It is now common in health care for a diverse range of professions and disciplines to work together in regular and close contact. Thus, there are now calls in the literature for research that documents insights on the ethical dimension of multidisciplinary relationships. Recent Australian research has responded to this call by examining how a multidisciplinary team of health professionals define and operationalize the notion of ethics in an acute ward hospital setting. This article provides findings from the research (...) study that indicate that, although there is a shared conceptualization of ethics as "patient-centered care", there can be times of conflict and tension in determining what is best for the patient. The discussion begins to build an understanding of how a multidisciplinary mix of health professionals responds to ethical conflict and tension. The authors' hope and expectation is that, by keeping the research focus on what health professionals in a multidisciplinary team (MDT) actually do, rather than exclusively on how they philosophically think about ethical dilemmas, the insights can be translated into practical strategies that can be utilized to strengthen the process of ethical decision making within the health care system. (shrink)

Ethical decision-making descriptive theoretical models often conflict with each other and typically lack comprehensiveness. To address this deficiency, a revised EDM model is proposed that consolidates and attempts to bridge together the varying and sometimes directly conflicting propositions and perspectives that have been advanced. To do so, the paper is organized as follows. First, a review of the various theoretical models of EDM is provided. These models can generally be divided into rationalist-based ; and non-rationalist-based. Second, the proposed (...) model, called ‘Integrated Ethical Decision Making,’ is introduced in order to fill the gaps and bridge the current divide in EDM theory. The individual and situational factors as well as the process of the proposed model are then described. Third, the academic and managerial implications of the proposed model are discussed. Finally, the limitations of the proposed model are presented. (shrink)

This study considers the ethical decision making of individual employees and the influence their perception of organizational expectations has on employee feelings about the decision making process. A self-administered questionnaire design was used for gathering data in this study, with a sample size of 245 full-time employees. The match between the ethical alternative chosen by the respondent and that alternative perceived to be encouraged by his/her organization was found to be significantly related to both feelings of (...) discomfort and feelings of intrapersonal role conflict. Implications for these findings are discussed. (shrink)

This paper presents the results of a national study of the beliefs and perceptions of small business professionals concerning ethics within their company and business in general. The study examined their views on the relationship between success and ethical conduct as well as the extent and nature of ethical conflicts experienced by the respondents. Some comparisons are made with similar studies that have been conducted in the past. Respondents have the most ethical conflicts with customers (...) and employees, and with regard to honesty in contracts/agreements. Most also believe that ethical standards are lower than they were 10 and 20 years ago, primarily because society's moral standards are lower. Additionally, they believe that the behavior of top management has the most influence on decisions in ethical situations. Finally, consistent with prior studies, they believe that they have the most responsibility to customers, ahead of employees and stockholders. (shrink)

The authors review the empirical literature in order to assess which variables are postulated as influencing ethical beliefs and decision making. The variables are divided into those unique to the individual decision maker and those considered situational in nature. Variables related to an individual decision maker examined in this review are nationality, religion, sex, age, education, employment, and personality. Situation specific variables examined in this review are referent groups, rewards and sanctions, codes of conduct, type of (...) ethical conflict, organization effects, industry, and business competitiveness. The review identifies the variables that have been empirically tested in an effort to uncover what is known and what we need to know about the variables that are hypothesized as determinants of ethical decision behavior. (shrink)

This paper will examine the effects of gender, age, work experience, academic status and legality on certain ethical decisions. Six scenarios representing ethical dilemmas were presented to both undergraduate and MBA students in an attempt to determine if various demographic factors influenced ethical decision making. While some past studies have suggested that gender has an important effect on ethical decision making, this study does not completely support this conclusion and suggests that age and/or length (...) of work experience should be included in any study of ethical decision making.The legality of the decisions was determined and compared to the reason given by the students for their decisions. In some cases the choice made by a majority of the students was not the one that was supported by the legal authorities which suggests that there may be conflicts between the ethical system of the respondents and the behavior expected of them by society. (shrink)

This paper presents the results of a national study of the beliefs and perceptions of small business professionals concerning ethics within their company and business in general. The study examined their views on the relationship between success and ethical conduct as well as the extent and nature of ethical conflicts experienced by the respondents. Some comparisons are made with similar studies that have been conducted in the past. Respondents have the most ethical conflicts with customers (...) and employees, and with regard to honesty in contracts/agreements. Most also believe that ethical standards are lower than they were 10 and 20 years ago, primarily because society's moral standards are lower. Additionally, they believe that the behavior of top management has the most influence on decisions in ethical situations. Finally, consistent with prior studies, they believe that they have the most responsibility to customers, ahead of employees and stockholders. (shrink)

Ethical dilemmas are the result of conflicts between potential benefits or harms for two or more competing interests. Therefore, ethical decision-making implies a responsibility to identify those interests, harms, and benefits. For this purpose, researchers have responsibilities to the research, the subjects of research, other researchers, the institution, society, the environment, and self.

Ethical dilemmas require evaluation of alternatives in light of conflicting principles. Because of the difficulty of making and defending such complex decisions, we may compromise the quality of our ethical decisions and debates. We need a methodology that combines the weighted effects of multiple ethical guidelines on the issue at hand. This paper describes how the Analytic Hierarchy Process can help us improve ethical decision making.

We investigated the ethical decision-making processes and intentions of 151 military personnel responding to 1 of 2 ethical scenarios drawn from the deployment experiences of military commanders. For each scenario, option choice and perspective affected decision-making processes. Differences were also found between the 2 scenarios. Results add to the emerging literature concerning operational ethical conflicts and highlight the complexity and challenge that often accompanies operational ethics.

We address how to ethically evaluate workplace practices when workplace behavioral norms conflict with employees’ attitudes toward those norms, which, according to research on psychological contract violations, regularly occurs. Drawing on Scanlonian contractualism, we introduce the intersubjective reflection process (IR process). The IR process ethically evaluates workplace practices according to whether parties to a workplace practice have intersubjectively valid grounds to veto the practice. We present normative and empirical justification for this process and apply the IR process to accounts of (...) workplace moral dilemmas. We end by identifying future directions for research related to the IR process. (shrink)

Current approaches to professional ethics emphasise the importance of upholding the ethical duties of autonomy, beneficence, non-maleficence, and justice in practice. All are prima facie duties, meaning that they must be respected on their own and, if the duties conflict, it is assumed that the dilemma can be resolved through rational decision making. There are, however, a number of limitations to this approach to professional ethics. This paper explores these limitations through an empirical study that examined the (...) class='Hi'>ethical dilemmas facing 24 professionals in their work with older people who were self-neglecting or living in squalor in Sydney, Australia. The research uncovered that two groups of professionals interpreted autonomy in different ways. Furthermore, when faced with difficult ethical dilemmas, participants agreed that the most satisfactory responses involved strategies that closely mirrored elements of alternative approaches to ethics, particularly the ethics of care and virtue ethics. The findings point to the relevance of a pluralistic approach to ethics in professional practice. (shrink)

BackgroundAlthough nurses are crucial to ensure patients’ peaceful death in hospitals, many nurses experience various ethical conflicts during end-of-life care. Therefore, research on nurses’ entire ethical decision-making process is required to improve nurses’ ethical decision-making in end-of-life care. This study aimed to identify Korean nurses’ ethical decision-making process based on their moral sensitivity to end-of-life patients.MethodsIn total, 171 nurses caring for terminal patients responded to the survey questionnaire. To measure the participants’ moral (...) sensitivity and ethical decision-making process, we used the Korean version of the Moral Sensitivity Questionnaire and Nurses’ Ethical Decision-Making around End of Life Care Scale. Finally, multiple linear regression analysis was used to investigate the effect of moral sensitivity on nurses’ ethical decision-making.ResultsThe mean of moral sensitivity was 4.8 ± 0.5 (out of 7), and that of ethical decision-making was 4.6 ± 0.5 (out of 6). Among the sub-dimensions of ethical decision-making, the highest score was in perceived professional accountability (5.2 ± 0.5), and the lowest in moral reasoning and moral agency (3.9 ± 0.6); the score of moral practice was 4.4 ± 0.7. In the multiple linear regression model, moral sensitivity (β = 0.852, p <.001), clinical department (β = − 7.018, p =.035), ethics education (β = 20.450, p <.001), job satisfaction (β = 5.273, p <.001), and ethical conflict (β = − 2.260, p = 0.031) were influential ethical decision-making factors.ConclusionsThis study revealed a gap between nurses’ thoughts and practices through the ethical decision-making process. They failed to lead their thought to moral practice. It also implies that moral sensitivity could positively affect nurses’ ethical decision-making. To make nurses morally sensitive, exposing them to various clinical cases would be helpful. Additionally, ethics education and clinical ethics supporting services are valuable for improving nurses’ ethical decision-making. If nurses improved their ethical decision-making regarding end-of-life care, their patients could experience a better quality of death. (shrink)

The business landscape today is characterized by looming global challenges like natural disasters, war, and industrial accidents throughout the world. However, there is limited research on describing how businesses operate and cope in extreme environments and whether principles of ethical decision-making can be used as guidelines in such situations. To address this gap we describe and analyze organizational and business responses to three different extreme environments, namely the fall 2012 Gaza conflict, Hurricane Katrina in New Orleans, and the (...) so-called triple disasters in Japan on March 11, 2011. We discuss moral issues surrounding helping one another with specific reference to criteria called the Kew Garden Principles and strategic corporate social responsibility. We conclude the paper with managerial and leadership implications for ethical decision-making in extreme situations. (shrink)

This article addresses one of the more disturbing questions raised by the major financial failures of the recent past; namely, how it could be that professionals, highly trained both in ethics and technical disciplines, should apparently collude with management in corporate misbehaviour. The article builds on evidence suggesting that professionals in employment contexts find ways of adapting in order to minimise perceived or actual conflict between their professional and organizational obligations and that this, in turn, may affect the way in (...) which they exercise professional judgment. It uses identity theory to propose that professionals may adopt modified identities when employed and that these identities may be expressed, in part, in the way in which they resolve ethical dilemmas. The article reports on the results of a qualitative study in which corporate counsel showed evidence of adopting these identities. The findings suggest that this line of research offers insight into a far more complex world of employed professionals than that traditionally hypothesised and that the popular approach of regulators and others to monitoring corporate governance by appointing professionals as gate-keepers within the organization is perhaps problematic. (shrink)

We develop a model of ethical decision making that integrates the decision-making process and the content variables considered by individuals facing ethical dilemmas. The process described in the model is drawn from Janis and Mann’s [1977, Decision Making: A Psychological Analysis of Conflict Choice and Commitment (The Free Press, New York)] work describing the decision process in an environment of conflict, choice and commitment. The model is enhanced by the inclusion of content variables derived (...) from the ethics literature. The resulting integrated model aids in understanding the complexity of the decision process used by individuals facing ethical dilemmas and suggests variable interactions that could be field-tested. A better understanding of the process will help managers develop policies that enhance the likelihood of ethical behavior in their organizations. (shrink)

This book debates competing approaches to ethical decision-making for members of the armed forces of liberal-democratic states. In this volume, four prominent thinkers propose and debate competing approaches to ethical decision-making for military personnel. Deane-Peter Baker presents and expounds the 'Ethical Triangulation' model, an ethical decision-making method he has employed through much of his career as an applied military ethicist. Rufus Black advocates for a natural law-based approach, one which has heavily influenced the (...) framework formally adopted by the Australian Defence Force. Roger Herbert outlines the 'Moral Deliberation Roadmap', the moral reasoning framework recently adopted by the US Naval Academy. Iain King then sets out a model of quasi-utilitarian decision-making developed in several post-conflict settings and refined at the UK's Royal College of Defence Studies. After the opening chapters in which each author outlines their favoured decision-making approach, the four contributors then evaluate each other's proposals, often critically. Philosopher David Whetham offers some concluding thoughts in which he summarises areas of agreement between the authors, identifies key areas of difference, and suggests directions for future research. This book will be of great interest to students of military ethics, the ethics of war, moral philosophy, and International Relations, as well as military professionals. (shrink)

It is commonly held that early career experiences influence ethical behavior. One way early career experiences might operate is to influence the decisions people make when presented with problems that raise ethical concerns. To test this proposition, 102 first-year doctoral students were asked to complete a series of measures examining ethical decision making along with a series of measures examining environmental experiences and climate perceptions. Factoring of the environmental measure yielded five dimensions: professional leadership, poor coping, (...) lack of rewards, limited competitive pressure, and poor career direction. Factoring of the climate inventory yielded four dimensions: equity, interpersonal conflict, occupational engagement, and work commitment. When these dimensions were used to predict performance on the ethical decision-making task, it was found that the environmental dimensions were better predictors than the climate dimensions. The implications of these findings for research on ethical conduct are discussed. (shrink)

This article considers ethical dilemmas that nurse managers may confront and suggests an ethical decision-making model that could be used as a tool for resolving such dilemmas. The focus of the article is on the question: Can nurse managers choose the ethically right solution in conflicting situations when nurses’ rights collide with patients’ rights to quality care in a world of cost-effective and economic constraint? Managers’ responsibility is to ensure and facilitate a safe and ethical working (...) environment in which nurses are able to give quality care to their patients. In nursing it is frequently declared that managers’ main obligations are to patients’ needs and their rights to receive quality care. However, managers’ ethical responsibilities are not only to patients but also to the nurses working in their institution. This article describes a real (but disguised) situation from an Israeli health care context to illustrate the dilemmas that may arise. The question is posed of whether nurse managers can maintain patients’ and nurses’ rights and, at the same time, fulfill their obligation to the conflicting demands of the organization. The article also offers a way to solve conflict by using an ethical decision-making model. (shrink)

BackgroundContemporary medical practice is complicated by many dilemmas requiring ethical sensitivity and moral reasoning.ObjectiveTo investigate physicians’ experience in ethical decision-making and their attitude towards ethics consultation.MethodsIn a cross-sectional survey 126 physicians representing the main clinics of Pleven University hospital were investigated by a self-administered questionnaire. The following variables were measured: occurrence, nature and ways of resolving ethical problems; physicians’ attitudes towards ethics consultation; physicians’ opinions on qualities and skills of an ethics consultant, and socio-demographic characteristics. Data (...) analysis included descriptive statistics, χ2 and t-test.ResultsResponse rate was 88.9% (n = 112). Men and women were equally represented (48.2%–51.8%). The sample consisted of experienced physicians: 42.9% had 11–20 years experience, and 33% had 21–30 years. According to 84.8% of respondents, ethical problems have been discussed in their specialty. Predominant dilemmas included relationships with patients and relatives (76.8%) and team work (67.6%). Over ¾ of physicians needed an advice in solving ethical problems. Ninety six percent responded positively to ethics consultation. They would mainly request it for resolving conflicts (72.5%), and in case of concern for the rightness of their decisions (52.7%). The image of an ethics consultant was built of clinical competence (70.9%), ability to deal with conflicts (59.1%), communication skills (58.2%), tolerance for different views (55.4%), and a special qualification in ethics (52.7%).ConclusionsThe study underlined that Pleven University hospital physicians face similar ethical dilemmas as their colleagues in other countries do. The expressed positive attitudes to ethics consultation should serve as a basis for further research and development of ethics consultation services. (shrink)

The aim of this study is to examine the decision-making processes at work among French buyers—whether beginners or more experienced individuals, when confronted with a dilemma involving an ethical or non-ethical choice to be made. We go on to illustrate these dilemmas through the use of five original scenarios that reproduce typical situations that arise in a purchasing context in relation to the environment, physical integrity, conflict of interest, or paternalism. Based on 172 participants, the results of (...) our study show that, ethical decision-making depends very clearly on two main factors: expertise and gender. The study also reveals that there is not always a coherent link between ethical choices made and the reasons and justifications given for those choices. Ethical options chosen are not exclusively justified on the grounds of purely ethical reasons but also on the grounds of commercial or economic reasons, or else reasons of avoidance. (shrink)

Managing Business Ethics: Solving Ethical Dilemmas teaches students how to navigate ethical issues they will inevitably encounter using the weight-of-reasons approach. This decision-making framework can be applied at the individual, organizational, and stakeholder levels. Authors Alfred Marcus and Timothy Hargrave underscore the need for employees at all levels to carefully consider the ethical implications of their actions. Each chapter provides a case to walk through application of the framework. Mini-cases within each chapter allow students to practice (...) applying this framework on their own. A wide range of longer, real-world case studies are presented, featuring companies relevant to students such as Facebook and Amazon. This practical, down-to-earth text delves into topics not covered extensively by other books such as slow and fast thinking, the inherent conflict between the individual and organization, conformity, and the difficulties of speaking truth to power. This compelling new text offers ample opportunity for students to engage in thoughtful reflection, discussion, and application as they grapple with ethical issues big and small. Key Features: - Presents a weight-of-reasons ethical decision making framework to help students understand the steps for making the right decisions and the importance of thinking through both short-term and long-term effects - In-text examples and end-of-chapter cases applications provide ample opportunity for students to see and apply the ethical decision making framework - 20 Real-World Cases on timely topics like Sexual Harassment at Google, pharmaceutical companies and the Opioid Epidemic, and Whole Food's Conscious Capitalism. (shrink)

Public health decisions made by the state involve considerable disagreements on the course of actions, uncertainties, and compromises that arise from moral tensions between the demands of civil liberties and the goals of public health. With such complex decisions, it can be extremely difficult to arrive at and justify the best option. In this article, we propose an ethical decision-making framework based on the philosophy of Ubuntu and argue that in sub-Saharan African settings, this approach provides attractive alternative (...) conventions of moral decision-making and a useful language for understanding moral reasoning and ethics. Through its emphasis on humanity, compassion, and social responsibility, Ubuntu (“I am because we are”) has the potential to facilitate solutions to and avert conflicts between individual rights and public health. The use of Ubuntu shifts the moral reasoning and ethics of decision-making from a field of philosophy shaped by the global north, to the everyday values, decision-making, and consequent practices of people in much of Africa. Using examples of Ebola, pandemic influenza, and tuberculosis, we illustrate how Ubuntu can be applied to tackle conflicting ethical problems in public health and medicine. (shrink)

This paper presents the results of five years of research involving three studies. The first two studies investigated the impact of the value honesty/integrity on the ethical decision choice an individual makes, as moderated by the individual personality traits of self-monitoring and private self-consciousness. The third study, which is the focus of this paper, expanded the two earlier studies by varying the level of moral intensity and including the influence of demographical factors and other workplace values: achievement, fairness, (...) and concern for others on the ethical decision process. These studies were designed using a laboratory format and a decision exercise that attempted to establish realistic business conflict situations through decision scenarios. Support is presented for the influence of gender and achievement on ethical choice. Recommendations for the future direction of this stream of research are given. (shrink)

Using professional accountants as respondents in Hong Kong, this study strives to develop a model to depict the effect of ethical reasoning on the relationships between guanxi and auditors; behaviour in an audit conflict situation. The results of the study found that (1) there is a significant relationship between an auditor's ethical judgement and one's moral cognitive development; (2) there is a relationship between an auditor's ethical judgement and the existence of guanxi; and (3) the impact of (...) guanxi on an auditor's judgement is depending on the level of ethical reasoning. (shrink)

New and experienced psychotherapists alike can find themselves overwhelmed by an ethical quandary where there doesn't seem to be an easy solution. This book presents positive ethics as a means to overcome such ethical challenges. The positive approach focuses on not just avoiding negative consequences, but reaching the best possible outcomes for both the psychotherapist and the client. The authors outline a clear decision-making process that is based on three practical strategies: the ethics acculturation model to help (...) therapists incorporate personal ethics into their professional roles, the quality enhancement model for dealing with high-risk patients who are potentially harmful, and ethical choice-making strategies to make the most ethical decision in a situation where two ethical principles conflict. Throughout the decision-making process, psychotherapists are encouraged to follow four basic guidelines: Focus on overarching ethical principles Consider intuitive, emotional, and other nonrational factors Accept that some problems have elusive solutions Solicit input from colleagues and consultation groups Numerous vignettes illustrate how to apply positive ethics to many different ethical challenges that psychotherapists will likely encounter in practice. (shrink)

This Korean study replicated a previously published American study. The conceptual framework and method combined ethical enquiry and phenomenology. The research questions were: (1) What is nursing students’ experience of ethical problems involving nursing practice? and, (2) What is nursing students’ experience of using an ethical decision-making model? The participants were 97 senior baccalaureate nursing students, each of whom described one ethical problem and chose to use one of five ethical decision-making models. From (...) 97 ethical problems, five content categories emerged, the largest being health professionals (69%). The basic nature of the ethical problems was the students’ experience of conflict, resolution and rationale. Using an ethical decision-making model helped 94% of the students. A comparison of the Korean and American results yields important implications for nursing ethics education, practice and research. (shrink)

This study examines the way ethical decisions are made in controversial cases at The Courier-Journal in Louisville, Kentucky, to see if codes of ethics can be efective at a newspaper known for its commitment to ethics. The study concludes that a code is efective in that environment especially on conflict-of-interest questions. A critical factor in the code's efectiveness is an ethical culture in which editors support ethical standards vigorously and foster a process that encourages newsroom debate over (...) controversial cases. (shrink)

Much of today's writing on medical ethics is strong on philosophical theory or on legal speculation, but weak on practice. In this book, practitioners in a wide range of specialties describe the process of making ethical decisions in their everyday work. A moral philosopher analyzes their conclusions, and the theological implications are developed by a Christian theologian and Rabbinic scholar. Thorough and eclectic, this book should be read by all who seek the good of the profession of medicine.

Using a conceptual framework and method combining ethical enquiry and phenomenology, we asked 73 senior baccalaureate nursing students to answer two questions: (1) What is nursing students’ experience of an ethical problem involving nursing practice? and (2) What is nursing students’ experience of using an ethical decision-making model? Each student described one ethical problem, from which emerged five content categories, the largest being that involving health professionals (44%). The basic nature of the ethical problems (...) consisted of the nursing students’ experience of conflict, resolution and rationale; 85% of the students stated that using an ethical decision-making model was helpful. Although additional research is needed, these findings have important implications for nursing ethics education and practice. (shrink)

Integrative Social Contracts Theory is a popular framework to assist managers in making decisions on international moral dilemmas. Although the theory has been praised for its comprehensiveness and sophistication, commentators have raised concerns regarding the justification and identification of substantive hypernorms, fundamental moral principles valid across cultures. This paper introduces the deliberative test, a new method for testing the cross-cultural validity of ethical norms in ISCT. The test relies on the concept of Deliberative Capacity, arising from new developments in (...) system-level deliberative democracy research, which studies deliberation at the level of national societies and over time. Based on this recent stream of research, the deliberative test has the potential of providing better guidance for managers to decide which norms to follow in case of conflicting standards between home and host countries. (shrink)

Cross cultural ethical conflicts are a major challenge for managers of multinational corporations (MNEs) when an MNE''s business practices and a host country''s practices differ. We develop a set of decision principles to help MNE managers deal with these conflicts and illustrate with examples of ethical conflicts faced by MNEs doing business in contemporary Russia (DeGeorge, 1994). We discuss the generalizability of the principles by comparing them to the Donaldson (1989) and Buller and Kohls (...) (1997) decision models. Finally we discuss changes in the cross cultural ethical problems facing MNE managers and offer suggestions for future corporate and academic work on these problems. (shrink)

Business ethics has emerged in recent years as a field of significant scholarly endeavour. Particularly well documented is the existence of ethical conflict at work and the reported inseparability of business decisions and moral consequences. However, to date, the majority of studies have been conducted in the American business context.This paper examines the concept of ethical conflict as experienced by employees in the Australian context. According to a sample of Western Australian managers, ethical conflicts at work (...) do occur — with relative frequency. Of considerable concern is the high incidence of cases where the demands of superiors are deemed to be the cause of this conflict. This finding is particularly disturbing as superiors are also the primary influence on employee ethical decision making. It would see that the ethics role models are also the instigators of unethical behaviour. (shrink)

Cross cultural ethical conflicts are a major challenge for managers of multinational corporations (MNEs) when an MNE's business practices and a host country's practices differ. We develop a set of decision principles to help MNE managers deal with these conflicts and illustrate with examples of ethical conflicts faced by MNEs doing business in contemporary Russia (DeGeorge, 1994). We discuss the generalizability of the principles by comparing them to the Donaldson (1989) and Buller and Kohls (...) (1997) decision models. Finally we discuss changes in the cross cultural ethical problems facing MNE managers and offer suggestions for future corporate and academic work on these problems. (shrink)

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

Background: The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - havebeen extremely influential in the field of medical ethics, and are fundamental for understanding the currentapproach to ethical assessment in health care. This study tests whether these principles can be quantitativelymeasured on an individual level, and then subsequently if they are used in the decision making process whenindividuals are faced with ethical dilemmas. Methods: The Analytic Hierarchy Process was used as a tool (...) for the measurement of the principles. Four scenarios, whichinvolved conflicts between the medical ethical principles, were presented to participants and they madejudgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if theywere in the situation. Results: Individual preferences for these medical ethical principles can be measured using the Analytic HierarchyProcess. This technique provides a useful tool in which to highlight individual medical ethical values. Onaverage individuals have a significant preference for non-maleficence over the other principles, however, andperhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specificethical dilemmas. Conclusions: People state they value these medical ethical principles but they do not actually seem to use them directly in thedecision making process. The reasons for this are explained through the lack of a behavioural model to accountfor the relevant situational factors not captured by the principles. The limitations of the principles in predictingethical decision making are discussed. (shrink)

Background: The parent of a child with profound cognitive disability will have complex decisions to consider throughout the life of their child. An especially complex decision is whether to place a tracheotomy to support the child’s airway. The decision may involve the parent wanting a tracheotomy and the clinician advising against this intervention or the clinician recommending a tracheotomy while the parent is opposed to the intervention. This conflict over what is best for the child may lead to (...) a bioethics consult. Objective: The study explores the conflicts that may arise around tracheotomy placements. Research design: This study is a retrospective cohort study of pediatric patients for whom a tracheotomy decision required a bioethics consult. Participants and research context: Pediatric patients aged birth to 18 years old with a bioethics consult for a tracheotomy decision conflict between April 2010 and December 2016. A standardized data collection tool was used to review notes entered by the palliative care team, social workers, primary clinical team interim summaries, and the bioethics consult service. Ethical considerations: The study was reviewed and approved by the medical center’s institutional review board. Results: There were 248 clinical bioethics consults during the identified study period. There were 31 consults involving 21 children where the word tracheotomy was mentioned in the consult, and 13 of the 21 consults were for children with profound cognitive disability. Discussion and conclusion: Clinicians need to be aware of their own biases when discussing a child’s prognosis and treatment options while also understanding the parents’ values and what the parent might consider to be burdensome in the care of their child and the acceptable burden for the child to experience. (shrink)

Background:Ethical conflict is a barrier to decision-making process and is a problem derived from ethical responsibilities that nurses assume with care. Intensive care unit nurses are potentially exposed to this phenomenon. A deep study of the phenomenon can help prevent and treat it.Objectives:This study was aimed at determining the frequency, degree, level of exposure, and type of ethical conflict among nurses working in the intensive care units.Research design:This was a descriptive cross-sectional research.Participants and research context:In total, (...) 382 nurses working in the intensive care units in Iranian hospitals were selected using the random sampling method. Data were collected using the Ethical Conflict in Nursing Questionnaire-Critical Care Version (Persian version).Ethical considerations:This study was approved by the Medical Research Ethics Committee. Ethical considerations such as completing the informed consent form, ensuring confidentiality of information, and voluntary participation were observed.Findings:The results showed that the average level of exposure to ethical conflict was 164.39 ± 79.06. The most frequent conflict was related to “using resources despite believing in its futility,” with the frequency of at least once a week or a month (68.6%, n = 262). The most conflictive situation was violation of privacy (76.9%, n = 294). However, the level of exposure to ethical conflict according to the theoretical model followed was the situation of “working with incompetent staff.” The most frequently observed type of conflict was moral dilemma.Conclusion:The moderate level of exposure to ethical conflict was consistent with the results of previous studies. However, the frequency, degree, and type of ethical conflict were different compared to the results of other studies. Recognizing ethical conflict among intensive care unit nurses can be useful as it allows to consolidate those measures that favor low levels of ethical conflict, design appropriate strategies to prevent ethical conflicts, and improve the nursing work environment. (shrink)

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles (...) help to understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (shrink)

It is a commonplace that in making decisions agents often have to juggle competing values, and that no choice will maximise satisfaction of them all. However, the prevailing account of these cases assumes that there is always a single ranking of the agent's values, and therefore no unresolvable conflict between them. Isaac Levi denies this assumption, arguing that agents often must choose without having balanced their different values and that to be rational, an act does not have to be optimal, (...) only what Levi terms 'admissible'. This book explores the consequences of denying the assumption and develops a general approach to decision-making under unresolved conflict. Professor Levi discusses conflicts of value in several domains - those arising in moral dilemmas, the drawing of scientific inferences, decisions taken under uncertainty, and in social choice. In each of these he adapts his theoretical framework, showing how conflict may often be reduced though not always altogether eliminated. (shrink)

One of the hardest parts of being a leader is handling disagreements about values. The skills required to do this are increasingly important in polarized societies where there is pressure for businesses and organizations to have a sense of purpose and "do the right thing." Our book helps readers address these challenges. To do this, we don''t give a simplistic cookie-cutter recipe for what is right and wrong. Rather, we guide readers on a journey to rigorously explore their values and (...) better understand the values of others. We discuss the human psychology that drives conflicts over values as well as the philosophical frameworks that have guided people for millennia. We provide strategies, based in research from psychology and the behavioral sciences, whichthat readers can use to implement their values in their lives and their organizations. Topics covered include moral intuitions, self-serving biases, situational pressures, social norms, the role of business in society, consequentialism/utilitarianism, motives, perspective-taking, justice, fairness, and liberty. (shrink)

Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. Participants: The 69 participants (...) attended a 1-year educational programme for ambulance nurses at a Swedish university. Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation. Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability. (shrink)

Artificial intelligence is nowadays a reality. Setting rules on the potential outcomes of intelligent machines, so that no surprise can be expected by humans from the behavior of those machines, is becoming a priority for policy makers. In its recent Communication “Artificial Intelligence for Europe”, for instance, the European Commission identifies the distinguishing trait of an intelligent machine in the presence of “_a certain degree of autonomy_” in decision making, in the light of the context. The crucial issue to (...) be addressed is, therefore, whether it is possible to identify a set of rules for data use by intelligent machines so that the decision-making autonomy of machines can allow for humans’ traditional informational self-determination, as enshrined in many existing legal frameworks and can actually turn out to be further beneficial to individuals. Governing the autonomy of machines can be a very ambitious goal for humans since machines are geared first to the principles of formal logic and then—possibly—to ethical or legal principles. This introduces an unprecedented degree of complexity in how a norm should be engineered, which requires, in turn, an in-depth reflection in order to prevent conflicts between the legal and ethical principles underlying humans’ civil coexistence and the rules of formal logic upon which the functioning of machines is based. (shrink)

Despite a decade of federal regulation and debate over the appropriateness of financial ties in research and their management, little is known about the actual decision-making processes of university conflict of interest (COI) committees. This paper analyzes in detail the discussions and decisions of three COI committees at three public universities in California. University committee members struggle to understand complex financial relationships and reconcile institutional, state, and federal policies and at the same time work to protect the integrity of (...) the scientific process, the autonomy and intellectual freedom of their faculty colleagues and students, and the financial interests of the university. (shrink)

During the last thirty years different methods have been proposed in order to manage and resolve ethical quandaries, specially in the clinical setting. Some of these methodologies are based on the principles of Decision-making theory. Others looked to other philosophical traditions, like Principlism, Hermeneutics, Narrativism, Casuistry, Pragmatism, etc. This paper defends the view that deliberation is the cornerstone of any adequate methodology. This is due to the fact that moral decisions must take into account not only principles and (...) ideas, but also emotions, values and beliefs. Deliberation is the process in which everyone concerned by the decision is considered a valid moral agent, obliged to give reasons for their own points of view, and to listen to the reasons of others. The goal of this process is not the reaching of a consensus but the enrichment of one's own point of view with that of the others, increasing in this way the maturity of one's own decision, in order to make it more wise or prudent. In many cases the members of a group of deliberation will differ in the final solution of the case, but the confrontation of their reasons will modify the perception of the problem of everyone. This is the profit of the process. Our moral decisions cannot be completely rational, due to the fact that they are influenced by feelings, values, beliefs, etc., but they must be reasonable, that is, wise and prudent. Deliberation is the main procedure to reach this goal. It obliges us to take others into account, respecting their different beliefs and values and prompting them to give reasons for their own points of view. This method has been traditional in Western clinical medicine all over its history, and it should be also the main procedure for clinical ethics. (shrink)