The aim of this research is to examine the impact of service quality on customer satisfaction in the post pandemic world in auto care industry. The car care vendor in the study made effective use of social media to provide responsive updates to the customers in the post pandemic world; such use of social media provides bases for service quality and customer satisfaction. The study examined the relationship between service quality and customer satisfaction using the SERVQUAL framework. (...) According to the findings, empathy, reliability, assurance, responsiveness, and tangibles have a significant positive relationship with customer satisfaction. Our findings suggest that it is critical for workshops to recognize the service quality factors that contribute to customer satisfaction. Findings also suggest that empathy, assurance, reliability, responsiveness, and tangibles contribute to customer satisfaction. Auto repair industry must regularly provide personal attention, greet customers in a friendly manner, deliver cars after services, notify customers when additional repairs are required, and take the time to clarify problems to customers. Furthermore, workshops must screen and hire courteous staff who can clearly communicate the services required to customers both in-person and online and effectively communicate the risks associated with repairs. Service quality seems to be aided by prompt services. (shrink)

In Decent People, Norman Care explores how we may understand and be reconciled to the fragility of our moral nature. In his highly original vision of what it means to be a decent person, Care claims that our moral-emotional nature pressures us to seek relief from moralized pain - pain that comes from our awareness of our own wrongdoing, the suffering of current or future people, and our experience of indifference to moral imperatives. Care argues that decent (...) people are neither 'pure' nor self-righteous and that they are vulnerable to the need for forgiveness. Decent people may take morality seriously, but they are not guaranteed success at its challenges. (shrink)

Today, many people have realized that the climate change and biodiversity loss issues lie in how and to what extent humans consume products for their lives in the Anthropocene era. Consumerism has pushed natural resource exploitation to its peak, and the depletion of resources is becoming increasingly prevalent. The beauty and personal care industry has a large market and high profits, especially in the high-income segment. However, this advantage also carries the risk of facing scrutiny, investigations, and (...) criticism from civil society organizations, environmental activists, and consumers. More than anyone else, the industry is vulnerable to the perils of unfavourable societal assessments, particularly the repercussions of consumer-led boycott actions. In this discourse, we suggest that, given the current circumstances, it is imperative for multinational beauty corporations to take a proactive role in allocating resources towards the development of sustainable agriculture practices. This entails not only advocating for the widespread adoption of environmentally conscious production methods but also dedicating efforts towards conducting research and innovation in the area of nature-friendly manufacturing techniques. Doing so will help demonstrate their commitment to the environment and actively provide convincing evidence to consumers of their social responsibility through emission reduction and biodiversity conservation activities. (shrink)

We assess the organizational culture in the finance industry in relation to the global financial crisis and consider the potential of cultural change to improve the financial sector. To avoid biases, we build on the person–organization fit literature and develop a novel, indirect method for assessing organizational culture that revolves around relationships between employees’ personal traits and their career success in the industry or organization under study. We analyze personal values concerning the pursuit of private gain (...) versus personal values concerning caring for others and consider whether employees that value self-enhancement more and self-transcendence less enjoy more career success relative to their peers when working in finance than when working in other industries. Results do not reveal any sort of cross-industry differences that would implicate the finance industry’s culture in the financial crisis. Instead, we find the opposite, namely that strong self-enhancement values and weak self-transcendence values go together with less career success in the finance industry compared to other industries. Hence, if anything, the culture in the finance industry does not seem to resonate well with professionals that seek to pursue personal gain at the expense of clients’ welfare. Implication is that cultural change has little potential to improve the financial system. Meanwhile, the method for assessing organizational culture indirectly by analyzing relationships between employees’ traits and their career outcomes has wider applicability, particularly when relying on scores or measures obtained directly from the people concerned is likely to render biased evidence. (shrink)

This paper begins with the lived accounts of emergency and critical care medical interventions in which an unhoused person is brought to the emergency department in cardiac arrest. The case is a dramatised representation of the extent to which biopolitical forces via reduction to bare life through biopolitical and necropolitical operations are prominent influences in nursing and medical care. This paper draws on the scholarship of Michel Foucault, Giorgio Agamben, and Achille Mbembe to offer a theoretical analysis of (...) the power dynamics that influence the health care and death care of patients who are caught in the auspices of a neoliberal capitalist healthcare apparatus. This paper offers analysis of the overt displays of biopower over those individuals cast aside as generally unworthy of access to healthcare in a postcolonial capitalist system, in addition to the ways in which humans are reduced to ‘bare life’ in their dying days. We analyse this case study through Agamben's description of thanatopolitics, a ‘regime of death’, and the technologies that accompany the dying process, particularly in that of the homo sacer. Additionally, this paper illustrates the ways in which necropolitics and biopower are integral to understanding how the most advanced and expensive medical interventions make visible the political values of the healthcare system and how nurses and healthcare functions in these deathworlds. The purpose of this paper is to develop a greater understanding of biopolitical and necropolitical operations in acute and critical care environments, and to offer guidance to nurses in these spaces as they work to uphold ethical duties in a system that increasingly dehumanises. (shrink)

We assess the organizational culture in the finance industry in relation to the global financial crisis and consider the potential of cultural change to improve the financial sector. To avoid biases, we build on the person–organization fit literature and develop a novel, indirect method for assessing organizational culture that revolves around relationships between employees’ personal traits and their career success in the industry or organization under study. We analyze personal values concerning the pursuit of private gain (...) versus personal values concerning caring for others and consider whether employees that value self-enhancement more and self-transcendence less enjoy more career success relative to their peers when working in finance than when working in other industries. Results do not reveal any sort of cross-industry differences that would implicate the finance industry’s culture in the financial crisis. Instead, we find the opposite, namely that strong self-enhancement values and weak self-transcendence values go together with less career success in the finance industry compared to other industries. Hence, if anything, the culture in the finance industry does not seem to resonate well with professionals that seek to pursue personal gain at the expense of clients’ welfare. Implication is that cultural change has little potential to improve the financial system. Meanwhile, the method for assessing organizational culture indirectly by analyzing relationships between employees’ traits and their career outcomes has wider applicability, particularly when relying on scores or measures obtained directly from the people concerned is likely to render biased evidence. (shrink)

Critics of industrial animal agriculture have argued that its practices are cruel, inhumane, or otherwise degrading to animals. These arguments sometimes form the basis of a larger case for the complete abolition of animal agriculture, while others argue for more modest welfare-based reforms that allow for certain types of industrial farming. This paper defends industrial farming against the charge of cruelty. As upsetting as certain practices may seem, I argue that they need not be construed as cruel or inhumane. Any (...) link between industrial farming and cruelty or inhumanity is contingent on certain cultural, behavioral, and psychological facts that are person-dependent. For many people working in animal agriculture, these facts do not obtain. To be sure, industrial animal agriculture has real moral hazards that must be carefully avoided, but all that this shows is that working with animals is not for everyone. (shrink)

Drawing on interviews with people from the advertising and technology industry, legal experts and policy makers, this paper assesses the rise of emotion detection in digital out-of-home advertising, a practice that often involves facial coding of emotional expressions in public spaces. Having briefly outlined how bodies contribute to targeting processes and the optimisation of the ads themselves, it progresses to detail industrial perspectives, intentions and attitudes to data ethics. Although the paper explores possibilities of this sector, it pays careful (...) attention to existing practices that claim not to use personal data. Centrally, it argues that scholars and regulators need to pay attention to the principle of intimacy. This is developed to counter weaknesses in privacy that is typically based on identification. Having defined technologies, use cases, industrial perspectives, legal views and arguments about jurisprudence, the paper discusses this ensemble of perspectives in light of a nationwide survey about how UK citizens feel about the potential for emotion detection in out-of-home advertising. (shrink)

Objective: To determine the views of people with multiple sclerosis (MS) and professionals in relation to confidentiality, consent and access to data within a proposed MS register in the UK. Design: Qualitative study using focus groups (10) and interviews (13). Setting: England and Northern Ireland. Participants: 68 people with MS, neurologists, MS nurses, health services management professionals, researchers, representatives from pharmaceutical companies and social care professionals. Results: People with MS expressed open and altruistic views towards the use of their (...) personal information to facilitate service provision and research, placing trust in responsible guardianship and legitimate use of their information. Participant’s proposed that people with MS should be able to select their individual level of involvement in a register using levels of consent. It was agreed that access to the register should be governed by a guardianship committee composed of a range of stakeholders. People with MS did not wish their details to be used by marketing agencies and did not consider this a legitimate use of their data. Whilst participants were positive of the role a register could play in promoting research, participants felt that access to data by pharmaceutical industries should be administered by the guardianship committee. People with MS are concerned should their employers be able to access their personal information. Professionals were more cautious than people with MS in their approach to the use of patient personal data within a register. Conclusions: Whilst all stakeholders were positive of the benefits of an MS register, development of such a resource must incorporate robust data security and guardianship measures in order to ensure that, whilst opportunities are maximised, risks to the privacy of individuals and legal challenges to professionals are avoided. (shrink)

Automobile insurance companies are joining the move to managed care in the hopes of reducing health-care expenditures arising out of automobile accidents. Industry interest is strong enough that large managed care organizations, such as Concentra Managed Care, Inc., and HNC Insurance Solutions, are beginning to offer their existing network of providers to persons seeking medical care for automobile accident injuries and their evaluation software to insurers.While insurance companies have successfully pressed four state legislatures and (...) one commissioner of insurance for authorization to offer consumers a managed care option in automobile insurance policies, these efforts have not gone unchallenged. Vocal opponents, primarily lawyer and chiropractic organizations, question whether persons injured in accidents will receive care when needed, what the quality of care received will be, and whether any savings will be passed on to consumers. (shrink)

Automobile insurance companies are joining the move to managed care in the hopes of reducing health-care expenditures arising out of automobile accidents. Industry interest is strong enough that large managed care organizations, such as Concentra Managed Care, Inc., and HNC Insurance Solutions, are beginning to offer their existing network of providers to persons seeking medical care for automobile accident injuries and their evaluation software to insurers.While insurance companies have successfully pressed four state legislatures and (...) one commissioner of insurance for authorization to offer consumers a managed care option in automobile insurance policies, these efforts have not gone unchallenged. Vocal opponents, primarily lawyer and chiropractic organizations, question whether persons injured in accidents will receive care when needed, what the quality of care received will be, and whether any savings will be passed on to consumers. (shrink)

Through careful interpretive analysis, the piece argues that the Christian cosmic vision reveals the wrongness of industrial animal agriculture and that taking up more intentional eating practices is a morally significant spiritual discipline for Christians. It also testifies to our claim in the introduction [to the "Food and Religion" chapter of *Food, Ethics, and Society*] that religious food ethics have practical advantages over purely secular ethics insofar as the latter usually tries to begin from a neutral perspective that has very (...) little power to compel a person, whereas religious food ethics hooks into one's deepest commitments. (shrink)

This study investigates the ethical climate types presented in the Korean tourism industry, the differences in the perceptions of these ethical climate types based on individual/organizational characteristics, and the influence of ethical climate types based on job satisfaction/organizational commitment. Empirical findings of this study identify six ethical climate types and demonstrate significant difference and significant influence of the proposed relationships. This research contributes to the existing body of academic work by using empirical data collected from 820 respondents across 14 (...) companies within the Korean tourism industry, to demonstrate the relationship between actual ethical climate types and ethical climate related factors. The findings of this study identify the new factor ‹moral caring,’ which describes an environment characterized by decisions that maximize collective interest, but based on an individual employee’s personal values and ethics. Such a factor has important implications for the service industry, where face-to-face encounters typify the relationship between employee and consumer. (shrink)

On January 1, 2006, Medicare Part D prescription drug coverage was initiated. Concern was immediately voiced by the American Association of Retired Persons (AARP) and Families USA that, in response to this program, the pharmaceutical industry may raise prices for drugs most often used by the elderly. This article examines the ethical implications of a revenue-maximizing pricing strategy in an industry in which third party financing mitigates an end product's true cost to the user. The perspectives of three (...) stakeholder groups are examined: the elderly, as consumers of prescription drugs, the pharmaceutical industry, as product manufacturer and beneficiary of derived profits, and the total U. S. population, as the ultimate payer for the program via tax revenues. Key questions explored include the relationships among price strategy and access to drugs at both the micro (Medicare cohort) and macro (total population) levels, and on drug development or enhancement. The role of profit in a capitalism-based health care system is also examined. Hospital industry impact on these same stakeholder groups in response to the original 1965 Medicare law is used to compare and contrast possible outcomes of the new drug program. It is predicted that pharmaceutical firms will mimic the hospital industry, adopting a price maximizing strategy for drugs covered by the program. In the process, a utilitarian effect occurs: the benefits of increased access and diffusion of drugs counterbalance inequities in financing Medicare Part D. (shrink)

Informed by a search of the literature about the usage of genetic testing information (GTI) by insurance companies, this paper presents a practical ethical analysis of several distinct public policy options that might be used to govern or constrain GTI usage by insurance providers. As medical research advances and the extension to the Human Genome Project (2016, https://en.wikipedia.org/wiki/human_genome_project_-_write) moves to its fullness over the next decade, such research efforts will allow the full synthesis of human DNA to be connected to (...) predictive health dispositions. As testing costs fall, there will be ever more pressure for citizens to disclose GTI. Genetic testing information is integral to future medical care because it can be used to better assess individually tailored medical therapies as well as to allow a more informed risk analysis by the insurance industry, which in some countries such as the USA underwrites a majority of citizen medical expenses. As discussed in this examination, the revelation of people’s uniquely personal GTI to insurers has enormous societal implications. The major contribution of the paper is to offer policy makers and concerned citizens a nuanced articulation of the basic options to regulate GTI, with a special consideration for ethical fairness and equity. As genetic-based medicine blossoms and pressures to reduce healthcare costs increase, there will be an ever greater impetus for countries to revisit their genetic testing policies. Organizations and policy makers striving to create GTI oversights perceived to be both “fair and effective” need to be aware of the ethical perspectives discussed in this paper. (shrink)

Unionization of home care has depended on the state location of the occupation. Government social policies and funding created home care, shaping the structure of the industry and the conditions of work. The welfare nexus, linking old age, disability, health, and welfare policies, however, also transformed care hidden in the home into a public service. Through case studies of California and Oregon, leaders in deinstitutionalizing care of the elderly and disabled, we explore the social struggles (...) that forced the state to recognize its invisible workforce. The home location of personal attendants and other health aides has entailed not only organizing challenges but policy innovation as well. Using the welfare state location of the labor, workers allied with consumers to develop the public authority as a newstructure of representation. The history of home care shows that social welfare and health policy have long been entangled with labor policy. (shrink)

There is an urgent need to learn how to appropriately integrate technologies into dementia care. The aims of this Delphi study were to project which technologies will be most prevalent in dementia care in five years, articulate potential benefits and risks, and identify specific options to mitigate risks. Participants were also asked to identify technologies that are most likely to cause value tensions and thus most warrant a conversation with an older person with mild dementia when families are (...) deciding about their use. Twenty-one interdisciplinary domain experts from academia and industry in aging and technology in the U.S. and Canada participated in a two-round online survey using the Delphi approach with an 84% response rate and no attrition between rounds. Rankings were analyzed using frequency counts and written-in responses were thematically analyzed. Twelve technology categories were identified along with a detailed list of risks and benefits for each. Suggestions to mitigate the most commonly raised risks are categorized as follows: intervene during design, make specific technical choices, build in choice and control, require data transparency, place restrictions on data use and ensure security, enable informed consent, and proactively educate users. This study provides information that is needed to navigate person-centered technology use in dementia care. The specific recommendations participants offered are relevant to designers, clinicians, researchers, ethicists, and policy makers and require proactive engagement from design through implementation. (shrink)

Mirvac chief executive Susan Lloyd-Hurwitz, not one usually associated with sympathy for tenants on the rental market, said earlier this year that ‘renting in Australia is generally a very miserable customer experience…the whole industry is set up to serve the owner not the tenant’ Her observation is basically correct and the solution she offers is to change the current situation where small investors, supported by generous government tax concessions, provide effectively all of the country’s private rental housing. Lloyd-Hurwitz wants (...) Mirvac, a property group currently managing over $15 billion of assets, to become an apartment landlord that would own not one or several properties like small investors currently do but rather thousands of properties to rent out. The proposal is for Mirvac to build apartment blocks and then, instead of selling individual apartments, rent them out on long-term or indefinite leases. This build-to-rent housing scheme would of course make the real estate–investment company a great deal of money. At the same time it would do very little to alleviate the current housing crisis. Such schemes are a nonstarter for people who want the security, stability and independence of home ownership, which is a very Australian aspiration that is increasingly becoming unobtainable not only for those experiencing homelessness, but also for the poor and middle-class. Those of us who care about finding a real solution to the housing crisis would do well to consider how we got into this situation in the first place, and then consider how this might inform what we do next. The following then, traces some of the historical and philosophical roots of our understanding of property and their institutionalisation via various levels of government, especially in the Australian context. (shrink)

The two major functions of vouchers are, first, to provide the poor with the means to avail themselves of medical services they could not otherwise afford; and second, to allow persons to choose health care providers and services for themselves rather than have them imposed benignly (or otherwise) intentioned goverment functionaries. When vouchers are combined with other measures to promote diversity and competition within the health care industry, a third goal can be achieved: the provision of health (...) goods at lower cost. (shrink)

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the (...) feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. (shrink)

This paper analyses the role of foreign and local companies in shaping Brazilian positions on global sustainability. It deals with an empirical investigation of CSR practices of firms from the electronics, food, and personal care sectors in response to pressures of 'market' and 'non-market' stakeholders. The results demonstrate that CSR decisions by foreign and local firms are triggered by organisational considerations and anticipated economic gains. The degree of implementation of CSR activities by foreign firms is more advanced than (...) that of local firms. The survey also confirms the hypothesis that market stakeholders exert pressure on companies and positively influence CSR. Non-market stakeholders seem to have a minor effect on corporate social responsibility decisions. We conclude that the institutional environment is a critical determinant of the extent to which the dialogue between stakeholders and companies leads to the attainment of sustainable development. (shrink)

This paper explores the ethical obligations of pharmaceutical companies to charge fair prices for essential medicines. The moral issue at stake here is distributive justice. Rawls'' framework is especially germane since it underlines the material benefits everyone deserves as Kantian persons and the need for an egalitarian approach for the distribution of society''s essential commodities such as health care. This concern for distributive justice should be a critical factor in the equation of variables used to set prices for pharmaceuticals.

The article addresses issues at the nexus of physician industrial action, moral agency, and responsibility. There are situations in which we find ourselves best placed to offer aid to those who may be in vulnerable positions, a behavior that is consistent with our everyday moral intuitions. In both our interpersonal relationships and social life, we make frequent judgments about whether to praise or blame someone for their actions when we determine that they should have acted to help a vulnerable person. (...) While the average person is unlikely to confront these kinds of situations often, those in the medical professions, physicians especially, may confront these and similar situations regularly. Therefore, when physicians withhold their services for whatever reason in support of industrial action, it raises issues of moral responsibility to patients who may be in a vulnerable position. Using theories of moral responsibility, vulnerability, and ethics, this paper explores the moral implications of physician industrial action. We explore issues of vulnerability of patients, as well as the moral responsibility and moral agency of doctors to patients. Determining when a person is vulnerable, and when an individual becomes a moral agent, worthy of praise or blame for an act or non-action, is at the core of the framework. Notwithstanding the right of physicians to act in their self-interest, we argue that vulnerability leads to moral obligations, that physicians are moral agents, and the imperatives of their obligations to patients clear, even if limited by certain conditions. We suggest that both doctors and governments have a collective responsibility to prevent harm to patients and present the theoretical and practical implications of the paper. (shrink)

In the regime of Anglo-American tort law, every person has a responsibility to comport him- or herself with “due care” in going about day-to-day activities so as not to imperil the health, safety, or general welfare of others. The gold standard for determining what constitutes due care in any particular situation is what a reasonable person, similarly situated, would do. Determinations of due care are necessarily fact specific. Nevertheless, the general objective is to strike an appropriate balance (...) between an unrealistically high standard of caution and one that fails to take into account the known or foreseeable risks of any human endeavor. The same standard applies to individuals regardless of their age, gender, race, and level of education or economic status. The standard also applies to fictional “persons” such as corporations. The usual or prevailing custom and practice in an industry or occupation may provide relevant evidence of what constitutes “due care” in the activities common to it, but that evidence can be effectively overcome or rebutted by competent, credible evidence that the custom and practice either diverges from what it has been asserted to be or that the custom and practice is itself unsafe or otherwise poses an unreasonable risk of harm to others. Until quite recently, a singular exception to this general principle of tort law was made for the medical profession. We will consider this exception in the next section. (shrink)

“Democratization” has recently become a popular trope in Western public discourses on medicine, where it refers to patient participation in the gathering and distribution of health-related data using various digital technologies, in order to improve healthcare technically and socially. We critically analyze the usage of the term from the perspective of the “politics of buzzwords.” Our claim is that the phrase works primarily to publicly justify the dramatic increase in the application of information and data technologies in healthcare and therefore (...) fosters the corresponding industry. As a buzzword, “democratizing healthcare” is characterized by vagueness, which is why it receives meaning only through a word collective—a group of words that provide it with a context and are often used together with it. We examine key terms associated with “democratization” in the healthcare discourse—participation, empowerment, and personalized medicine—and show that the buzzword receives rhetorical power through the ambiguous reference to these concepts. As a consequence, the idea of “democracy” becomes diluted into meaning merely “access to,” and “healthcare” is reduced to the notion of a preventive, nonacute, monitored form of medical care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Re-examining Empirical Data on Conflicts of Interest Through the Lens of Personal NarrativesEmily E. Anderson and Elena M. KrausIntroductionThe personal stories submitted by physicians and researchers for this symposium add much–needed dimension to conversations on conflicts of interest in medicine and research. Narratives from individuals living with conflicts of interest can serve as a unique lens through which to consider psychological and economic theories and survey data (...) on physician and patient views. In our reading of these personal narratives, we identified four primary themes that will serve as springboards for our commentary. We aim to triangulate clusters of meaning drawn from the narratives with relevant data from published empirical studies and identify gaps in knowledge where more research is needed. These themes are: the unique environments of medicine and research; weighing the potential benefits of conflicts of interest against the risks; conflict of interest management; and the roles and responsibilities of diverse stakeholder groups.The Unique Challenges of the Medical and Research EnvironmentsThe reflections of the narrative authors draw attention to many of the unique environmental aspects of medicine and medical research that make physicians and researchers especially vulnerable to conflicts of interest. Conflicts of interest may be more ubiquitous in medicine than in any other industry (Kassirer, 2006). As the narratives demonstrate, conflicts of interest emerge across a range of health care delivery and research activities. Surveys have shown that 94 percent of physicians have some kind of relationship with industry (Campbell, Gruen, Mountford, et al., 2007). There is also evidence that physician interactions with medical industry begin early and are a regular part of a physician’s professional practice along the career continuum (Wazana, 2000).Medicine as a profession is distinct from banking or law. It is often said that medicine is an art; in treating patients, creative individualized solutions and gut instinct are as (if not more) important than the application of scientific knowledge. Uncertainty surrounds medical decision making. There is limited precision with respect to diagnoses and prognoses, limited data regarding the effectiveness of many treatments, and a range of patient values and preferences. Because of this uncertainty, rules about practice standards, especially with respect to avoidance and management of conflicts of interest, cannot be as explicit as they are in law or business. As demonstrated by the story presented by Sal Cruz–Flores, research and practice often intersect. And, there is no system in greater need of reform—and no system about which there are more divergent opinions as to what shape that reform should take—than the United States health care [End Page 91] system. The narratives of Tony Mikulec, Govind Nagaldinne, and David M. Zientek demonstrate how various aspects of the structure of healthcare service provision and third–party payer arrangements have the potential to harm patients. Conflicts of interest comprise more than relationships with pharmaceutical and medical device manufacturers.The narratives of Laura Jean Bierut and David M. Zientek also discuss examples of conflicts of interest that arise from factors beyond relationships with industry or the direct potential for financial gain. This may be somewhat unique to the medical milieu. Non-financial conflicts such as a desire for the prestige bestowed upon scientists who make key discoveries, a requirement to publish for tenure and promotion, the need to maintain one’s license or other privileges, or simply the pressure of a competitive environment can influence physician and researcher behavior. As noted by Bierut, more research on how to identify and manage non-financial conflicts is needed.The Potential Benefits and Harms of Conflicts of InterestConflicts of interest are usually presented in a negative light, particularly those that involve physician relationships with the pharmaceutical industry. To “have a conflict of interest” is to be in a situation or role where there is potential for personal interests to be prioritized over professional responsibilities. However, in terms of public perception, it seems that conflicts of interest have become almost synonymous with wrongdoing. Perhaps this is due to the barrage of media reports during the last decade on significant harms caused by financial conflicts of interest in business, journalism, and sports as well as in medicine (Steinbrook, 2004). Amidst... (shrink)

This paper explores food commoning through an ethnographic case study in Catalonia as our primary site while the Norwegian case is juxtaposed as a comparison, two agriculturally and economically different European countries. The ethnography analyses cooperation networks between organic food producers’ and consumers’ involving different nodes of community gardening initiatives, self-employed growers, local farmers and all of them under a unique cooperative integrating a community economy. The result it is a myriad of exchange practices ranging from reciprocity and barter to (...) market exchange without intermediaries through on-line platforms. Along these exchanges different options of currency intervene giving rise to novel social and cooperative relations. Similar initiatives in Norway show less variation and are less experimental regarding forms of payment but share similarities in relation to material articulations, concerns and forms of alternative practice. Although these novel forms do not represent a complete break from the more standardized supply chains, and hence from the oppositions/contradictions of production and consumption, the participants see themselves as contributing to a more general process of de-commodification of food. We explore the extent to which the meaning and moral values are mutually constituted in relation to socioeconomic exchanges and environmental caring that each person experiences based on different forms of cooperation and reciprocity. Food, we suggest, is more than a commodity on the market that we may influence through our role as consumers. It is a significant focal point connecting our lives to those of others that articulates one’s relations to society in a political manner. (shrink)

This paper explores food commoning through an ethnographic case study in Catalonia as our primary site while the Norwegian case is juxtaposed as a comparison, two agriculturally and economically different European countries. The ethnography analyses cooperation networks between organic food producers’ and consumers’ involving different nodes of community gardening initiatives, self-employed growers, local farmers and all of them under a unique cooperative integrating a community economy. The result it is a myriad of exchange practices ranging from reciprocity and barter to (...) market exchange without intermediaries through on-line platforms. Along these exchanges different options of currency intervene giving rise to novel social and cooperative relations. Similar initiatives in Norway show less variation and are less experimental regarding forms of payment but share similarities in relation to material articulations, concerns and forms of alternative practice. Although these novel forms do not represent a complete break from the more standardized supply chains, and hence from the oppositions/contradictions of production and consumption, the participants see themselves as contributing to a more general process of de-commodification of food. We explore the extent to which the meaning and moral values are mutually constituted in relation to socioeconomic exchanges and environmental caring that each person experiences based on different forms of cooperation and reciprocity. Food, we suggest, is more than a commodity on the market that we may influence through our role as consumers. It is a significant focal point connecting our lives to those of others that articulates one’s relations to society in a political manner. (shrink)

Among American adults 20 years and older, 59 percent take at least one prescription drug on a regular basis. Unlike most branded drugs, which are generally drugs that have a trade name and are protected by a patent, off‐patent generic drugs make up approximately 90 percent of prescriptions annually filled in the United States; yet in 2017, generic drugs made up only 23 percent of total drug costs in the U.S. The U.S. Food and Drug Administration has taken the lead (...) in encouraging increased competition in the nation's prescription drug marketplace, most recently with its release of the agency's Drug Competition Action Plan, but also with its regulatory guidance and enforcement efforts to eliminate “gaming” of the regulatory process by both branded and generic pharmaceutical manufacturers. Such “gaming” activities include “pay‐for‐delay” agreements involving financial compensation between branded and generic pharmaceutical manufacturers to forestall the emergence into the market of generic pharmaceuticals to compete against a formerly patent‐protected branded drug. A combination of new enabling legislation, federal judicial guidance, and agency regulatory activities show promise in encouraging increased competition in the prescription drug marketplace, with the American consumer the ultimate beneficiary of lower health care costs and improved overall personal health. (shrink)

A power of attorney for healthcare (POAHC) form gives designated individuals legal status to make healthcare decisions when patients are unable to convey their decisions to medical staff. Completion of a POAHC form is crucial in the provision of comprehensive healthcare, since it helps to ensure that patients’ interests, values, and preferences are represented in decisions about their medical treatment. Because increasing numbers of people suffer from debilitating illness and cognitive deficits, healthcare systems may be called upon to navigate the (...) complexities of patients’ care without clear directives from the patients themselves. Hence, the healthcare industry encourages all individuals to complete a POAHC form to ensure that persons who have the patients’ trust are able to act as their surrogate decision makers. However, sometimes POAHC agents, even when they are patients’ trusted agents, lack the capacity to make fully informed decisions that are in the patients’ best interests. We describe designated surrogate decision makers who have impaired or diminished judgment capacity as incapacitated surrogates. Decision making that is obviously flawed or questionable is a significant impediment to providing timely and appropriate care to patients. Moreover, failure to redress these issues in a timely and efficient manner can result in significant costs to an institution and a diminished quality of patient care. The authors offer a legal, ethical, and interdisciplinary framework to help navigate cases of incapacitated surrogates. (shrink)

As evidence of the unintended consequences of industrial farm animal production continues to mount, it is becoming increasingly clear that, far from being a trivial matter of personal preference, eating is an activity that has deep moral and spiritual significance. Surprising as it may sound, the simple question of what to eat can prompt Christians daily to live out their spiritual vision of Shalom for all creatures--to bear witness to the marginalization of the poor, the exploitation of the oppressed, (...) the suffering of the innocent, and the degradation of the natural world, and to participate in the reconciliation of these ills through intentional acts of love, justice, mercy, and good stewardship. The aim of this work is to understand the cultivation of more intentional "compassionate eating" habits as a form of engaged Christian discipleship that responds to a wide array of practical, moral, and spiritual problems affecting all aspects of creation--human, animal, and environmental. The guiding suggestion is that compassionate eating is a spiritual discipline that offers a symbolically significant and practically effective way to live in faithful anticipation of the "peaceable kingdom" described in Judeo-Christian creation and redemption narratives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managed Health Care: New Ethical Issues for All*Martina Darragh (bio) and Pat Milmoe McCarrick (bio)Changes in the way that health care is perceived, delivered, and financed have occurred rapidly in a relatively short time span. The 50-year period since World War II encompasses enormous growth in medical technology, soaring health care costs, and significant fragmentation of the two-party patient- physician relationship. This relationship first grew to (...) include the third-party payer, the health insurance industry, and now “with great speed and relatively little public awareness, a significant change has occurred in the way some decisions are made about a patient’s medical care” (III, Institute of Medicine 1989).The new means of providing health care bring an increasing number of parties into clinical decision-making processes. With this change, ethical issues that once concerned only health care professionals, the physician or the nurse, have expanded to include the patient and the groups who “manage” care—e.g., health maintenance organizations (HMOs), preferred provider organizations (PPOs), point of service groups (POSs), independent practice associations (IPAs), insurance reviewers, hospital administrators, institutional managers, and, the most recent players, purchasers of group health care who base their decisions on competitive pricing.The term “managed care” refers to a variety of continually adapting and developing arrangements that involve four groups. These groups, which have been labeled by the world of business, not health, are the “consumer” (once the patient), the “provider” (the physician and other health care professionals), the “insurer” (the reimburser for any care), and the “purchaser of care” or the primary buyer of health services (the large employer organization). Capitation is a common way to pay for health services in managed care systems. A certain dollar amount is negotiated for health services for a specified number of patients whether the care is delivered or not; the provider shares with the [End Page 189] insurer any financial risk for the actual cost of care (III, Centers for Disease Control 1995).When the Clinton administration’s health care reform movement failed to gain support in the U.S. Congress, the use of managed care to control rising health care costs accelerated. The literature on managed care and its effect on the patient-physician relationship reflects this shift. During the era of health care reform, “debate centered on how managed care could control costs, on the use of technology and patient satisfaction, [and] on access and barriers to care” (IV, Emanuel and Dubler 1995). When managed care organizations began contracting with physicians to provide health care services subject to the plans’ provisions, these plans became agents in clinical decision making on a wide-spread basis. HMO enrollment grew to 51 million persons by 1994 (III, Centers for Disease Control 1995). This “corporatization” of health care has sparked a plethora of articles about the effects of the marketplace on the physician’s ability to do what is best for the patient, and on the patient’s ability to trust the physician to do so.Many authors make it clear that managed care itself is not the problem, but rather the development of for-profit managed care plans by “corporate conglomerates with billions of dollars in assets that compensate their executives as grandly as basketball players” (V, Kassirer 1995) “in a marketplace that is largely unregulated” (I, Zoloth-Dorfman and Rubin 1995). “Some, mostly older plans that were created when cost containment was an unexpected benefit rather than their central purpose, deliver high-quality care economically. Unfortunately, others cut costs by recruiting the healthiest patients, excluding the sickest, rationing care by making it inconvenient to obtain, and denying care by a variety of mechanisms” (V, Kassirer 1995).These cost-containment features now play an intimate role in clinical practice. When a managed care plan contracts with a physician, the doctor becomes a “double agent” with contractual obligations to the plan to provide a preset amount of services and professional responsibilities to each patient to authorize necessary treatment (V, Angell 1993). This duality can undermine the physician’s fiduciary responsibility to the patient wherein the physician “has power over the affairs of [the patient]...and is required by law to act on that person’s... (shrink)

The “learning health care system” is being heralded as offering great potential for improving the quality and cost-worthiness of medical care by closely integrating the care of patients with the accumulation of aggregate data that can guide evidence-based medicine. By using electronic medical records, routine patient care and administrative data will be available for systematic observational studies. With the aid of these electronic medical records, quality-improvement studies of institutional practices and pragmatic, comparative effectiveness randomized trials of (...) individual treatments could become standard features of the medical care environment in the LHS. In this.. (shrink)

Life-saving healthcare technology evolves over time, raising new ethical questions. What was once experimental becomes standard care, and what was once unthinkable becomes the next frontier. Ethici...

In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. However, most citizens seem reluctant to adopt the practice; the number of patients who have an advance directive is low across most countries. The article discusses the key argument for seeing such documents as an instrument of self-interpretation and life-planning, which ultimately have to be interpreted by third parties as well. Interpretation by third parties and the process of self-reflection are conceptually (...) linked by a qualitative concept of identity. Identity is conceived here as constructed in a processual dialogue between a personal and a cultural perspective. How the cultural dimension comes into play in understanding the motivation, rejection or content of wished for end-of-life-decisions, is shown by a brief review of empirical and cultural studies. Understanding advance directives as a culturally embedded tool of self-interpretation should help to overcome urgent moral problems in clinical settings: how to interpret such documents, how to deliberate on the content and on the best form. (shrink)

The Institute of Medicine's report, the American Medical Association's project, the Open Society Institute's and the initiative sponsored by the Robert Wood Johnson Foundation have focused attention on improving the care of dying patients. These efforts include advance care planning and the use of written advance directives. Although previous studies have provided quantitative descriptions of patient preferences for life-sustaining treatment, including those documented in written ADs, to our knowledge open-ended written preferences have not been studied. Studies of these (...) open-ended preferences could highlight issues with respect to quality end-of-life care. The purpose of this study was to explore the open-ended proxy, health, and personal care preferences of people with HIV as expressed in a written AD form. (shrink)

Individualized care and equality of care remain two imperatives for formulating any scientifically and morally informed public health policy. Yet both continue to be elusive goals, even in the age of genomics, proteomics, and evidence-based medicine. Nonetheless, with the rapid growth and improvement of human biotechnologies, the need to individualize therapies while allocating medical care equally may result partly from our biological constitution. Human beings are all unique, and their biological differences significantly influence variability in disease causation (...) and therapeutic response to treatments. However, because humans have equal moral worth, there is no ethically justifiable reason to establish an a .. (shrink)

Abstract:This paper utilizes a qualitative case study of the health care industry and a recent legal case to demonstrate that stakeholder theory’s focus on ethics, without recognition of the effects of incentives, severely limits the theory’s ability to provide managerial direction and explain managerial behavior. While ethics provide a basis for stakeholder prioritization, incentives influence whether managerial action is consistent with that prioritization. Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the (...) explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering. (shrink)

Abstract:This paper utilizes a qualitative case study of the health care industry and a recent legal case to demonstrate that stakeholder theory’s focus on ethics, without recognition of the effects of incentives, severely limits the theory’s ability to provide managerial direction and explain managerial behavior. While ethics provide a basis for stakeholder prioritization, incentives influence whether managerial action is consistent with that prioritization. Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the (...) explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering. (shrink)

My humanity is fractured if I neglect to care for vulnerable others. Indeed, if we grasp Virginia Held’s care ethics, we acknowledge that all humans are interdependent and that the vulnerable among us deserve particularly conscientious consideration—some level of care. Accordingly, I agree with Rosemarie Tong when she proposes that those who dodge caring roles marginalize themselves from society. This marginalization can occur if I squirm out of attending to my ailing family members’ needs, or if I (...) avoid (employment or volunteer) opportunities to care for those other than my family. It can also occur if I draw an arbitrary dichotomy between “work” and care, and devalue those in caring roles. Indeed, the United .. (shrink)