Epigrams of Lingayat saints of the 16th century espousing the Advaita school in Hindu philosophy; transcribed from a palm-leaf manuscript preserved in the Karnatak University.

The relationship between social segregation and workplace segregation has been traditionally studied as a one-way causal relationship mediated by referral hiring. In this paper we introduce an alternative framework which describes the dynamic relationships between social segregation, workplace segregation, individuals’ homophily levels, and referral hiring. An agent-based simulation model was developed based on this framework. The model describes the process of continuous change in composition of workplaces and social networks of agents, and how this process affects (...) levels of workplace segregation and the segregation of social networks of the agents (people). It is concluded that: (1) social segregation and workplace segregation may co-evolve even when hiring of workers occurs mainly through formal channels and the population is initially integrated (2) majority groups tend to be more homophilous than minority groups, and (3) referral hiring may be beneficial for minority groups when the population is highly segregated. (shrink)

Many studies of the labour market spatial mismatch rely on the deductivenomological model of causation to test the theory that low-skilled, inner-city residents have been isolated from the knowledge of job opportunities by the suburbanization of jobs. The logic of this approach follows the deductivenomological model of explanation which establishes causation by measuring the constant conjunctions between ‘causes’ and ‘effects’. As an alternative, I have used a realist approach to the study of the labour market spatial mismatch that uses a (...) ‘causal-explanatory’ method. This approach entails the qualitative description of the causal mechanism in order to discover and conceptualize its causal properties. The results suggest that the spatial mismatch theory could be refined in order to accommodate the finding that workers in excluded ghettos do not necessarily rely solely on local social networks to find out about job vacancies. Instead, workers with employment experience have strong workplace-based social networks. Since employers recruit workers by relying on referrals from trusted workers, these workplacebased social networks can put job seekers at the front of the hiring queue, regardless of where they live. (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Road to RedemptionAnonymous TwoI “am Dr X.* and I am a trained and board certified neonatologist with some years of experience in a high volume NICU with complex pathologies. I have been dismissed from the care of your baby by the fetal surgeon who is not trained in what he’s attempting to do,” that was how I felt when I left the operating room (OR), after performing initial (...) resuscitation on a newborn with congenital diaphragmatic hernia (CDH) with very poor prenatal prognostic indices. CDH is a diaphragm abnormality that allows abdominal organs to move into the chest and restrict lung development. The better part of me knew not to make such a statement and chose not to do so, as this was about the family and a very sick baby, not the professional wrangling of two medical teams or the expression of frustration by a neonatologist who was morally conflicted.I work in a level four Neonatal Intensive Care Unit (NICU) and a very large one by any standard. Staff turnover had been an almost nonexistent issue in previous years because of the very conducive work environment of the NICU. Every team member (physician, nurse, respiratory therapist, pharmacist, etc.) felt like a stakeholder in providing optimal outcomes for the vulnerable neonates in the NICU.As change is the only constant thing in life, the hospital management decided to explore new frontiers and open a center for fetal medicine, with the hope of being a referral center in the region. They brought in a surgeon who came highly recommended for clinical acumen, but not for interpersonal relationship skills (unbeknownst to me). This surgeon, Dr Y., was hired to oversee the fetal center and build it into a center of excellence. Since this had to be a collaborative effort, other specialties (and subspecialties) had to be involved to make this a success. A representative from each of these specialties, including bioethics, was assigned to the fetal center team.The first inkling of a major problem occurred with the very first patient. The team met for the weekly meeting, reviewed the patient’s history and made a tentative plan, which included multidisciplinary counseling. This would require either a joint meeting with the patient or individual consults with the patient at her convenience. The following week at the weekly meeting, Dr Y. informed the group that he had met with the patient and counseled her and she had agreed to an extraordinary procedure for an oral lesion. In my opinion (and that of others), this lesion was not obstructive and could be immediately dealt with at delivery by an Otolaryngologist (ENT) surgeon, without putting the mother at risk for complications arising from the procedure being offered. There was a long discussion about why this was inappropriate [End Page E1] and why further imaging, discussion between the subspecialties and counseling should have been done prior to making this delivery plan. All felt this delivery plan could be remedied prior to delivery. However the surgeon had made plans with the obstetric team (who were at his mercy for financial/ political reasons) to continue with this plan. On the day of delivery, the NICU resuscitation team was called to another operating room instead of the labor and delivery room. I was even more appalled when I realized that the oral lesion was the size of a peanut! I felt like I failed in my obligation of veracity by avoiding the mother’s questions regarding the necessity of the procedure. Every member of my team felt the same and on several occasions I had to reassure concerned nurses that this was an aberrant occurrence that would not repeat itself... so I thought.I informed my departmental chairperson, Dr Z., who had a conversation with the fetal surgeon, Dr. Y., to inform him of my concerns and the effect of Dr. Y.’s actions on my group (physician, nurse practitioner, nurses). This led to being labeled unsupportive of Dr Y.’s goals and caused a less than cordial relationship towards me and the entire NICU group. The next week a picture of Dr Y. and the parents with the baby was on the front page... (shrink)

In the 1990s, the role of the chief executive officer (CEO) of major United States corporations underwent a profound transformation in which CEOs went from being bureaucrats or technocrats to shareholder partisans who acted more like proprietors or entrepreneurs. This transformation occurred in response to changes in the competitive environment of U.S. corporations and also to the agency theory argument that high levels of compensation by means of stock options helped to overcome the agency problem inherent in the separation of (...) ownership and control. Some critics charge that this new CEO role is objectionable for a variety of reasons, which may also be applicable to the current financial crisis in which CEO misconduct may have played a part. These objections are based largelyon a team production model of corporate governance, which is held by these critics to be superior to the standard agent-principal model. This article examines the objections offered by critics of the changed role of the CEO and argues that their negative assessment of this development and their use of the team production model to support their conclusions are not warranted. CEOs have changed from hired hands to co-owners, and this change may have contributed in some measure to the current financial crisis. However, in determining the morally preferable role of the CEO, care must be taken not to discard what is sound in the changed role. (shrink)

Currently, the preferred accommodation for conscientious objection to abortion in medicine is to allow the objector to refuse to accede to the patient’s request so long as the objector refers the patient to a physician who performs abortions. The referral part of this arrangement is controversial, however. Pro-life advocates claim that referrals make objectors complicit in the performance of acts that they, the objectors, find morally offensive. I argue that the referral requirement is justifiable, although not in the (...) way that people usually assume that it is. (shrink)

The first priority of this response is to address Libet's rebuttal of my reinterpretation of his data. Then, because many authors have commented on various aspects of the debate, the rest of the response is organized in terms of subject matter, not as replies to each individual commentator. First, I reply to an objection expressed by two separate commentators to part of my reinterpretation of those of Libet's data supposedly supporting backward referral. This leads to a brief discussion of (...) the whole concept of backward referral. The relevance of the flash-lag illusion to possible measurement errors in the Libet/Trevena and Miller paradigm is addressed next. Finally, I have a few words to say on the relationship between quantum mechanical ontology and free will. (shrink)

Currently, the preferred accommodation for conscientious objection to abortion in medicine is to allow the objector to refuse to accede to the patient’s request so long as the objector refers the patient to a physician who performs abortions. The referral part of this arrangement is controversial, however. Pro-life advocates claim that referrals make objectors complicit in the performance of acts that they, the objectors, find morally offensive. McLeod argues that the referral requirement is justifiable, although not in the (...) way that people usually assume. (shrink)

Practices such as physician assisted suicide, even if legal, engender a range of moral conflicts to which many are oblivious. A recent proposal for physician assisted suicide provides an example by calling upon physicians opposed to suicide to refer patients to other, more sympathetic, physicians. However, the proposal does not address the moral concerns of those physicians for whom such referral would be morally objectionable. Keywords: collaboration, euthanasia, intrinsic evil, material cooperation, projects, referral, toleration CiteULike Connotea Del.icio.us What's (...) this? (shrink)

Private detectives and deception as official work -- Building believable lies -- Justifying work-related deceptions -- The shadow world of unofficial deception -- Subterranean education and training -- Deception as social currency -- Goofing off and getting along -- The everyday ethics of workplace lies -- Appreciating deception in thinking about organizations.

The pastoral role is a significant leadership function within the global evangelical church and is critical to the ongoing health, nurturing and spiritual development of the church and its members. There is limited literature and reflection on hiring for the church, yet the selection of a pastoral leader is more than an employment exercise as it involves important Christian values, perceptions and priorities of the church and the denomination. This article records a study on pastoral hiring process within (...) a significant evangelical denomination in Canada. It uses a descriptive, multiple case-study approach involving four churches engaged in a pastoral search process. Findings revealed a convergence between church practices and typical organisational processes with pragmatic strategies for hiring decisions. In a secularising society of Canada, it is especially important that the church critically reflects on maintaining scriptural values on its hiring practices and not be shaped by the commercially driven business context to distinguish ethical practice and maintain its Christian witness. Contribution: This study provides new knowledge in the field of congregational studies on a much-neglected area of Christian practice, motivating for critical reflection and scriptural integrity within pastoral hiring processes. (shrink)

A remarkable hypothesis has recently been advanced by Libet and promoted by Eccles which claims that there is standardly a backwards referral of conscious experiences in time, and that this constitutes empirical evidence for the failure of identity of brain states and mental states. Libet's neurophysiological data are critically examined and are found insufficient to support the hypothesis. Additionally, it is argued that even if there is a temporal displacement phenomenon to be explained, a neurophysiological explanation is most likely.

Why do organizations conduct job interviews? The traditional view of interviewing holds that interviews are conducted, despite their steep costs, to predict a candidate’s future performance and fit. This view faces a twofold threat: the behavioral and algorithmic threats. Specifically, an overwhelming body of behavioral research suggests that we are bad at predicting performance and fit; furthermore, algorithms are already better than us at making these predictions in various domains. If the traditional view captures the whole story, then interviews seem (...) to be a costly, archaic human resources procedure sustained by managerial overconfidence. However, building on T. M. Scanlon’s work, we offer the value of choice theory of interviewing and argue that interviews can be vindicated once we recognize that they generate commonly overlooked kinds of noninstrumental value. On our view, interviews should thus not be entirely replaced by algorithms, however sophisticated algorithms ultimately become at predicting performance and fit. (shrink)

Background: A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identification of vulnerabilities and the required changes that the healthcare management system should undergo. Objectives: This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends. Methods: Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. (...) Individuals were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period. Results: In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media. Conclusions: Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics. (shrink)

An ethical dilemma exists regarding client referral. Standards 2.01(b) (Boundaries of Competence) and 3.01 (Unfair Discrimination) of the American Psychological Association's Ethical Principles of Psychologists Code of Conduct provide psychologists with contradictory reasons to take possibly conflicting and incompatible courses of action when considering whether to refer a client. The professional literature that has explored the benefits of referring clients when the psychologist does not believe that he or she is able to work with the client's presenting concern, however, (...) has failed to examine the times in which referring may not be appropriate and, more specifically, may be an act of discrimination. This article seeks to initiate the discussion around this issue. (shrink)

It is widely believed that preferential hiring practices inevitably result in hiring less qualified candidates for jobs. Indeed, this follows analytically from some definitions of preferential hiring (e.g. George Sher's). This paper describes several preferential hiring strategies that do not have this consequence. Sher's definition is thus shown to be inadequate and an alternative definition is proposed.

Researchers conducting large community-based studies among underserved populations may collect data on health conditions that are little-acknowledged in the local setting, and for which there are few if any services for referral of participants who need follow-up diagnosis and care. In the design and planning of studies for such settings, investigators and research ethics committees may struggle to determine what constitutes effective referral and whether it is reasonably available. We offer a guiding framework for referral planning, informed (...) by our experiences of research in the field and of service on research ethics committees, to support evaluation of local referral resources and consideration of the benefits, burdens and risks of referral in the local setting. The framework addresses both the impact of referral on the well-being of the people who would be referred and the impact that referral of study participants would have on local people outside the study. We use a sustained discussion of three field-based case examples to illustrate the ethical concerns at issue and to demonstrate the use of the referral planning framework. (shrink)

Patient referral management is an integral part of clinical practice. However, in low-resource settings, referrals are often delayed. The World Health Organization categorizes three types of referral delays; delay in seeking care, in reaching care and in receiving care. Using two case studies of maternal referrals (from a low-resource state in India), this article shows how a culture of downstream blaming permeates referral practice in India. With no referral guidelines to follow, providers in higher-facilities evaluate the (...) clinical decision-making of their peers in lower-facilities based on patient outcome, not on objective measures. The fear of punitive action for an unfavorable maternal outcome is a larger driving factor than patient safety. The article argues for the need to formulate an ecosystem where patient responsibility is shared across the health system. In conclusion, it discusses possible solutions which can bridge communication and information gap between referring facilities. (shrink)

Being poor can influence how one makes ethical decisions in various fields. Nepotism is one such area, emerging as kinship-based favoritism in the job market. People can be poor on at least three levels: one can live in a poor country, be poor compared to others around them, or feel poor in their given situation. We assumed that these levels can simultaneously influence nepotistic hiring decisions among Hungarian and US participants. Prior cross-cultural, non-experimental studies demonstrated that nepotism is more (...) prevalent in poorer countries such as Hungary than in richer countries such as the United States. However, contrary to our expectations, in our non-representative, preliminary study, US participants showed stronger nepotistic behavioral tendencies than Hungarians. Furthermore, people with lower socioeconomic status had less nepotistic intentions than richer people. When participants were asked to imagine themselves as a poor person, they tended to be more nepotistic than had they imagined themselves to be rich. Finally, nepotistic hiring intentions were in general stronger than non-nepotistic hiring intentions. These seemingly paradoxical results were interpreted in the light of the COVID-19 job market context and were explained by the mechanisms described by research on wealth and immoral behaviors, as well as the presence of risk aversion. (shrink)

Women from post-socialist countries started migrating to Turkey in the second half of the 1990s to work in the domestic work sector. Migrant domestics have formed their niche as live-in caregivers, due to the disinclination of the existing local labour power to work in the care sector. Yet, the employer mothers, besides asking their live-in workers to tend their children, often demand that they also do the daily chores in the home, purposely leaving the heavy cleaning to their Turkish domestics. (...) This way, live-in migrant domestics are promoted from the status of foreign employees to fictitious family members, to eventually embody `the ideal housewife'. (shrink)

When hiring for an open position, the branch manager of Intermountain Trust Bancorp was challenged with an ethical dilemma he was not anticipating. An internal applicant challenged the hiring manager's ethical values by insisting that their friendship and other external employment factors be taken into consideration in the hiring decision. This is a classic case of a candidate using undue influence1 to manipulate a colleague and gain employment. In what started as a routine decision, the manager was (...) faced with an unforeseen ethical quagmire. This case describes a real situation that had local impact on the stakeholders of a regional bank, and provides a true example of the types of difficult situations that can affect candidate selection in hiring decisions. (shrink)

The rubber hand illusion is one of the most commonly used paradigms to examine the sense of body ownership. Touches are synchronously applied to the real hand, hidden from view, and a false hand in an anatomically congruent position. During the illusion one may perceive that the feeling of touch arises from the false hand, and that the false hand is one's own. The relationship between referral of touch and body ownership in the illusion is unclear, and some articles (...) average responses to statements addressing these experiences, which may be inappropriate depending on the research question of interest. To address these concerns, we re-analyzed three freely available datasets to better understand the relationship between referral of touch and feeling of ownership in the RHI. We found that most participants who report a feeling of ownership also report referral of touch, and that referral of touch and ownership show a moderately strong positive relationship that was highly replicable. In addition, referral of touch tends to be reported more strongly and more frequently than the feeling of ownership over the hand. The former observations confirm that referral of touch and ownership are related experiences in the RHI. The latter, however, indicate that when pooling the statements one may obtain a higher number of illusion ‘responders’ compared to considering the ownership statements in isolation. These results have implications for the RHI as an experimental paradigm. (shrink)

Background: The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team. Method: Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP. Results: The median DUP across (...) the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route (p < .001), and age of onset, with earlier age of onset associated with shorter DUP (p = .015). Conclusion: These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services. (shrink)

The original data reported by Benjamin Libet and colleagues are reinterpreted, taking into account the facilitation which is experimentally demonstrated in the first of their series of articles. It is shown that the original data equally well or better support a quite different set of conclusions from those drawn by Libet. The new conclusions are that it takes only 80 ms for stimuli to come to consciousness and that “subjective back-referral of sensations in time” to the time of the (...) stimulus does not occur. (shrink)

The Matthean parable of the labourers in the vineyard is open to multiple interpretations. For some, the parable may speak of God's unlimited grace and generosity; for others the parable may speak of God's unfairness. The present study is set within the context of an emerging interest in the concept of grace as a topic for empirical enquiry. The study draws on the theoretical framework provided by the notion of ordinary theology and employs the sensing, intuition, feeling and thinking (SIFT) (...) approach to biblical hermeneutics, which is rooted in Jungian psychological type theory. Data were drawn from two one-day workshops with Church of England Readers (lay ministers). On each occasion the participants were divided into three separate groups according to their preferences for thinking or feeling (the two judging functions proposed by psychological type theory) and within these groups they were invited to explore the messages about grace in Matthew 20:1-15 (Jesus' parable of the labourers in the vineyard). The rich data gathered from these workshops generated insights into contemporary theologies of grace and also confirmed the hypothesis that a biblical interpretation of grace is shaped by the reader's psychological type preference for thinking or feeling. While feeling types tended to empathise, thinking types pondered motives and unfairness. CONTRIBUTION: Situated within the reader perspective approach to biblical hermeneutics, the SIFT method is concerned with identifying the influence of the psychological type of the reader in shaping the interpretation of sacred text. Employing this method, the present study contributes to three fields of scholarship: to the field of homiletics and hermeneutics, to the field of ordinary theology and to the emerging field concerned with the concept of grace as a topic for empirical enquiry. (shrink)

In an article published recently in this journal Daniel Hill argues that it is unacceptable that British law allows doctors to refuse to terminate non-emergency pregnancies but not to refuse to refer given that many doctors who are opposed to non-emergency abortion will be opposed also to any action that aids non-emergency abortion, including the action of referral. In this reply, I argue that Hill’s argument fails to describe properly the correct function of the law, which has never been (...) about ensuring people can exercise moral consistency in their behaviours. (shrink)

This paper presents the behavioral interview model that we developed to formalize our hiring practices when we, most recently, needed to hire a new clinical ethicist to join our staff at the Center for Ethics at Washington Hospital Center.

The idea that jobs should be awarded purely on merit has become something of an axiom, but the moral basis of it remains elusive. If employers are under a duty to appoint the most qualified candidate, to whom exactly is this duty owed, and on what grounds? I distinguish two kinds of answers to this question. Candidate-centred arguments are those according to which qualifications generate entitlements for their bearer, such that the most qualified applicant for a job has some moral (...) claim or right to it. But of course job-seekers are not the only parties with a stake in personnel selection decisions. The existing employees of an organisation, its clients and creditors, its shareholders, and society more generally are also affected. The duty to hire on merit, one might argue, is owed ultimately to one or more of these “stakeholder” groups. I refer to arguments with this structure as stakeholder-centred. The purpose of the paper is to carefully distinguish, organise and scrutinise various arguments within these camps; to sketch a map of the ethical terrain, so to speak. What the sketch reveals is that both the scope and weight of the duty to hire on merit — the exceptions to it, and the stringency of it — vary depending on its grounds. The argumentative strategy that we adopt to justify meritocracy, then, is of both theoretical and practical importance. (shrink)

The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles ofnon-maleficence, beneficence, AutonomyandJusticeas an analytic framework.Suboptimal referrals can (...) causeharmby hindering safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patientbenefitsfrom the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patientautonomyis compromised from the lack of information needed to facilitate benefit–risk communication. Finally, suboptimal referrals challengejusticebased on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct. (shrink)

An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections are deemed (...) acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional. (shrink)

Using a manually collected dataset on the overseas experiences of directors of Chinese listed firms, we examine the effects of returnee directors on firms’ corporate social responsibility engagement. Our results show that returnee directors significantly improve their firms’ CSR engagement. The positive relationship between the percentage of returnee directors and CSR engagement is more significant when a firm is in a competitive industry, when a firm has no government ownership, when a firm’s CEO is not politically connected, and when a (...) firm’s CEO is older. Furthermore, we find that only long-term foreign professional or academic experience matters, whereas short-term visiting experience does not. Finally, our results are robust after controlling for endogeneity. Therefore, this paper offers clear policy implications by suggesting that hiring more returnees as corporate directors is an efficient way to enhance firms’ CSR, which may be of particular interest to regulators in emerging markets. (shrink)

In this article I argue that justice often requires that candidates who are sufficiently qualified for jobs be hired via lottery on the basis that this is the best way to recognise each candidate's equal moral claim to access meaningful work. In reaching this conclusion I consider a variety of potential objections from the perspectives of the employer, of the most qualified candidate, and of third parties, but ultimately reject the idea that a person's status as the most qualified candidate (...) can explain why they ought to be appointed over other sufficiently qualified candidates. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of participation (...) was 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments conducted in 2015 across (...) publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

Christopher Cowley 1 has recently put forward three arguments against the legal accommodation of a general practitioner’s conscientious objection to abortion referrals. i He claims that the adoption of these arguments does not undermine a more general right to CO to involvement in abortion. I argue that Cowley is seriously mistaken. His three arguments, especially the second and third, proceed on a path directed towards the outright rejection of a right to CO in healthcare contexts. A common problem with Cowley’s (...) three arguments is that they overlook the peremptory significance for CO analysis of both the internal, deliberating perspective of those with a CO and the good of moral integrity. This paper supports the view that either there are strong prima facie grounds for holding that a right to CO extends in principle to the issue of referrals or the claim of a general right to CO is easily assailable. (shrink)

Fundamentally, intentions do not matter to the permissibility of actions, according to Thomas Scanlon (among others). Yet, discriminatory intentions seem essential to certain kinds of direct discrimination in hiring and firing, and appear to be something by virtue of which, in part at least, these kinds of discrimination are morally impermissible. Scanlon's account of the wrongness of discrimination attempts to accommodate this appearance through the notion of the expressive meaning of discriminatory acts and a certain view about how permissibility (...) relates to the meaning of actions. This paper explores the scope, strengths and weaknesses of this account. Specifically, it challenges the view that discrimination reflecting hierarchical value judgments necessarily involves a wrong that renders such discrimination more objectionable than other forms. (shrink)