the working hypotheses on which he is willing to act. But to have considered the evidence for the hypotheses on which he has acted or is prepared to act, could be practically useful only to one who had in one way or another come by a sound idea of the evidence on which one should act, if one's actions are not to end in disappointment. The result at which a man's thought on this matter of evidence may have arrived, will constitute his theory of evidence; and the task of constructing the soundest possible theory of evidence is the undertaking of philosophy. (shrink)

4. The Mind's Lawmaking: Critical Idealism. Pleased with something dramatic in the phrase, we often characterize experiment as “a question put to Nature.” But if there be anything flattering to our state in Nature's submission to our questioning, there can be nothing grateful to our heart in her manner of answering. “Are we all to die?” Nature answers, “Yes.” “Will the sun that warmed our fathers last out our children?” Nature answers, “No.” Thus Nature giveth and Nature taketh away; her (...) complaisance ends with letting us know her way with us. (shrink)

The study ascertained (1) whether an observer's scope of justice with reference to either the moral agent or the target person of a moral act, would affect his/her judgements of the ethicality of the act, and (2) whether observer judgements of ethicality parallel the moral agent's decision processes in systematically evaluating the intensity of the moral issue. A scenario approach was used. Results affirmed both research questions. Discussions covered the implications of the findings for the underlying cognitive processes of moral (...) judgements, for the link between judgements of fairness and ethicality, as well as for the debate of ethical absolutism versus relativism. (shrink)

The Toronto experience suggests that there may be several general lessons for academic health sciences complexes to learn from the Olivieri/Apotex affair regarding the ethics, independence, and integrity of clinical research sponsored by for profit enterprises. From a local perspective, the OAA occurred when there already was a focus on the complex and changing relationships among the University of Toronto, its medical school, the fully affiliated teaching hospitals, and off campus faculty because of intertwined interests and responsibilities. The OAA became (...) a catalyst that accelerated various systemic reforms, particularly concerning academic/industry relations. In this article, the evolving governance framework for the Toronto academic health sciences complex is reviewed and these policy and process reforms discussed. These reforms have created collaborative activity among research ethics boards and contract research offices of the partner institutions, and allowed the joint university/hospital ethics centre to play a role in governance and policy, while respecting the missions and mandates of the involved institutions. Although few of the policies are dramatically innovative, what is arguably novel is the elaboration of an overarching governance framework that aims to move ethics to a central focus in the academic complex. Time alone will tell how sustainable and effective these changes are. (shrink)

s This paper reports studies designed to examine perceptions of preferential selection. Subjects evaluated the fairness of hypothetical cases of selection decisions based on either candidate sex or ethnic origin. A within-subjects design and a between-subjects design yielded convergent results showing that (1) preferential selection was perceived as unfair, irrespective of respondent sex or the basis for the preferential treatment (i.e., candidate sex or ethnic origin), (2) the level of perceived injustice was directly related to the discrepancy in merits between (...) the successful minority candidate and the more qualified yet unsuccessful majority candidate, and (3) the provision of either an ethical or legislative justification for the selection decisions further exacerbated feelings of injustice. Possible interpretations for the findings and practical implications of the study were then discussed. (shrink)

The rational-agent frame of reference for the analysis of corporate strategic decision-making may be expanded to a moral-agent perspective where decision content is seen as comprising both commercial and ethical factors. Relevant factors may then be classified on the basis of the ethical decision principles to which they relate: rational-egoism, self-referential altruism or deontology. This approach is then applied to the problem of decision support for strategic divestment by MNCs.

The American Urological Association (AUA) and American College of Surgeons (ACS) codes of professionalism require surgeons to disclose the specific roles and responsibilities of trainees to patients during the informed consent process. The objective of this study is to analyze how these requirements are met by urology training programs. An anonymous electronic survey was distributed to the program directors (PDs) of the 143 Accreditation Council for Graduate Medical Education urology residency programs in the United States in 2021. Information was collected (...) regarding program demographics, aspects of the program’s consent process, and the disclosure to patients of the role and participation of residents in their surgery. There were 49 responses to the survey (34.3% response rate). Nearly 70 percent of PDs reported that attending physicians lead the consent process. The topics covered during consent discussion include possible complications (25%), expected recovery time (23%), length of the surgery (22%), the people involved (18%), and their specific roles (7%). Many PDs do not explicitly discuss trainee involvement (48.8%) or when a resident is to perform the majority of the case (87.8%). The majority of PDs (78.8%) communicate medical student involvement, but 73.2 percent reported having a patient decline participation of a trainee after describing their role. Despite the AUA and ACS codes of professionalism, many urologists do not disclose resident involvement in surgery to patients. Further discussions are needed to explore how to better balance resident education and patient autonomy. (shrink)

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide.Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines (...) for the procedure before it was introduced in the United States. We used a process of research ethics consultation that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery. (shrink)

An organizing framework is set out for the diverse literature on business ethics in relation to strategic management. It consists of sets of bi-polar components, spanning themes and topical themes, with a derived typology of contributions. Then, in the spirit of classical pragmatism, the organizing framework is re-cast as an integrative conceptual model of the strategy–ethics relationship. The approach recognizes that both pragmatism and dialectics can underpin progress towards integration, encompassing both normative and empirical aspects.

A new framework-based approach to teaching and analyzing business ethics cases is set out. Using the framework, students are encouraged to adopt two different perspectives: business as usual and a more obviously moral point of view. Subsequently, they are prompted to craft a synthesis or compromise. Several pedagogical benefits flow from adopting the approach, including the cultivation of moral tolerance and improvements in the structure and scope of written action justifications. In addition, the framework enables students to relate ethical theories (...) to the cases in a systematic way, thereby addressing a long-standing concern of business ethics educators. (shrink)

While studies on the characteristics of flow states and their relation to peak performance exist, little is known about the dynamics by which flow states emerge and develop over time. The current paper qualitatively explores the necessary pre-conditions to enter flow, and the development of flow over time until its termination. Using an elicitation interview, participants were asked to recall their flow experiences in sports or music performances. The analysis resulted in the identification of the following three phases that athletes (...) and musicians experience during flow: Preparation to enter flow; Entry into the flow state and; Exit from the flow state. These three phases are characterized by several sub-themes contributing to the experience of flow. The function of emotions is crucial, as they play a core role across all three phases and regulate flow over time. The findings provide insights into the phenomenological characteristics of the transition and maintenance of the three proposed phases and the temporal dynamics of flow. (shrink)

In this contribution, we set out a framework for ethical research and innovation. Our framework draws upon recent scholarly work recommending the introduction of new models at the intersection of ethics, strategy, and science and technology studies to inform and explicate how the decisions of researchers can be considered ethical. Ethical research and innovation is construed in our framework as a dynamic process emerging from decisions of multiple stakeholders in innovation ecosystems prior to, during and after the execution of a (...) research and innovation project. The framework can be used by different types of research organizations to implement governance models of ethical research and innovation. (shrink)

Many tensions exist within the nexus of corporate social responsibility, competitive strategy, and political activity. Previously, these aspects of strategic management have been considered in relative isolation or at best in pairs. Accordingly, an attempt is made here to set out a general strategic problem of the corporation, in which all three aspects are combined. This project reveals a particular need to explicate the political assumptions held by or on behalf of the corporation. Examples might include the classical liberal model, (...) global hypercompetition, or variants of the stakeholder model. The project also reinforces the broader notion that when one adopts the perspective of a corporate strategist, one can sometimes find potentially productive ways of reframing issues in ethics, economics, and politics. (shrink)

Many leading management scientists have advocated ethicalism: the incorporation of social and ethical concerns into traditional "rational" OR-MS techniques and management decisions. In fact, elementary forms of decision analysis can readily be augmented, using ethical theory, in ways that sweep in ethical issues. In addition, alternative conceptual models of Decision-Analysis, Game-Theory and Optimality are now available, all of which have brought OR-MS and Business-Ethics into a closer alignment.

Currently, entrepreneurs and corporations overwhelmingly do not view the alleviation of global poverty as a strategic priority. Yet business activity can have a negative as well as a positive effect on each distinctive form of poverty. In order to reduce poverty, entrepreneurs have to find ways of limiting the negative aspects. This might be achieved by deliberately augmenting strategies so that they can achieve a synthesis, in partnership with governments and NGO’s.

Epistemic justifications for democracy have been offered in terms of two different aspects of decision-making: voting and deliberation, or ‘votes’ and ‘talk.’ The Condorcet Jury Theorem is appealed to as a justification in terms votes, and the Hong-Page “Diversity Trumps Ability” result is appealed to as a justification in terms of deliberation. Both of these, however, are most plausibly construed as models of direct democracy, with full and direct participation across the population. In this paper, we explore how these results (...) hold up if we vary the model so as to reflect the more familiar democratic structure of a representative hierarchy. We first recount extant analytic work that shows that representation inevitably weakens the voting results of the Condorcet Jury Theorem, but we question the ability of that result to shine light on real representative systems. We then show that, when we move from votes to talk, as modeled in Hong-Page, representation holds its own and even has a slight edge. (shrink)

Contemporary perspectives on conciousness provide us with a powerful metaphor for the corporate planning process; although organisations ultimately differ, in systems terms, from organisms. Like consciousness, planning has survival value and confers operational advantages.

The rational-agent frame of reference for the analysis of corporate strategic decision-making may be expanded to a moral-agent perspective where decision content is seen as comprising both commercial and ethical factors. Relevant factors may then be classified on the basis of the ethical decision principles to which they relate: rational-egoism, self-referential altruism or deontology. This approach is then applied to the problem of decision support for strategic divestment by MNCs.

Purpose: This review identifies the prominent topics in the literature pertaining to the ethical, legal, and social issues raised by research investigating personalized genomic medicine. Methods: The abstracts of 953 articles extracted from scholarly databases and published during a 5-year period were reviewed. A total of 299 articles met our research criteria and were organized thematically to assess the representation of ELSI issues for stakeholders, health specialties, journals, and empirical studies. Results: ELSI analyses were published in both scientific and ethics (...) journals. Investigational research comprised 45% of the literature reviewed and the remaining 55% comprised normative analyses. Traditional ELSI concerns dominated the discourse including discussions about disclosure of research results. In fact, there was a dramatic increase in the number of articles focused on the disclosure of research results and incidental findings to research participants. Few papers focused on particular disorders, the use of racial categories in research, international communities, or special populations. Conclusion: Considering that strategies in personalized medicine increasingly target individuals’ unique health conditions, environments, and ancestries, further analysis is needed on how ELSI scholarship can better serve the increasingly global, interdisciplinary, and diverse PGM research community. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)