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

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

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

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

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

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

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

No longer holders of a discretionary right to intervene, all States are now burdened with the responsibility to take action under the doctrine of responsibility to protect …. [Potential intervener...

While new generations of implantable brain computer interface devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. Results (...) show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent—predictive and advisory—BCI technologies essential to prevent potential iatrogenic harms. (shrink)

Making data broadly accessible is essential to creating a medical information commons. Transparency about data-sharing practices can cultivate trust among prospective and existing MIC participants. We present an analysis of 34 initiatives sharing DNA-derived data based on public information. We describe data-sharing practices captured, including practices related to consent, privacy and security, data access, oversight, and participant engagement. Our results reveal that data-sharing initiatives have some distance to go in achieving transparency.

Campaigning activities of non-governmental organisations (NGOs) have increased public awareness and concern regarding the alleged unethical and environmentally damaging practices of many major multinational companies. Companies have responded by developing corporate social responsibility strategies to demonstrate their commitment to both the societies within which they function and to the protection of the natural environment. This has often involved a move towards greater transparency in company practice and a desire to engage with stakeholders, often including many of the campaign organisations that (...) have been at the forefront of the criticisms of their activity. This article examines the ways in which stakeholder dialogue has impacted upon the relationships between NGOs and businesses. In doing so, it contributes to the call for more ‘stakeholder-focused’ research in this field (Frooman in Acad Manag Rev 24(2): 191–205, 1999; Steurer in Bus Strategy Environ 15: 15–69 2006). By adopting a stakeholder lens, and focusing more heavily upon the impact on one particular stakeholder community (NGOs) and looking in depth at one form of engagement (stakeholder dialogue), this article examines how experiences of dialogue are strategically transforming interactions between businesses and NGOs. It shows how experiences of stakeholder dialogue have led to transformations in the drivers for engagement, transformations in the processes of engagement and transformations in the terms of engagement. Examining these areas of transformation, the article argues, reveals the interactions at play in framing and shaping the evolving relationships between business and its stakeholders. (shrink)

Background:Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing contexts remains ambiguous.Objective:This article is an analysis of the concept (...) of moral courage in nursing.Design:Rodgers’ evolutionary method of concept analysis provided the framework to conduct the analysis.Data sources:The literature search was carried out in September 2015 in six databases: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and The Philosopher’s Index. The following key words were used: “moral” OR “ethical” AND “courage” OR “strength” AND “nurs*” with no time limit. After applying inclusion and exclusion criteria, 31 studies were included in the final analysis.Ethical considerations:This study was conducted according to good scientific guidelines.Results:Seven core attributes of moral courage were identified: true presence, moral integrity, responsibility, honesty, advocacy, commitment and perseverance, and personal risk. Antecedents were ethical sensitivity, conscience, and experience. Consequences included personal and professional development and empowerment.Discussion and conclusion:This preliminary clarification warrants further exploring through theoretical and philosophical literature, expert opinions, and empirical research to gain validity and reliability for its application in nursing practice. (shrink)

Prior research has demonstrated that accountants differ from the general population on many personality traits. Understanding accountants’ personality traits is important when these characteristics may impact professional behavior or ability to work with members of the business community. Our study investigates the relationship between Machiavellianism, ethical orientation, anti-intellectualism, and social desirability response bias in Canadian accountants. We find that Canadian accountants score much higher on the Machiavellianism scale than U.S. accountants. Additionally, our results show a significant relationship between Machiavellianism and (...) relativism, idealism, anti-intellectualism, and social desirability response bias. Our results indicate that professional Canadian accountants may not share the same personality characteristics as U.S. accountants. We extend previous research investigating Canadian accountants, by explicitly recognizing the impact of social desirability response bias, and by including anti-intellectualism. (shrink)

Roy T Cook examines the Yablo paradox--a paradoxical, infinite sequence of sentences, each of which entails the falsity of all others that follow it. He focuses on questions of characterization, circularity, and generalizability, and pays special attention to the idea that it provides us with a semantic paradox that involves no circularity.

Advances in technologies and biomedical informatics have expanded capacity to generate and share biomedical data. With a lens on genomic data, we present a typology characterizing the data-sharing landscape in biomedical research to advance understanding of the key stakeholders and existing data-sharing practices. The typology highlights the diversity of data-sharing efforts and facilitators and reveals how novel data-sharing efforts are challenging existing norms regarding the role of individuals whom the data describe.

Background:The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients’ rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions.Objectives:To examine ethics interventions conducted on healthcare professionals and healthcare students to (...) achieve ethics-related outcomes.Research design:A systematic review.Methods:Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher’s Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis.Ethical consideration:This systematic review was conducted following good scientific practice in every phase.Findings:It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics.Conclusion:Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals. (shrink)

The introduction of artificial intelligence (AI) challenges much of our traditional understanding of military ethics. What virtues and what sort of ethics education are needed as we move into an ever more AI-driven military reality? In this article we suggest and discuss key virtues that are needed, including the virtue of prudence and the accompanying virtue of good and proper storytelling. We also reflect on the ideal of “explainable AI,” and philosophize about the role of fear in helping us understand (...) what is actually at stake in a military infused with AI-enabled and AI-driven weapons. (shrink)

Computer-mediated interaction on the Internet provides new opportunities to examine the links between reputation, risk, and the development of trust between individuals who engage in various types of exchange. In this article, we comment on the application of experimental sociological research to different types of computer-mediated social interactions, with particular attention to the emergence of what we call ‘trust networks’ (networks of those one views as trustworthy). Drawing on the existing categorization systems that have been used in experimental social psychology, (...) we relate the various forms of computer-mediated exchange to selected findings from experimental research. We develop a simple typology based on the intersection of random versus fixed-partner social dilemma games, and repeated versus one-shot interaction situations. By crossing these two types of social dilemma games and two types of interaction situations, we show that many forms of Internet exchange can be categorized effectively into four mutually exclusive categories. The resulting classification system helps to integrate the existing research on t rust in experimental social psychology with the emerging field of computer-mediated exchange. (shrink)

RESUMO O objetivo deste artigo é analisar e avaliar um conjunto de textos aqui denominados textos-moldura presentes nas obras de Bakhtin e do Círculo traduzidas no Brasil desde 1979, com vistas a traçar um panorama nacional crítico do contexto de recepção da obra bakhtiniana e evidenciar algumas de suas especificidades, indiciadas nos diálogos que empreendem com os aspectos sociais, históricos e culturais. Pretende-se, ainda, contribuir para o aprofundamento dos estudos dialógicos e sua incontestável dimensão interdisciplinar. Além da perspectiva dialógica, as (...) reflexões apoiam-se, também, em teorias da tradução, caso específico da que discute a “relação entre um texto de partida e um contexto de chegada”, ou ainda “um modo de ler um texto em dado contexto”. Parte de uma pesquisa maior, os resultados aqui apresentados dizem respeito unicamente a uma das obras do Círculo: Marxismo e filosofia da linguagem. Problemas fundamentais do método sociológico na Ciência da linguagem e suas duas traduções brasileiras. ABSTRACT This article aims to analyze and evaluate a number of texts called frame-texts found in the works of Bakhtin and the Circle, which have been translated in Brazil since 1979. Our objective is to offer a critical overview of the context of the reception of their work nationwide and highlight some of its specific features, apprehended in the dialogues established with social, historical and cultural aspects. We also intend to contribute to deepening the dialogical studies and its undeniable interdisciplinary dimension. In addition to the dialogic perspective, these reflections rely on theories of translation, especially those that discuss the “relationship between a text and its context of reception” or “a certain way of reading a text in a given context.” This discussion is part of a larger research study, and the results presented herein are related to one of the works of the Circle, namely, Marxism and the Philosophy of Language and its two translations into Brazilian Portuguese. (shrink)

The political and financial investments in the implementation of forensic DNA databases and the ethical issues related to their use and expansion justify inquiries into their performance and general utility. The main function of a forensic DNA database is to produce matches between individuals and crime scene stains, which requires a constant input of individual profiles and crime scene stains. This is conditioned, among other factors, by the legislation, namely the criteria for inclusion of profiles and the periods of time (...) and conditions for their retention and/or deletion. This article aims to provide an overview of the different legislative models for DNA databasing in Europe and ponder if wider inclusion criteria – and, consequently, database size – translates into more matches between profiles of crime scene stains and included individuals. The legislation governing forensic DNA databases in 22 countries in the European Union was analysed in order to propose a typology of two major groups of legislative criteria for inclusion/retention of profiles that can be classified as having either expansive effects or restrictive effects. We argue that expansive criteria for inclusion and retention of profiles do not necessarily translate into significant gains in output performance. (shrink)

In this essay we introduce a new tool for studying the patterns of sentential reference within the framework introduced in [2] and known as the language of paradox $\mathcal {L}_{\mathsf {P}}$ : strong $\mathcal {L}_{\mathsf {P}}$ -homomorphisms. In particular, we show that (i) strong $\mathcal {L}_{\mathsf {P}}$ -homomorphisms between $\mathcal {L}_{\mathsf {P}}$ constructions preserve paradoxicality, (ii) many (but not all) earlier results regarding the paradoxicality of $\mathcal {L}_{\mathsf {P}}$ constructions can be recast as special cases of our central result regarding (...) strong $\mathcal {L}_{\mathsf {P}}$ -homomorphisms, and (iii) that we can use strong $\mathcal {L}_{\mathsf { P}}$ -homomorphisms to provide a simple demonstration of the paradoxical nature of a well-known paradox that has not received much attention in this context: the McGee paradox. In addition, along the way we will highlight how strong $\mathcal {L}_{\mathsf {P}}$ -homomorphisms highlight novel connections between the graph-theoretic analyses of paradoxes mobilized in the $\mathcal {L}_{\mathsf {P}}$ framework and the methods and tools of category theory. (shrink)

Despite widespread interest in the topic of moral repair in the business ethics literature and in the workplace, little is currently known about moral repair with regard to the self—i.e., how and why individuals repair themselves in the aftermath of harming others within workplace contexts and what factors may influence the success of self-repair. We conducted a qualitative study in the context of health care organizations to develop an inductive model of self-repair in the workplace. Our findings reveal a set (...) of factors, including reactions to the harm incident, motivating factors, and methods of self-repair that involve intrapersonal (e.g., self-compassion) and interpersonal (e.g., seeking feedback and support from co-workers and managers) actions. We discovered that self-repair, or what we characterize as “moral self-repair” is a complex process characterized by important ethical, emotional, and social dimensions and that the effectiveness of self-repair actions is moderated by the actions of those within the organization (e.g., co-workers, managers) and outside the organization (e.g., families, friends, counselors). These social actors can promote self-repair by offering encouragement and support, or undermine self-repair by communicating a lack of trust and respect that reinforces self-blame. This model of self-repair is intended to guide future ethics research on the topic of moral self-repair and offers insight to practicing managers. (shrink)

The excellent article in the January number of the Classical Quarterly upon a mistaken interpretation of Philebus 31 c contains the somewhat incorrect statement that this interpretation is the general one: and the article itself is anticipated by a short note in a paper which I published in the Transactions of the Oxford Philological Society for 1881–2. I have nothing to complain of, for it may partly serve me right. Besides, my paper, though duly registered in the Revue de Philologie, (...) is omitted from the index of that periodical; the aforesaid Transactions are out of print, and by some mischance my correction of the wrong rendering did not appear in the last edition of Jowett's Plato, though Jowett intended it should. (shrink)

The excellent article in the January number of the Classical Quarterly upon a mistaken interpretation of Philebus 31 c contains the somewhat incorrect statement that this interpretation is the general one: and the article itself is anticipated by a short note in a paper which I published in the Transactions of the Oxford Philological Society for 1881–2. I have nothing to complain of, for it may partly serve me right. Besides, my paper, though duly registered in the Revue de Philologie, (...) is omitted from the index of that periodical; the aforesaid Transactions are out of print, and by some mischance my correction of the wrong rendering did not appear in the last edition of Jowett's Plato, though Jowett intended it should. (shrink)

In the last number of the Journal of Philology a change of punctuation in Sophist 244 C, together with a new interpretation, is proposed. To this serious exception must be taken; or perhaps not too serious, because the proposal can hardly be due to anything but haste and want of revision.It is not only in disagreement with a familiar idiom, but is easily seen to be inconsistent with the context, which can have barely received attention.The passage is as follows: ξE.

In this paper we compare the propositional logic of Frege’s Grundgesetze der Arithmetik to modern propositional systems, and show that Frege does not have a separable propositional logic, definable in terms of primitives of Grundgesetze, that corresponds to modern formulations of the logic of “not”, “and”, “or”, and “if…then…”. Along the way we prove a number of novel results about the system of propositional logic found in Grundgesetze, and the broader system obtained by including identity. In particular, we show that (...) the propositional connectives that are definable in terms of Frege’s horizontal, negation, and conditional are exactly the connectives that fuse with the horizontal, and we show that the logical operators that are definable in terms of the horizontal, negation, the conditional, and identity are exactly the operators that are invariant with respect to permutations on the domain that leave the truth-values fixed. We conclude with some general observations regarding how Frege understood his logic, and how this understanding differs from modern views. (shrink)

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses’ reluctance to work in these settings are determined. This paper considers the influence that multiple‐source care funding issues have on nursing home nurses’ experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North (...) East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with ‘selling beds’; and coping with self‐funding residents’ changing expectations of care. The findings of the study suggest that multiple‐source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention. (shrink)