Hospital ethics committees have evolved as a response to complicated legal, ethical, and social dilemmas that accompany modern medicine. In the United States, their growth has been augmented by Joint Commission for the Accreditation of Healthcare Organizations standards and the Patient Self-Determination Act. There appears to be an implicit presumption that all clinical ethics consultation practices are relatively similar. Finally, there is heightened awareness of the needs for quality standards and assessment of the outcomes of ethics consultations.

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

The ramifications of including genetic components in the clinical studies conducted in non-academic settings create unique ethical challenges. We used a qualitative research design consisting of semi-structured interviews that took place between October 2010 and September 2012. The sample consisted of 80 participants − 38 physicians and 42 coordinators − who worked across a number of different settings, including clinics, private practices, small hospitals, free standing research centers, and blended hospital-institutes in both rural and urban communities in 13 states across (...) the United States. The respondents primarily conducted industry sponsored trials and recruited their own patients as research participants. A majority of the respondents (65%) reported that most of the studies they conducted included an additional genetics component, and so participants were asked to donate specimens for genomics or biobanking. While genomics association studies were perceived as being of benefit, awareness of ethical implications associated with such studies was limited. The rapid advances in genetic technologies make it hard for clinicians and coordinators to help patients make informed decisions about participating in clinical research, and underscore the need to ensure that the regulations governing research on human subjects keep pace with the social and technological changes. It seems essential to discern legitimate ethical concerns and find ways to convey what is going on, what is possible and what might not be possible in terms of protecting privacy, anonymity, and confidentiality. (shrink)

A few weeks ago, a rural hospital administrator phoned with a question posed by his management team. “If you were going to give us some ethics resources,” he queried, “just exactly what would they...

Clinical research is increasingly conducted in settings that include private physicians’ offices, clinics, community hospitals, local institutes, and independent research centers. The migration of such research into this new, non–academic environment has brought new cadres of researchers into the clinical research enterprise and also broadened the pool of potential research participants. Regulatory approaches for protecting human subjects who participate in research have also evolved. Some institutions retain their own Institutional Review Boards (IRBs), but Independent IRBs, community hospital IRBs and community–based (...) IRBs also fulfill oversight responsibilities. This article sheds light on this evolving world by discussing the findings gleaned from two studies: a study of the decision making processes used by members who serve on different kinds of IRBs and a study of the decision making processes employed by research participants. The article then discusses how the key findings may inform proposed revisions to the Common Rule. (shrink)

Over the past 20 years, clinical research has migrated from academic medical centers to community-based settings, including rural settings. This evolving research environment may present some moral hazards or challenges that could undermine traditionally accepted standards for the protection of human subjects. The study described in this article was designed to explore the influence of motives driving the decisions to conduct clinical trial research in rural community settings. The researchers conducted semi-structured interviews with 80 participants who conducted clinical trials with (...) rural subjects. The interviews provided a way to examine the influence of budgetary factors when deciding to conduct a clinical study, how information about the budget and the purpose of the study is conveyed to research participants, and the potential willingness of clinicians and coordinators to enroll in the kinds of studies they offer. The findings suggest that clinical trial research in rural communities may challenge clinicians’ abilities to balance the needs of the patient with the needs of the research enterprise. Few respondents seemed to recognize the traditionally recognized hazards of a dual relationship, specifically the moral risks of trying to attend to the interests of both patient and industry. It seems important to re-examine how we protect human subjects and what such protection should look like as research becomes part of the way medical care is provided, even in very rural areas. (shrink)

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

Two core motivational systems have been conceptualized as underlying emotion and behavior. The approach system drives the organism toward stimuli or events in the environment, and the avoidance system instead deters the organism away from these stimuli or events. This approach—avoidance dichotomy has been central to theories of emotion. Advances in neuroscience complementing well-designed behavioral experiments have begun to elucidate the neural mechanisms underlying approach—avoidance motivation, suggesting that these two systems exist in parallel and are lateralized in the brain. This (...) review explores the notion of approach—avoidance and the cerebral lateralization of these motivational tendencies. (shrink)

Provability, Computability and Reflection.

The purpose of the research is to explicate the Buddhist principles of ethical analysis of premeditated murder as an immoral act. The author solves this problem through the method of case study of exegetical treatises of outstanding Buddhist thinkers Vasubandhu (4th-5th centuries) and Yašomitra (8th century). It is shown that the ethical analysis of premeditated murder is based on a religious anthropological concept (the Buddhist doctrine of human action producing karmic retribution). Sinful intent is interpreted as an immoral mental urge (...) that generated a verbal intention to take the life of a certain person or a certain animal. According to the canonical point of view, there are three mental roots of immoral acts - greed, hatred, ignorance. The ethnical analysis of sinful intent is aimed at determining the connection of intent with any of these three mental phenomena. In accordance with this principle, Buddhist thinkers have identified three types of premeditated murder. All of them produce a “black” (unfavorable) karmic fruit, i.e. an unfortunate form of rebirth, exacerbating physical suffering. Great attention is paid by the author to the problem of the karmic responsibility of individuals ordering murders and the executors of such orders. In the considered sources, the verbal order to kill and its physical execution are interpreted as equally immoral actions that produce collective karmic responsibility. The author of the research examines in detail a special class of premeditated murder, fraught with inevitable infernal retribution. This class includes murders of benefactors (mother, father, arhat) and Buddhist ascetics practicing asceticism. These malicious sins were interpreted as an insurmountable obstacle to achieving a soteriological goal, even in the distant transcendental future. It is shown that Buddhist exegetes have developed principles for diagnosing these sins and characterized the immoral personal characteristics of sinners (disrespect towards parents, Buddhist preachers and religious ascetics, heretical denial of spiritual values, shamelessness, arrogance, ignorant self-will, misanthropy). (shrink)

Dinh, Hoa Trung At the forefront of the current debate on 'assisted death' is the autonomy argument. Advocates of assisted death often appeal to respect for autonomy as a trump card that can override all other considerations: the value of human life, the prohibition of killing in the medical tradition, and other social responsibilities. For Kant, who invented the concept of autonomy and regarded it as the manifestation of human dignity, the concept of killing oneself is rationally indefensible and totally (...) at odds with the exercise of autonomy. This article discusses the origin of respect for autonomy in health ethics, and provides a Kantian critique of physician-assisted death. (shrink)

Dinh, Hoa Trung Every war is sustained by a narrative that explains the conflict and the necessity of the use of force. A war narrative gives the assembly a common identity, a sense of solidarity, and a mandate for action. This paper examines the ethical significance of war narratives, with particular reference to the Vietnam War, and how war narratives can continue to foster enmity for decades after the fighting. The paper discusses two war narratives that played vital roles in (...) the Vietnam conflict: the Revolution narrative, and the Republic narrative. Drawing from the works of Jon Sobrino and Jurgen Moltmann, who identify the crucified Christ with the victims of violence, this paper demonstrates that the cross can offer a new vision for peaceful coexistence beyond war and animosity. (shrink)

The European Commission has recently proposed the introduction of legally binding quotas for women on corporate boards of European companies. This proposal has put the spotlight on the question of whether increasing female representation on the board brings economic benefits to the firm. In order to shed light on the issue, this study investigates the direct and indirect effects of women on the board on firm value. We use a simultaneous equation model to estimate the effects of women on the (...) board on firm value, financial performance, and compliance with ethical and social principles adopted by the firm. We find no evidence that a higher female representation on the board directly affects firm’s value. However, we find indirect effects. Women on the board are positively related with financial performance (measured in terms of return on assets and return on sales) and with ethical and social compliance, which in turn are positively related with firm value. The findings in this study suggest that greater female representation on corporate boards of large European firms can increase firm value indirectly. Further, part of the indirect effect comes from stronger compliance with ethical principles, something that is not captured by accounting-based financial performance. (shrink)

Storchak, Ehlis, and Fallgatter provide an extensive literature review on electrophysiological measurements, which indicate that general predictive deficits in self‐monitoring are associated with various positive symptoms in patients with schizophrenia.

This paper investigates the role of a pre-existing body-model that is an enabling constraint for the incorporation of objects into the body. This body-model is also a basis for the distinction between body extensions (e.g., in the case of tool-use) and incorporation (e.g., in the case of successful prosthesis use). It is argued that, in the case of incorporation, changes in the sense of body-ownership involve a reorganization of the body-model, whereas extension of the body with tools does not involve (...) changes in the sense of body-ownership. (shrink)

Decision-making capacity is the gatekeeping element for a patient’s right to self-determination with regard to medical decisions. A DMC evaluation is not only conducted on descriptive grounds but is an inherently normative task including ethical reasoning. Therefore, it is dependent to a considerable extent on the values held by the clinicians involved in the DMC evaluation. Dealing with the question of how to reasonably support clinicians in arriving at a DMC judgment, a new tool is presented that fundamentally differs from (...) existing ones: the U-Doc. By putting greater emphasis on the judgmental process rather than on the measurement of mental abilities, the clinician as a decision-maker is brought into focus, rendering the tool more of an evaluation guide than a test instrument. In a qualitative study, the perceived benefits of and difficulties with the tool have been explored. The findings show on the one hand that the evaluation aid provides basic orientation, supports a holistic perspective on the patient, sensitizes for ethical considerations and personal biases, and helps to think through the decision, to argue, and to justify one’s judgment. On the other hand, the room for interpretation due to absent operationalisations, related ambiguities, and the confrontation with one’s own subjectivity may be experienced as unsettling. (shrink)

Servant leadership offers a compelling ideal of self-sacrificing individuals who put the needs of others before their own and cultivate a culture of growth in their organisations. Although the theory’s attempts to emphasise the moral, emotional and relational dimensions of leadership are laudable, it has primarily assumed a decontextualised view of leadership untouched by power. This article aims to problematise servant leadership by undertaking an intersectional analysis of an Asian cis-male heterosexual senior manager in Australia. Through in-depth interviews with the (...) manager and his staff, the article shows how his attempts to practice servant leadership were informed by intersecting power dynamics of race, gender, sexuality, age and class that subordinated him to white power. The findings demonstrate the ways servant leadership is necessarily embedded in wider power structures that shape who gets to be a “servant leader” and who remains merely a “servant”. (shrink)

Philosophy professor, humorist, and identical twin Helena de Bres takes the curious, wondrous, ludicrous experience of being a twin as a lens through which to reconsider our place in the world and how we relate to others. Which one are you? Are you the same? Can you read each other's minds? Identical twins get the weirdest existential questions from strangers, also from loved ones, in fact, even from themselves. For twins fascinate all of us... including twins. For Helena (...) de Bres, this fascination was never far from philosophy's most unnerving unknowns. What makes someone themselves rather than someone else? What does perfect love look like? Can we really act freely? Drawing from her relationship with her own twin Julia, and accompanied by Julia's line drawings, Helena uses twinhood to rethink the limits of personhood, consciousness, love, freedom, even justice. With her inimitably candid, goofy, brilliant voice, she explores the long tradition of twin representations in art, myth, and popular culture; their "freakish" history; their peculiar social standing; and what it's really like to be one of two. With hope and humor, she argues that our reactions to twins reveal our broader desires and fears about selfhood, fate, and human connection, and that reflecting on twinhood can help each of us-twin and singleton alike-to recognize our own multiplicity, and approach life with greater curiosity, imagination, and courage. (shrink)

Purpose The purpose of this paper is to report on empirical work conducted to open up algorithmic interpretability and transparency. In recent years, significant concerns have arisen regarding the increasing pervasiveness of algorithms and the impact of automated decision-making in our lives. Particularly problematic is the lack of transparency surrounding the development of these algorithmic systems and their use. It is often suggested that to make algorithms more fair, they should be made more transparent, but exactly how this can be (...) achieved remains unclear. Design/methodology/approach An empirical study was conducted to begin unpacking issues around algorithmic interpretability and transparency. The study involved discussion-based experiments centred around a limited resource allocation scenario which required participants to select their most and least preferred algorithms in a particular context. In addition to collecting quantitative data about preferences, qualitative data captured participants’ expressed reasoning behind their selections. Findings Even when provided with the same information about the scenario, participants made different algorithm preference selections and rationalised their selections differently. The study results revealed diversity in participant responses but consistency in the emphasis they placed on normative concerns and the importance of context when accounting for their selections. The issues raised by participants as important to their selections resonate closely with values that have come to the fore in current debates over algorithm prevalence. Originality/value This work developed a novel empirical approach that demonstrates the value in pursuing algorithmic interpretability and transparency while also highlighting the complexities surrounding their accomplishment. (shrink)