While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals’ moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical and logistical facts (...) in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change. (shrink)

Lack of specificity around stakeholder identity remains a serious obstacle to the further development of stakeholder theory andits adoption in actual practice by business managers. Nowhere is this shortcoming more evident than in stakeholder theory’s treatment of the constituency known as “community.”In this paper we attempt to set forth what we call “the Problem of Community” as indicative of the definitional problems of stakeholdertheory. We then begin the process of gaining greater specificity around our notions of community and the role (...) of community in stakeholder theory and management. In doing so, we identify the emergence of two fairly new forms of community that we believe are particularly relevant to the stakeholder theorist and practicing manager. These two new variants of community—the virtual advocacy group and the community of practice—extend the notion of community in new directions, which have strikingly different implications for stakeholder theory and practice. (shrink)

The 2006 outbreak of E. coli O157:H7, traced to bagged spinach from California, illustrates a number of contradictions. The solutions sought by many politicians and popular food analysts have been to create a centralized federal agency and a uniform set of production standards modeled after those of the animal industry. Such an approach would disproportionately harm smaller-scale producers, whose operations were not responsible for the epidemic, as well as reduce the agroecological diversity that is essential for maintaining healthy human beings (...) and ecosystems. Why should responses that only reinforce the problem be proffered? We use the framework of accumulation and legitimation to suggest corporate and government motives for concealing underlying problems and reinforcing powerful ideologies of individualism, scientism, and centralizing authority. Food safety (or the illusion of safety) is being positioned to secure capital rather than public welfare. We propose implementing the principle of subsidiarity as a more democratic and decentralized alternative. Because full implementation of this principle will be resisted by powerful interests, some promising intermediate steps include peer production or mass collaboration as currently applied to disease prevention and surveillance, as well as studying nascent movements resisting current food safety regulations. (shrink)

BackgroundClinical ethics support aims to support health care professionals in dealing with ethical issues in clinical practice. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization. In this paper we present a specific way of organizing CES, which we have called integrative CES, and argue that this approach meets some of the challenges regarding implementation and organization.MethodsThis integrative approach was developed in an iterative process, combining actual experiences in a case study (...) in which we offered CES to a team that provides transgender health care and reflecting on the theoretical underpinnings of our work stemming from pragmatism, hermeneutics and organizational and educational sciences.ResultsIn this paper we describe five key characteristics of an integrative approach to CES; 1. Positioning CES more within care practices, 2. Involving new perspectives, 3. Creating co-ownership of CES, 4. Paying attention to follow up, and 5. Developing innovative CES activities through an emerging design.ConclusionsIn the discussion we compare this approach to the integrated approach to CES developed in the US and the hub and spokes strategy developed in Canada. Furthermore, we reflect on how an integrative approach to CES can help to handle some of the challenges of current CES. (shrink)

In this article, I argue that if we challenge some tacit assumptions of narrow rationality that endure in much of entrepreneurial studies, we can elevate entrepreneurial ethics beyond mere external constraints on rational action, and move toward fuller integration of ethics as an intrinsic part of the process of value creation itself. To this end, I propose the concept of practical wisdom as a framework for exploring entrepreneurial decision making and action that can broaden the scope of our research to (...) recognize entrepreneurship as an inherendy normative enterprise. Specifically, I suggest that a framework built upon a concept of practical wisdom enables us to adopt a richer and more complex view of entrepreneurial decision making that is well suited to the dynamic and uncertain context of entrepreneurship. Further, this framework enriches our view of entrepreneurial ethics to include consideration of the personal character, values, and purpose of the entrepreneur. By examining entrepreneurship through a lens of practical wisdom, we can open up new avenues of fruitful inquiry for scholars of entrepreneurship. (shrink)

Drawing on the built environment concept of “inclusive design” and its emphasis on creating accessible environments for all persons regardless of ability, I suggest that a central task for feminist disability theory is to redesign foundational philosophical concepts to present opportunities rather than barriers to inclusion for people with disability. Accounts of autonomy within liberal philosophy stress self-determination and the dignity of all individual persons, but have excluded people with intellectual disability from moral and political theories by denying their capacity (...) for individual autonomy, seen as a chief marker of moral personhood. This paper modifies and extends feminist theories of relational autonomy by arguing for the need to view autonomy as a feature of persons that is manifested only through relations of support, advocacy, and enablement. An “inclusively designed,” relational account negotiates the tensions encountered in attempts to apply autonomy to people with high support needs, and politicizes the concept as an advocacy tool for people with intellectual disability and their allies. (shrink)

It is common to believe that some of our concerns are deeper concerns of ours than are others and that some of our attitudes are central rather than peripheral to our psychological identity. What is the best approach to characterizing depth or centrality to the self? This paper addresses the matter of the depth and authenticity of attitudes and the relation of this matter to the autonomy of action. It defends a conception of the real self in terms of preferences (...) and convictions that cohere in a particular structural sense. It thereby gives content to the notion of wholeheartedness to which various action theorists make appeal. The approach is defended in part by an examination of how it handles the phenomenon of ambivalence.1. (shrink)

This paper presents the contribution of the pragmatic sociology of critical capacities to the understanding of environmental conflicts. In the field of 'environmental valuation', nowadays colonised by economics, the approach of plural modes (or 'regimes') of engagement provides a sociological understanding of the unequal power of conflicting 'languages of valuation'. This frame entails a shift from 'values' to 'modes of valuation', and links modes of valuation to modes of practical engagement and coordination with the surrounding environment. Different social sources of (...) incommensurability are thus detected and reframed as critical tension within and among modes of human coordination with the environment. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

The prevalence of Clinical ethics support services is increasing. Yet, questions about what quality of CES entails and how to foster the quality of CES remain. This paper describes the development of a national network, which aimed to conceptualize and foster the quality of CES in the Netherlands simultaneously. Our methodology was inspired by a responsive evaluation approach which shares some of our key theoretical presuppositions of CES. A responsive evaluation methodology engages stakeholders in developing quality standards of a certain (...) practice, instead of evaluating a practice by predefined standards. In this paper, we describe the relationship between our theoretical viewpoint on CES and a responsive evaluation methodology. Then we describe the development of the network and focus on three activities that exemplify our approach. In the discussion, we reflect on the similarities and differences between our approach and other international initiatives focusing on the quality of CES. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Some feminist epistemologists make the radical claim that there are varieties of epistemically valid warrant that agents access only through having lived particular types of contingent history, varieties of epistemic warrant to which, moreover, the confirmation-theoretic accounts of warrant favored by some traditional epistemologists are inapplicable. I offer Aristotelian virtue as a model for warrant of this sort, and use loosely Aristotelian vocabulary to express, and begin to evaluate, a range of feminist epistemological positions.

While no one seems to believe that business schools or their faculties bear entire responsibility for the ethical decision-making processes of their students, these same institutions do have some burden of accountability for educating students surrounding these skills. To that end, the standards promulgated by the Association to Advance Collegiate School of Business, their global accrediting body, require that students learn ethics as part of a business degree. However, since the AACSB does not require the inclusion of a specific course (...) to achieve this objective, it may be satisfied by establishing a stand-alone course in ethical decision-making, by integrating ethical decision-making into the existing curricula, by some combination of the two strategies, or through some alternative mechanism. Notwithstanding the choice of delivery process, though, the institution must ensure that it is able to demonstrate the students' achievement of learning with regard to ethics, a bar that was raised, or arguably simply modified, in 2003. With learning objectives designed precisely to measure the student delta based on content, process and engagement in a particular class, those programs that have opted for stand-alone ethics courses may be more prepared to respond to assessment-related inquiries regarding their programs or satisfaction of the standards. The relevance of the AACSB standards modification to the current efforts at ethics integration in business programs is instead a re-examination of how to create a program of integration that is designed to ensure the most effective learning results possible, while responding to the challenges presented by the integrated approach. The purpose of this article is to explore some of those challenges that may be somewhat universal to business school programs implementing the integrated approach, and to share one large university's response to those challenges, along with lessons learned. (shrink)

In qualitative interviews with a diverse group of experts, the vast majority believed unregulated researchers should seek out independent oversight. Reasons included the need for objectivity, protecting app users from research risks, and consistency in standards for the ethical conduct of research. Concerns included burdening minimal risk research and limitations in current systems of oversight. Literature and analysis supports the use of IRBs even when not required by regulations, and the need for evidence-based improvements in IRB processes.

This article analyses ethnographic material gathered in Sweden amongst dancers in the Church of Sweden. With the help of the writings of Sarah Coakley and Simone Weil I explore if, and how, dancing could be considered a contemplative practice in the Christian traditions of the Latin West.

A sociologist examines contemporary engagements of queer bodies and identities with fertility biomedicine. Drawing on social science, media culture, and the author’s own empirical research, three questions frame the analysis: 1. In what ways have queers on the gendered margins moved into the center and become implicated or central users of biomedicine’s fertility offerings? 2. In what ways is Fertility Inc. transformed by its own incorporation of various gendered and queered bodies and identities? And 3. What are the biosocial and (...) bioethical implications of expanded queer engagements and possibilities with Fertility Inc.? The author argues that “patient” activism through web 2.0 coupled with a largely unregulated free-market of assisted reproduction has included various queer identities as “parents-in-waiting.” Such inclusions raise a set of ethical tensions regarding how to be accountable to the many people implicated in this supply and demand industry. (shrink)

In this article, I question the production of certain cultural and geographic zones under the new emergency protocols mandated through COVID-19 governance, by drawing upon the theoretical model of...

In this paper, we examined how companies are employing new media to engage in dialogue with their stakeholders about corporate social responsibility -related matters. Through a qualitative theory-building study conducted in three stages over a period of 2 years, we discovered that corporations with reputations for CSR have built virtual spaces for dialogue about CSR, but that these spaces remain empty of dialogue. Our theory-building model highlights how the mix of four dialogue processes may allow companies to create open dialogue (...) about CSR initiatives and avoid leaving these spaces empty. Contributions for CSR studies are discussed. (shrink)

This paper discusses the widespread use of "trolley problems" in the ethics classroom from a critical perspective. After tracing the enormous popularity of ‘trolleyology’ in recent moral philosophy, differentiating various functions these hypotheticals are supposed to fulfill in ethical discourse and carving out the underlying conception of normative ethics as a quasi-scientific enterprise, I examine how they are constructed and how they affect their recipient. Against this background, I argue that despite their popularity, the use of trolley problems in the (...) ethics classroom turns out to be questionable for a number of reasons, most of which have already been advanced in the philosophical debate but hardly been reflected upon in the didactic context. Finally, I argue that the deconstruction of trolleyesque scenarios would be a good educational use of them. When it comes to using cases for didactic purposes, I suggest we give trolley problems a rest and develop more realistic scenarios. (shrink)

The following address considers the relevance of business ethics education to our students. Is our concept of ethics one of practiceand application? And, if so, are we accountable to our students, our institutions and ourselves, for the practical impact that we haveor, conversely, that we do not have? Aren’t we responsible in part if one of our students ventures forth and does not act in an ethicalmanner? Though a positive response to this query may not be popular, what is the (...) alternative? If we are not responsible for the impact(or lack thereof) that we have on our students, then what is our purpose? The discussion further explores the nature of this impact andthe process by which we can amplify the results. (shrink)

The American Assembly of Collegiate Schools of Business has called for stronger ethics programs. There are two problems with this battle cry. First, the AACSB rejects, with weak arguments, the single best way to get ethics into the curriculum. Second, the AACSB can only vaguely describe some unpromising alternatives to that strategy. A number of leading business ethicists have challenged the AACSB to defend and clarify its views, to little avail. The proposed Procedures and Standards cannot by themselves bring about (...) any significant change in the teaching of business ethics. There is a gap between the AACSB’s professed objectives and the means for achieving the objectives and determining whether they are being achieved. The Statement about Curriculum Content gives great prominence to the teaching of business ethics, but the interpretation of the statement, especially in the standards for measuring achievement, shows how improbable it is that the proposed Procedures and Standards will have the desired impact. We must recognize the constraints on the AACSB as we consider current standards and the controversy over a free-standing course versus an integrated curricular approach. The evident conclusion is a call, not only to the AACSB but to all business school educators, to set the stage for strengthened ethics education rather than to have standards imposed on us from outside. (shrink)

Essays and articles in the November‐December 2022 issue of the Hastings Center Report explore the complexities of medical decision‐making. A case‐study essay, for example, argues that the dismaying decision to perform resuscitation efforts on a patient who had obviously been dead for some time can be understood in the context of the harmful practice of defensive medicine. A narrative essay concerns whether an adolescent with locked‐in syndrome should be asked her wishes about life‐sustaining interventions, and the articles illuminate the ethical (...) value of the parental role in pediatric decision‐making, an array of ways in which patient decision‐making is interdependent, and the limitations of measures designed to evaluate the quality of a patient's decision and decision‐making process. (shrink)

In this paper, we examine the drivers involved in an alternative business model: cross-sector social partnerships between for-profit, predominantly multinational corporations and nonprofit organizations. We explore these cross-sector social partnerships from the perspective of these primary stakeholders, examining the questions of power differentials and the definitions and determinants of success. In order more deeply to understand these drivers, we review the evolution of the concept of “value” and the perception of the value that each stakeholder brings to the partnership. We (...) then describe and offer the results of an empirical, qualitative study of 18 CSSPs, where we analyze each partner's representations of success, outcomes sought and distinctions in determinants of value within the partnerships. (shrink)

A single mother doing her best to raise her children. A small business owner realizing her dreams in a rural Kansas town. A caregiver for a disabled child. All these Kansans deserve the ability to...

The American Assembly of Collegiate Schools of Business has called for stronger ethics programs. There are two problems with this battle cry. First, the AACSB rejects, with weak arguments, the single best way to get ethics into the curriculum. Second, the AACSB can only vaguely describe some unpromising alternatives to that strategy. A number of leading business ethicists have challenged the AACSB to defend and clarify its views, to little avail. The proposed Procedures and Standards cannot by themselves bring about (...) any significant change in the teaching of business ethics. There is a gap between the AACSB’s professed objectives and the means for achieving the objectives and determining whether they are being achieved. The Statement about Curriculum Content gives great prominence to the teaching of business ethics, but the interpretation of the statement, especially in the standards for measuring achievement, shows how improbable it is that the proposed Procedures and Standards will have the desired impact. We must recognize the constraints on the AACSB as we consider current standards and the controversy over a free-standing course versus an integrated curricular approach. The evident conclusion is a call, not only to the AACSB but to all business school educators, to set the stage for strengthened ethics education rather than to have standards imposed on us from outside. (shrink)

A sample survey of members of the Association of Environmental and Resource Economists (AERE) found relatively low rates of obvious ethical misconduct, such as data fabrication and falsification, and higher rates of dubious behaviors, such as deliberate overstatement of positive and understatement of negative results. AERE members reported that job-related pressures-including competition with peers, pressure due to professional implication and on-the-job pressure-were the most important causes. The most effective preventive measures, according to respondents, were discussion of ethics in existing classes, (...) codes of ethics, and short courses at professional meetings. The vast majority of AERE members were against government audits and regulations. (shrink)

Research ethics consultation is increasingly recognized as a potentially valuable mechanism for addressing the depth and breadth of ethical issues that arise in research related to human health and well-being. However, fundamental questions remain, including: What is “research ethics consultation”? And what is its justification beyond the purposes already served by existing entities? We examine how a research ethics consultation service may differ from or complement the role of an institutional review board by offering a definition of research ethics consultation (...) and by exploring the potential scope of a consultation service in terms of types of clients served, questions addressed, and advice provided at various stages of the research process. We then consider the relationship between research ethics consultation services and IRBs, as well as the issues that may arise between them, including possible conflicts of interest. (shrink)

Explores a Foucaultian understanding of the subject in relation to truth and power.

Background The use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa. Main body This article discusses some of the ethical challenges that were encountered in these research projects. Among (...) these challenges was the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor. Conclusion It is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa. (shrink)