Background Scientific advances have resulted in more complex medical systems, which in turn have led to an increase in the number of patient safety incidents. In this environment, the importance of honest disclosure of PSIs is rising, which highlight the need to settle a reliable system. This study aimed to investigate the effects of patient safety culture and ethical awareness on open disclosure of PSIs. Methods Data were collected from 389 nurses using self-reported perceptions of open disclosure (...) of PSIs, perceptions of patient safety culture, and ethical awareness. Results Perception of open disclosure of PSIs was significantly correlated with ethical awareness and perception of patient safety culture. Ethical awareness had the greatest impact on perception of PSIs, and two components of the perception of patient safety culture, namely overall knowledge about patient safety and staffing, were found to have significant effects. Conclusions To enhance nurses’ perception of open disclosure of PSIs, educational curriculum and programs that teach and practice fundamental ethical values are needed. Furthermore, it also calls for effort on the part of healthcare institutions and the government, as well as people’s trust, to implement a legal safety net and foster patient safety culture to promote honest disclosure of PSIs to patients. (shrink)

The current investigation examines the incidence of clients telling their psychotherapists of committing violent crimes for which they have not been prosecuted. Thirteen percent of the psychologists surveyed indicated that on at least one occasion a client self-disclosed to them during a psychotherapy session that he/she had murdered someone, not including the killing of another person in the line of duty in the military or as a public peace officer. One third of the psychologists had clients self-disclose an unprosecuted (...) class='Hi'>incident of a sexual assault, and more than two thirds had clients self-disclose an unprosecuted incident of a physical assault during a psychotherapy session. Data are reported on psychotherapists' views of the impact of such disclosures on the psychotherapy relationship, adequacy of being informed regarding legal obligations after hearing such reports of violence, and adequacy of graduate preparation to deal with these clinical situations. (shrink)

BackgroundExperience with open disclosure and its study are restricted to certain western countries. In addition, there are concerns that open disclosure may be less suitable in non-western countries. The present study explored and compared the in-depth perceptions of the general public and physicians regarding open disclosure in Korea.MethodsWe applied the COREQ checklist to this qualitative study. We conducted 20 in-depth interviews and four focus group discussions with 16 physicians and 18 members of the general public. In-depth interviews (...) and focus group discussions were performed according to semi-structured guidelines developed according to a systematic review of open disclosure. We conducted a directed content analysis by analyzing the verbatim transcripts and field notes in accordance with the predetermined guidelines.ResultsOpen disclosure perceptions were summarized in terms of the “five Ws and one H”. All physician and general public participants acknowledged the normative justifiability of open disclosure. The participants mostly agreed on the known effects of open disclosure, but the physicians had negative opinions on its expected effects, such as decreased intention of the general public to file lawsuits and increased credibility of medical professionals. Generally, the participants thought that open disclosure is required for medical errors causing major harm. However, the physicians and general public had conflicting opinions on the need for open disclosure of near misses. Most physicians did not know how to conduct open disclosure and some physicians had bad experiences due to inappropriate or incomplete open disclosure.ConclusionPhysicians and the general public in Korea acknowledge the need for open disclosure. Guidelines according to the type of patient safety incident are required to encourage physicians to more readily conduct open disclosure. Furthermore, hospitals need to consider organizing a dedicated team and hiring experts for open disclosure. (shrink)

ObjectivesTo compare changes in the number and amount of payments received by orthopedic and non-orthopedic surgeons from industry between 2014 and 2017.MethodsUsing the Centers for Medicare and Medicaid Services (CMS) Open Payment database from 2014 to 2017, we conducted a retrospective cohort study of industry payments to surgeons, including general payments and research payments.ResultsAmong orthopedic surgeons, the total number of general payments decreased from 248,698 in 2014 to 241,966 in 2017, but their total value increased from $97.1 million in 2014 (...) to $110.2 million in 2017. Among non-orthopedic surgeons, the total number decreased from 604,884 in 2014 to 582,490 in 2017, while the total value remained stable at approximately $159 million. Between 2014 and 2017, there was a differential increase in the median number of general payments received by non-orthopedic when compared to orthopedic surgeons (incidence rate ratio, 1.09; 95% CI, 1.08–1.09; p < 0.001), but a differential decline in the median value of general payments (− 8.9%; 95% CI, − 9.5%, − 8.4%; p < 0.001). Findings were consistent when stratified by nature of payment. In contrast, between 2014 and 2017, there was neither a differential change in the median number nor median value of research payments received by non-orthopedics.ConclusionExamination of a natural experiment of prior public disclosure of payments to orthopedic surgeons suggests that the Physician Payment Sunshine Act was associated with an increase in the number, but a decline in the value, of general payments received by non-orthopedic surgeons, but not on research payments received. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Cloning without Prior Approval:A Response to Recent Disclosures of NoncomplianceRuth Macklin (bio)Editor's note: In September 1994, the Kennedy Institute of Ethics Journal published a special issue on the ethics of embryo splitting or "cloning," which included papers originally prepared for a workshop on embryo splitting sponsored by the National Advisory Board on Ethics in Reproduction (NABER) and NABER's report, Human Cloning through Embryo Splitting. The impetus for the project (...) was embryo-splitting research conducted by Drs. Jerry L. Hall, Robert J. Stillman, and others, at George Washington University and presented in October 1993 at a joint meeting of the American Fertility Society and the Canadian Fertility and Andrology Society. Media coverage at the time reported that the research had been approved by the university's formal review committees. However, it came to light in December 1994 that the researchers had not obtained approval from the university's institutional review board prior to conducting the research. Following a university investigation, the researchers were disciplined and instructed to destroy their data. The university also voluntarily forwarded the records of the incident to the Office for Protection from Research Risks at the National Institutes of Health. Dr. Hall resigned from George Washington University in September 1994.In the following postscript to her article on the ethics of embryo splitting (KIEJ, September 1994), Ruth Macklin discusses these events. The letters and memoranda that she cites were obtained from NIH through the Freedom of Information Act.My article, "Splitting Embryos on the Slippery Slope: Ethics and Public Policy" (KIEJ, September 1994), included a brief assessment of the ethics of the Hall-Stillman embryo-splitting experiment conducted at George Washington University (GWU). The article reviewed the researchers' stated purpose ("to help infertile couples by reproducing nature's ability to reproduce twins"), the features of the research itself (splitting embryos that never could become viable and with no plan to implant either the original or the split embryos), and the review procedures surrounding the experiment. I said that the researchers might be [End Page 57] faulted for not waiting until embryo research guidelines had been established at the national level; on the other hand, they surely could not fail to conform to such national guidelines when none existed.My conclusions were based on information that had been reported in the print media. Dr. Robert J. Stillman's statement that the experiment "had been approved by the university's formal review committees and peer reviewed by colleagues" was reported in the Washington Post on October 25, 1993, (Sawyer 1993). However, in light of the recent disclosure that the researchers had not obtained approval from George Washington University's IRB before proceeding with the research (Schwartz 1994), I now draw a sharply different conclusion about the ethics of the researchers' behavior.The most glaring flaw was the researchers' failure to submit a protocol to their institution's IRB in advance of embarking on the research. Following an investigation of the matter, the Office for Protection from Research Risks (OPRR) made the further determination that "the failure on the part of GWU research investigators and administrators to notify the IRB promptly about noncompliance in this research constitutes additional serious noncompliance" with research regulations (J. Thomas Puglisi, Chief of the Compliance Oversight Branch, Division of Human Subject Protections, OPRR, letter to Stephen J. Trachtenberg, President of George Washington University, 23 August 1994). Is it reasonable to suppose that these researchers were unaware of their obligations (a) to obtain prior review and approval from the IRB and (b) to notify the IRB promptly about their noncompliance? Regarding the latter item, Dr. Puglisi's letter to the President of GWU states that "the notification requirement has been a longstanding element of the GWU MPA [multiple project assurance], which should have been familiar to all members of the GWU research community." I shall concentrate on the researchers' more glaring ethical omission, failure to obtain prior review and approval from the IRB.Did either or both of these researchers contend that they were unaware of any review requirements for their research? Hall blames Stillman, Director of the Division of Reproductive Endocrinology, Fertility, and IVF Programs, for not making the requirement... (shrink)

This study examines whether private information exchange between institutional investors and public companies in engagement dialogs on sustainability issues improves the publicly disclosed measurements of the target company’s financial and non-financial performance and transparency. It uses a unique dataset containing 326 private reports related to environmental, social, and anti-corruption recommendations to address material incidents among publicly traded MSCI World Index portfolio companies of Nordic institutional investors. The results indicate that target companies appear to have similar values with matched companies on (...) sustainability performance and transparency ratings in the 3 years following the initiation of private reporting. Unexpected sustainability incidents are subsequently reflected in the next year’s fall in the market value of target companies relative to MSCI World Index. This paper provides empirical evidence for the legitimacy-based provision of private sustainability information used in a larger disclosure system of public companies. (shrink)

Medication error is the most common and consistent type of error occurring in hospitals. This article attempts to explore the ethical issues relating to the nursing management of medication errors in clinical areas in Macau, China. A qualitative approach was adopted. Seven registered nurses who were involved in medication errors were recruited for in-depth interviews. The interviews were transcribed and analyzed using content analysis. Regarding the management of patients, the nurses acknowledged the mistakes but did not disclose the incidents to (...) patients and relatives. Concerning management of the nurses involved by senior staff, most participants experienced fairness, comfort and understanding during the process of reporting and investigation. The ethical issues relating to the incidents were discussed, particularly in the Chinese context. There is a need for further study relating to the disclosure of medication incidents to patients and some suggestions were made. (shrink)

We theorize that social media will reduce the incidence of corporate greenwash. Drawing on the management literature on decoupling and the economic literature on information disclosure, we characterize specifically where this effect is likely to be most pronounced. We identify important differences between social media and traditional media, and present a theoretical framework for understanding greenwash in which corporate environmental communications may backfire if citizens and activists feel a company is engaging in excessive self-promotion. The framework allows us to (...) draw out a series of propositions regarding the impact of social media on corporate decisions whether to greenwash, and what channels to use for environmental communication. We conclude with a number of suggestions for future research. (shrink)

We study whether greater social trust is associated with a lower incidence of corporate misconduct. Both social norm and network theory suggest that social trust can affect managerial behavior and reduce the likelihood of misconduct behavior. Consistent with this prediction, we find that social trust is negatively associated with corporate misconduct behavior. Moreover, we show that, when media coverage is higher, the negative relation between social trust and corporate misconduct behavior is more pronounced. Further analyses suggest that social trust can (...) help mitigate both disclosure-related and nondisclosure-related misconduct. (shrink)

The objective of this study was to analyze the quality of climate information disclosed by companies and the impression management strategies they have developed to justify or conceal negative aspects of their performance. The study is based on a qualitative content analysis of the sustainability reports of 21 energy-sector companies that use the Global Reporting Initiative with A or A+ application levels over a period of 5 years. It contributes to the literature on climate disclosure by demonstrating the ineffectiveness (...) of the external assurance process in ensuring the quality and representativeness of the data. Significant non-compliance with GRI standards was identified in 86 of the 93 reports audited by a third party. In addition, six of the 21 companies surveyed were found to disclose increasingly opaque information over time, concealing information on the measurement and methodology used. Through this study, four impression management strategies were identified. These are employed either to justify certain information or to conceal it. In exposing the high incidence of non-compliance in GRI reporting and the use of impression management strategies by companies, this study shows that it will be difficult or impossible for stakeholders to reasonably assess, monitor and compare companies’ climate performance on the basis of these reports. (shrink)

This paper addresses the theoretical framework on corporate social reporting. Although that corporate social reporting has been analysed from different perspectives, legitmacy theory currently is the dominating perspective. Authors employing this framework suggest that social and environmental disclosures are responses to both public pressure and increased media attention resulting from major social incidents such as the Exxon Valdez oil spill and the chemical leak in Bhopal (India). More specifically, those authors argue that the increase in social disclosures represent a strategy (...) to alter the public''s perception about the legitimacy of the organisation. Therefore, we suggest using corporate communication as an overarching framework to study corporate social reporting in which corporate image and corporate identity are central. (shrink)

In the United States, the IRS now requires charities to publicly disclose any significant asset diversion, which is the theft or unauthorized use of assets, that the charity identifies during the year. We use this new disclosure to investigate whether strong governance reduces the likelihood of a charitable asset diversion. Specifically, for a sample of 1528 charities from 2008 to 2012, we simultaneously examine eleven measures of governance that capture four broad governance constructs: board monitoring, independence of key individuals, (...) tone at the top, and capital provider oversight. We find consistent evidence that good governance across all four constructs is negatively associated with the probability of an asset diversion. Of the eleven governance measures, our results indicate that monitoring by debt holders and government grantors, audits, and keeping managerial duties in-house are most strongly associated with lower incidence of fraud. Our results also indicate that the likelihood of a fraud is negatively associated with a board review of the Form 990, the existence of a conflict of interest policy, and the presence of restricted donations. In addition, we document that the likelihood of an asset diversion is negatively associated with program efficiency and positively associated with growth and organizational complexity. (shrink)

How a person perceives a wrongdoing being committed by a coworker will affect whether the incident is reported within the organization. A significant factor that may influence the decision to report a wrongdoing is the perceived intentionality of the wrongdoer. This study sought to examine if differences in perceptions of a wrongdoing could affect the disclosure of unethical behavior. Three hundred seventy-two registered nurses (N = 372) responded to a survey consisting of both intentional and unintentional wrongdoings that (...) could occur by a nurse. Results of a paired t-test were as predicted. More wide ranging revelations found that respondents were more likely to discuss the unintentional wrongdoings with the wrongdoer in lieu of officially reporting to an immediate supervisor, or a member of upper management. Discussion, limitations, and suggestions for future research are provided. (shrink)

Protecting the privacy of individually-identifiable health data and promoting the public’s health often seem at odds. Privacy advocates consistently seek to limit the acquisition, use, and disclosure of identifiable health information in governmental and private sector settings. Their concerns relate to misuses or wrongful disclosures of sensitive health data that can lead to discrimination and stigmatization against individuals. Public health practitioners, on the other hand, seek regular, ongoing access to and use of identifiable health information to accomplish important public (...) health objectives. The collection and use of identifiable health data by federal, tribal, state, and local health authorities support nearly all public health functions and goals.Identifiable health data are the lifeblood of public health practice. When aggregated, these data help authorities monitor the incidence, patterns, and trends of injury and disease in populations. Health data are acquired by public health authorities through testing, screening, and treatment programs. (shrink)

BackgroundRespect for confidentiality is important to safeguard the well-being of patients and ensure the confidence of society in the doctor-patient relationship. The aim of our study is to examine real situations in which there has been a breach of confidentiality, by means of direct observation in clinical practice.MethodsBy means of direct observation, our study examines real situations in which there has been a breach of confidentiality in a tertiary hospital. To observe and collect data on these situations, we recruited students (...) enrolled in the Medical Degree Program at the University of Cordoba. The observers recorded their entries on standardized templates during clinical internships in different departments: Internal Medicine; Gynecology and Obstetrics; Pediatrics; Emergency Medicine; General and Digestive Surgery; Maxillofacial Surgery; Plastic Surgery; Orthopedics and Traumatology; Digestive; Dermatology; Rheumatology; Mental Health; Nephrology; Pneumology; Neurology; and Ophthalmology.ResultsFollowing 7138 days and 33157 h of observation, we found an estimated Frequency Index of one breach per 62.5 h. As regards the typology of the observed breaches, the most frequent were related to the consultation and/or disclosure of clinical and/or personal data to medical personnel not involved in the patient’s clinical care, as well as people external to the hospital. As regards their severity, severe breaches were the most frequent, accounting for 46.7 % of all incidents. Most of the reported incidents were observed in public areas, such as corridors, elevators, the cafeteria, stairs, and locker rooms.ConclusionsIn addition to aspects related to hospital organization or infrastructure, we have shown that all healthcare personnel are involved in confidentiality breaches, especially physicians. While most are committed unintentionally, a non-negligible number are severe, repeated breaches, thus suggesting a certain carelessness, perhaps through ignorance about certain behaviors that can jeopardize patient confidentiality. (shrink)

Based on 12 in-depth, semi-structured interviews, this study explores the attitudes of news media professionals toward Codes of Practice and guidelines and how they may conflict in the coverage of murder-suicide incidents. There is a dearth of research in this area, even though four organizations in Ireland have issued guidelines on how journalists should report on cases of this nature. This study found that news media professionals have a largely positive attitude toward guidelines and codes; however, news media conventions and (...) routines can conflict with recommendations. Furthermore, the interview subjects’ sense of duty to the public, to provide a full and frank disclosure of information often outweighed their responsibility to any guide or code in the context of covering cases of murder-suicide. This raises critical issues for the coverage of cases of this nature, particularly when news values clash with Codes of Practice and guidelines. (shrink)

A just culture is a culture of trust, learning and accountability. It is particularly important when an incident has occurred; when something has gone wrong. How do you respond to the people involved? What do you do to minimize the negative impact, and maximize learning? This third edition of Sidney Dekker's extremely successful Just Culture offers new material on restorative justice and ideas about why your people may be breaking rules. Supported by extensive case material, you will learn about (...) safety reporting and honest disclosure, about retributive just culture and about the criminalization of human error. Some suspect a just culture means letting people off the hook. Yet they believe they need to remain able to hold people accountable for undesirable performance. In this new edition, Dekker asks you to look at 'accountability' in different ways. One is by asking which rule was broken, who did it, whether that behavior crossed some line, and what the appropriate consequences should be. In this retributive sense, an 'account' is something you get people to pay, or settle. But who will draw that line? And is the process fair? Another way to approach accountability after an incident is to ask who was hurt. To ask what their needs are. And to explore whose obligation it is to meet those needs. People involved in causing the incident may well want to participate in meeting those needs. In this restorative sense, an 'account' is something you get people to tell, and others to listen to. Learn to look at accountability in different ways and your impact on restoring trust, learning and a sense of humanity in your organization could be enormous. (shrink)

This paper aims to investigate the extent of anti-corruption reporting by ASEAN companies and examine whether coercive factors influence the level of disclosure. The authors adopt indicators from the Global Reporting Initiative version 4.0 to measure the extent of anti-corruption disclosures in 117 companies’ reports. Informed by a coercive isomorphism tenet drawn from the institutional theory, the authors propose that several institutional factors influence the extent of their voluntary disclosures. The findings reveal that a large degree of variability difference (...) between the average levels of anti-corruption disclosure in Thailand and the Philippines. The dependence on government tenders and foreign ownership are associated with the level of disclosure. Surprisingly, the United Nation Global Compact membership is not a significant determinant of anti-corruption reporting. This signifies that the membership in the international initiative does not correspond to individual company’s commitment to disclose anti-corruption information. In spite of significant efforts undertaken by global organizations to combat corruption, the level of anti-corruption disclosure is significantly different among the four countries under study. The disclosure of sensitive information such as the confirmed incidences of corruption cases requires careful consideration by the top management as it is subjected to legal implications and reputational risks. Thus, impression management can complement the coercive pressure in explaining the level of anti-corruption reporting. This study is among the first studies which explores the association between coercive factors and the level of anti-corruption disclosure in ASEAN region. (shrink)

Protecting the privacy of individually-identifiable health data and promoting the public’s health often seem at odds. Privacy advocates consistently seek to limit the acquisition, use, and disclosure of identifiable health information in governmental and private sector settings. Their concerns relate to misuses or wrongful disclosures of sensitive health data that can lead to discrimination and stigmatization against individuals. Public health practitioners, on the other hand, seek regular, ongoing access to and use of identifiable health information to accomplish important public (...) health objectives. The collection and use of identifiable health data by federal, tribal, state, and local health authorities support nearly all public health functions and goals.Identifiable health data are the lifeblood of public health practice. When aggregated, these data help authorities monitor the incidence, patterns, and trends of injury and disease in populations. Health data are acquired by public health authorities through testing, screening, and treatment programs. (shrink)

The advent of the Internet has had a significant impact on the formation of an information-driven, rapid-paced society. The number of Internet users reached 50 million in only five years compared to 13 years for television and 38 years for radio. Consumer expectation for access, convenience, and speed has made the cyberspace superhighway a medium for knowledge exchange and for e-commerce. The Internet offers a wide variety of health services and products to healthcare professionals as well as to the public. (...) Online pharmaceutical sales are predicted to reach $20–25 billion over the next four years. This is a dramatic increase when compared to the $1.9 billion in 1999. At the click of the mouse, medications can be ordered and delivered conveniently to your door. Yet, consumer discomfort with the security of information provided via the Internet is growing, and recent incidents involving disclosure of healthcare information serve to heighten this concern. (shrink)

How a person perceives a wrongdoing being committed by a coworker will affect whether the incident is reported within the organization. A significant factor that may influence the decision to report a wrongdoing is the perceived intentionality of the wrongdoer. This study sought to examine if differences in perceptions of a wrongdoing could affect the disclosure of unethical behavior. Three hundred seventy-two registered nurses (N = 372) responded to a survey consisting of both intentional and unintentional wrongdoings that (...) could occur by a nurse. Results of a paired t-test were as predicted. More wide ranging revelations found that respondents were more likely to discuss the unintentional wrongdoings with the wrongdoer in lieu of officially reporting to an immediate supervisor, or a member of upper management. Discussion, limitations, and suggestions for future research are provided. (shrink)

Para hacer justicia hay que saber la verdad. Existen al menos dos justicias, una humana, otra divina. Eventualmente la segunda precave los errores de la primera y enmienda lo obrado por la desmesura de los mortales, imponiendo su dominio, mandato y castigo. Este ensayo reflexiona respecto del tema de la verdad como aletheia, esto es, como desocultación y rememoración, en la obra Edipo rey de Sófocles. En este drama la justicia la impondrá Apolo y devendrá violenta, a causa de lamentables (...) “hechos de sangre” ocultados y olvidados. Desde el oráculo de Delfos, salpicando y chorreando sangre de los ojos del rey de Tebas, la verdad divina emergerá exigiendo venganza, sin compasión alguna para sus protagonistas. La verdad como aletheia no es solo poder, justicia y castigo por medio del logos -y aquí lo relevante-, también es grito, sangre y muerte, es tragedia. To do justice we must know the truth. There are at least two types of justice: human and divine. Eventually the second one prevents errors of the first and amends uncontrollable human actions, imposing its power, order and punishment. This essay reflects on the theme of truth as aletheia, that is, as disclosure and remembrance in Sophocles' King Oedipus. In this drama, Apollo’s justice prevails and turns violent, because of unfortunate “bloodshed” hidden and forgotten incidents. From the Delphi Oracle, the divine truth will emerge spilling blood from Thebas King’s eyes, demanding vengeance, without mercy for its players. The truth as aletheia is not only power, justice and punishment through the logos -this being what is relevant- but cry, blood and death, and tragedy. (shrink)

Nursing homes' ethics committees play a role in designing policies to assure ethical care. The administrative structure of nursing homes is not as large as that of hospitals. Nursing home staff and administration can respond to medical accidents in a way that treats family unethically and does serious harm to the facility. This paper describes incidents in which nursing homes attempted to conceal accidental deaths. It describes how such incidents are discovered, and the consequences of such efforts, and suggests ways (...) to prevent such incidents.This paper presents a retrospective review of a convenience sample of eight cases in which it was discovered that a nursing home attempted to conceal an accidental death. The effort to conceal an accidental death requires a coordinated effort to: [1] limit dissemination of information about the accident by staff and records, [2] decrease suspicion about the death, and [3] decrease the likelihood that an inquiry, if launched, will succeed. This effort begins as a reflexive, emotional and defensive response to the accident and consolidates as an institutional strategy to conceal both the accident and the concealment. The effort is coordinated by administrators who coerce cooperation from front line staff, alter medical records, and fail to follow reporting procedures. The attempt to conceal a lethal accident adversely affects the facility and the healthcare system. Ethics committees should work with professional organizations and administrator to assure proper management and disclosure of harmful accidents. (shrink)

In corporate social responsibility reporting, companies are expected to fully disclose the negative social and environmental impacts of their activities. This study investigates how Chinese companies respond to this challenge by analyzing the representations of occupational fatalities and injuries in 92 CSR reports from 37 Chinese Fortune 500 companies. A move-step analysis was performed on one part of the CSR report, which is the section providing information on occupational incidents. It was found that the negative information was typically disclosed via (...) four rhetorical moves, which are ‘preparing the reader’, ‘delivering the bad news’, ‘mitigating the bad news’ and ‘reassuring the reader’. Communicating bad news through the four moves helps manage the reader’s perception of the reporting company and its CSR performance. The study calls for greater attention to the impression-managing aspects of companies’ self-disclosure of organizational bad news. (shrink)

Many major medical institutions have now embraced the idea that it is best to be honest with patients and families when an error causes harm that could have been avoided. This kind of disclosure improves patient safety and quality of care; enhances satisfaction for patients, families, and providers; and reduces malpractice litigation costs. The University of Michigan has perhaps the best‐known program. Since 2001, that institution has seen more than a 55 percent drop in the number of new malpractice (...) claims filed, a comparable reduction in lawsuits, and a dramatic drop in both defense costs and malpractice payouts—money then redirected toward quality improvement. A few states have also embraced this approach, sometimes known as “Candor” (for “communication and optimal resolution”). Yet all of these efforts face a major challenge. Although many physicians would like very much to achieve insight, reconciliation, and quality improvement in just this way, many fear that money paid to resolve an incident in which they were involved can result in a lifelong black mark in the National Practitioner Data Bank. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryRathi Mahendran, Associate ProfessorThe doctor-patient relationship has an important role in medical practice and in medical ethics.1 In modern times, the word “boundary” is used to frame the relationship. In the context of therapy, Gutheil and Simon have described it as “the edge of appropriate or professional behaviour, transgression of which involves the therapist stepping out of the clinical role”.2 Boundaries establish for medical professionals the distinctions between (...) professional and personal identity.3 In a therapeutic setting, boundaries distinguish acceptable and appropriate interactions and the parameters of professional conduct.4 Implicit in the concept of boundaries are the basic ethical principles of beneficence (doing good, acting in another person’s best interests), non-maleficence (doing no harm) and justice with respect for the individual’s needs and autonomy.The doctor-patient relationship is particularly important in psychological therapies where trust, integrity, confidentiality, a safe environment and empathy are fundamental to the therapeutic process. A person with BPD manifests emotional dysregulation with instability in interpersonal relationships, self-image, affect and impulsivity.5 This, together with identity disturbances, makes them a particularly vulnerable group with heightened reliance on their therapist.6Psychotherapy has been described as an interaction which serves to alleviate distress, change behaviour and alter the patient’s perspective of issues. This description however does not reflect the magnitude and significant power differentials in the relationship. Trust and a close bond are needed to allow issues to be addressed.7 In the process, patients’ fantasies and unmet emotional needs [End Page 191] might lead them to knowingly or unknowingly view their therapist differently and to seek a relationship. Similarly, multiple factors in the therapist (situational factors, intrapsychic and interpersonal factors) can undermine the therapeutic process.8Boundary TransgressionsThere is really no universal definition for a “therapeutic boundary” possibly because, as Simon explains, it is “a function of the nature of the patient, the treatment and the status of the therapeutic alliance”.9 Minor violations are referred to as boundary crossings which may arise because the therapist exhibits poor judgement.10 Such actions are non-exploitative and pose little risk to patients.11 Duckworth et al. describe how boundary crossings begin as “exaggerations of desirable attitudes”. Special arrangements and sessions for the patient and extending therapy sessions may be construed as desirable and arguably as effective for the therapeutic alliance.12 Yet, if not examined objectively, they become “subtle breaks in the therapeutic frame”.13Psychotherapists trained in analytic therapy hold very rigid views of doctor-patient interactions in psychological therapy. Some would argue that providing a personal telephone number for a patient in crisis situations is a permissible boundary crossing.14 Similarly, self-disclosure for modelling and on-site behaviour therapy interventions may be viewed as necessary for the therapeutic encounter.15The most commonly recognised boundary crossing, however, is self-disclosure.16 It occurs when the therapist relates a personal experience or information to the patient which is how the incident began in this case.17 It gradually progressed to an informal, friendly style of interaction, accepting a hug, thanking her for being a good friend, all of which are dissonant with the psychotherapeutic process.18In the first place, should the therapist have even offered to drive her home, notwithstanding the heavy downpour? While that offer could be viewed as helpful, the disclosure of marital problems was inappropriate and created confusion. We can only speculate upon the therapist’s behaviour. Was he trying to establish for his patient that they were both experiencing problems to gain her trust? Was he exhibiting some form of identification or did he have some unmet need for affirmation and for care and nurturance? It is difficult to rationalise the apparently thoughtless and impulsive behaviour.19The therapist was, at that point, vulnerable with marital problems and facing separation.20 Procci has highlighted that therapists who breach boundaries, “usually have serious personal problems and may have a psychiatric diagnoses”.21 Even though the relationship was non-sexual, it [End Page 192] moved beyond a boundary crossing and should be viewed as a boundary violation. While the most serious form of boundary violation is the sexual encounter... (shrink)

Dance, Music and Dramaturgy: collaboration plan and dramaturgical apparatus – The unfolding of the concept of dramaturgy and the problematics of contemporary choreography are, today, a vast and diverse field of research, bearing numerous disclosures that lead to their reciprocal implication. Apart from that, dance and music share significant complementary ties allowing for the consideration of a common compositional inquiry. Reflecting on the compositional processes of dance and music, this article cross-examines the collaboration between choreographers and composers, integrating the incidence (...) of dramaturgy in the strategies of choreographic and musical composition. (shrink)

With her heavy-equipment operator certification in hand, Fiona is a new hire on a construction crew; the only woman in a family-owned organization aside from the HR manager, the sister of the company president and vice-president. Soon after her hire, the president of the company began a pattern of sexually targeting Fiona. She went to great lengths to avoid her boss, but the harassment and assaults continued. After one incident, Fiona reported the abuse to the company VP who offered (...) her a financial settlement in exchange for her silence. Fiona thought speaking out would put an end to the strain the abuse had caused, but other dilemmas had just begun. The case allows students to examine the competing interests Fiona faces in deciding whether to accept a financial settlement from her employer, that would greatly help her family, but at the cost of signing a non-disclosure agreement. (shrink)

Protecting the privacy of individually-identifiable health data and promoting the public’s health often seem at odds. Privacy advocates consistently seek to limit the acquisition, use, and disclosure of identifiable health information in governmental and private sector settings. Their concerns relate to misuses or wrongful disclosures of sensitive health data that can lead to discrimination and stigmatization against individuals. Public health practitioners, on the other hand, seek regular, ongoing access to and use of identifiable health information to accomplish important public (...) health objectives. The collection and use of identifiable health data by federal, tribal, state, and local health authorities support nearly all public health functions and goals.Identifiable health data are the lifeblood of public health practice. When aggregated, these data help authorities monitor the incidence, patterns, and trends of injury and disease in populations. Health data are acquired by public health authorities through testing, screening, and treatment programs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 47, no. 1. © 2021 by Feminist Studies, Inc. 15 Candice Lyons Behind the Scenes: Elizabeth Keckley, Slave Narratives, and the Queer Complexities of Space In the fall of 1867—just two years after the conclusion of the American Civil War—former First Lady Mary Todd Lincoln, finding herself in dire financial straits, traveled incognito to New York. She hoped to sell select pieces from her famed wardrobe in (...) order to supplement her income, which was, at the time, rather meager. Accompanying the recently widowed socialite was her self-described “modiste” and “confidante ” Elizabeth Keckley, a formerly enslaved African American dressmaker who had been “intimately associated” with Lincoln for years.1 Despite the various measures undertaken to ensure the scheme’s success, including attempts to extort monied East Coast Republicans and strategic appeals to the press, it ultimately proved fruitless. Political nemeses seized on the opportunity to publicly mock Lincoln, who was seen as an “extravagant and improper” social climber, for her “pecuniary embarrassment,” treating the public auction of her clothing as a spectacle akin to the World Fair.2 Eventually, the former First Lady was forced to retreat to her home in Chicago, leaving Keckley behind to tend to her affairs. 1. Elizabeth Keckley, Behind the Scenes: Or, Thirty Years a Slave and Four Years in the White House (New York: Open Road Integrated Media, 2015): Location no. 406, 54, 53. 2. Carolyn Sorisio, “Unmasking the Genteel Performer: Elizabeth Keckley’s Behind the Scenes and the Politics of Public Wrath,” African American Review 34 (2000): 20; Keckley, Behind the Scenes, Location no. 1321. 16 Candice Lyons This decision, however, left the ordinarily sought-after seamstress in dire straits of her own, given that the time she was compelled to dedicate to what would come to be known as “The Old Clothes Scandal ” necessitated closing down her then-thriving business in Washington, DC.3 This, coupled with the fact that indemnification for her services was not forthcoming from Mrs. Lincoln, was likely at least partially at the root of Keckley’s decision to publish her now-infamous memoir, Behind the Scenes: Or, Thirty Years A Slave and Four Years in the White House in 1868.4 Keckley explained that she penned her autobiographical text in a bid to “defend [her]self” and Lincoln against charges of impropriety following the New York incident. However, perhaps unsurprisingly, the book’s release had the exact opposite effect: Keckley’s literary disclosures were met with scorn, regarded by large swaths of white Americans, including some of the same people who had been most vocal in their condemnation of Mary Todd Lincoln, as constituting a set of socially impermissible transgressions of class, race, and gender. Sales of the book were subsequently suppressed, Keckley’s relationship with Lincoln (who had been caught off guard by the text’s release) came to an abrupt end, and there was even a brief, parodic pamphlet produced, titled Behind the Seams; by a Nigger Woman Who Took in Work from Mrs. Lincoln and Mrs. Davis, which cast the entire ordeal as a sort of (racist) cautionary tale.5 Given the clear disdain held for Lincoln by people across the political spectrum at the time, it can be difficult to make sense of the visceral reaction prompted by Keckley’s airing of the controversial figure’s dirty laundry (pun intended). Considering the ways Behind the Scenes implicitly challenged the fixity of hierarchical distinctions between Black and white, employee and employer, however, repudiation of the work might be understood as inevitable. Further, given the “intimate” and ambiguous nature of Lincoln and Keckley’s relationship, the book may also 3. Sorisio, “Unmasking the Genteel Performer,” 19. 4. The text’s infamy is in part attributable to its anomalous structure, which rendered it distinct from many of the era’s other book-length slave narratives ; whereas monographs such as Harriet Jacobs’s 1861 Incidents in the Life of a Slave Girl centered on the author’s experience of and eventual escape from slavery, Keckley’s work deals only briefly with these matters, primarily concerning itself with the intimate affairs of the author’s (white) employer. 5. Sorisio, “Unmasking the Genteel Performer,” 19. Candice... (shrink)

This essay explores Wittgenstein’s encounter with Stumpf’s work in Tone Psychology during a rarely studied period in Wittgenstein’s early career when he worked as a researcher in Myers’s laboratory for experimental psychology in Cambridge. I argue that Stumpf’s emphasis on the notion of musicality as the ability to characterize what is ‘musical’ about music troubled Wittgenstein’s initial formulation of his career-long adherence to the comparison between language and music. In the Tractatus the importance of internal projective relations far exceeds that (...) of arbitrariness in language. This results in the curious elision of musicality in the Tractatus, as shown in his gramophone analogy. The acknowledgment of the enormous complexity pertaining to the facts of human life remained underdeveloped in Wittgenstein’s philosophy until the anthropological turn in his middle-period. Only then do we see the blooming of the language-as-music simile and its eventual impact on Wittgenstein’s later philosophy. (shrink)

ObjectiveIn this study, we extend the impact of mindfulness to the concept of least-worst decision-making. Least-worst decisions involve high-uncertainty and require the individual to choose between a number of potentially negative courses of action. Research is increasingly exploring least-worst decisions, and real-world events (such as the COVID-19 pandemic) show the need for individuals to overcome uncertainty and commit to a least-worst course of action. From sports to business, researchers are increasingly showing that “being mindful” has a range of positive performance-related (...) benefits. We hypothesized that mindfulness would improve least-worst decision-making because it would increase self-reflection and value identification. However, we also hypothesized that trait maximization (the tendency to attempt to choose the “best” course of action) would negatively interact with mindfulness.MethodsThree hundred and ninety-eight participants were recruited using Amazon MTurk and exposed to a brief mindfulness intervention or a control intervention (listening to an audiobook). After this intervention, participants completed the Least-Worst Uncertain Choice Inventory for Emergency Responders (LUCIFER).ResultsAs hypothesized, mindfulness increased decision-making speed and approach-tendencies. Conversely, for high-maximizers, increased mindfulness caused a slowing of the decision-making process and led to more avoidant choices.ConclusionsThis study shows the potential positive and negative consequences of mindfulness for least-worst decision-making, emphasizing the critical importance of individual differences when considering both the effect of mindfulness and interventions aimed at improving decision-making. (shrink)

Name der Zeitschrift: Semiotica Jahrgang: 2014 Heft: 202 Seiten: 183-205.

In the marketplace of opinions concerning the metaphysics of mind and consciousness panqualityism (PQ) occupies an interesting position. It is a distinct variant of neutral monism, as well as of protophenomenalism, and as such it strives to carve out a conceptual niche midway between physicalism and mentalism. It is also a brand of Russellian monism, advocated by its supporters as a less costly and less extravagant alternative to panpsychism. Being clearly articulated and relatively well-developed it constitutes an intriguing view. Nonetheless, (...) the present paper takes a decisively critical stance towards PQ. In particular, it challenges it on two principal grounds. First, I argue that PQ's analysis of experience, and of the qualities tasked with constituting the phenomenal character of experience, is fundamentally flawed. Second, I argue that PQ's attempt to explain phenomenal consciousness as a function of reflective awareness is equally misguided. Along the way, the paper also points the shortcomings of previously established critiques of PQ. All in all, the discussion identifies some difficulties that are likely to generalize beyond PQ's specific circumstances, raising concerns regarding the viability of a "middle of the road" solution to the mind–body problem. (shrink)

This paper explores abuse received by a Chilean right-wing female politician in tweets produced with the #CamilaPeluche hashtag, which aimed to shame her sexually. The data considers the period of 22 days since the creation and spread of the hashtag, which took place 5 days into the 2019 uprising in Chile. This paper follows a corpus-based critical discourse analysis that examines the most frequently used adjectives, that is, predication strategies, that characterise the politician, as well as their legitimating function through (...) the identification of van Leeuwen’s legitimation strategies. Results showed that what started as gendered aggression evolved towards a focus on social class and political stance due to the politician’s characteristics and those of the sociohistorical context where the aggressions originated. Furthermore, it was found that the politician’s anti-democratic values were used to justify abuse against her, presenting it as reasonable. (shrink)

Most regulations and guidelines require that potential research participants be told a great deal of information during the consent process. Many of these documents, and most of the scholars who consider the consent process, assume that all this information must be disclosed because it must all be understood. However, a wide range of studies surveying apparently competent participants in clinical trials around the world show that many do not understand key aspects of what they have been told. The standard view (...) of the conditions for valid consent therefore implies that these people have failed to give valid consent to research participation. In this paper we argue that the standard view is false. The primary function of the requirement that researchers disclose information about a study is the avoidance of illegitimate control over someone’s consent decision, which is a form of fraud.We derive the content and manner of appropriate disclosure by analysing the ways in which the manipulation of information can invalidate consent. Our analysis shows that the informational requirements for valid consent are conceptually distinct and thus unlikely to have identical contents. This implies that consent can be valid when not everything that ought to be disclosed by the person asking for consent is understood by the person who proffers it. (shrink)

The American Journal of Bioethics, Volume 12, Issue 10, Page 10-12, October 2012.

The analysis of critical incidents in the pre-professional practice of teacher training is essential to promote reflection. Building upon this notion, the urgent need for a reflective practice in the training of science teachers is addressed. In this context, future educators are instructed in the preparation of reports that highlight the critical incidents experienced in their pedagogical work. From these perspectives, reflective practice emerges as a fundamental resource to solidify their identity and pedagogical mastery by incorporating experiences for guidance purposes, (...) emphasizing the significance of reflection. (shrink)

Medical aid in dying (MAiD), despite being legal in many jurisdictions, remains controversial ethically. Existing surveys of physicians’ perceptions of MAiD tend to focus on the legal or moral permissibility of MAiD in general. Using a novel sampling strategy, we surveyed physicians likely to have engaged in MAiD-related activities in Colorado to assess their attitudes toward contemporary ethical issues in MAiD.

ZusammenfassungDer finale Dialog zwischen Kriemhild und Hagen in der Schlussszene der 39. Aventiure im Nibelungenlied – von der Forschung bis heute irreführend als »2. Hortforderungsszene« bezeichnet – wird als eine psychologisch basierte Finte Hagens gedeutet, die nicht nur eine individuelle Innensphäre der Figur Kriemhilds verifiziert, sondern zugleich das furiose Ende der burgundischen Nibelungen kohärent motiviert. Das Nibelungenlied erscheint in diesem Kontext als literarisches Zeugnis eines zeitgenössischen Ringens um politische Stabilität und traditionelle Wertvorstellungen, das besonders über die Figurenrolle Dietrichs im Spannungsfeld (...) heroischer Gewaltverherrlichung und höfischer Interessenwahrung problematisiert ist.The final dialogue between Kriemhild and Hagen in the closing scene of the Nibelungenlied’s 39th Aventiure – to date falsely designated as the second »Hortforderungsszene« – is here interpreted as a psychological feint of Hagen, which not only verifies the individual interior life of Kriemhild but also provides a coherent motivation for the stirring end of the Burgundian Nibelungen. In this context, the Nibelungenlied appears as a literary testimony of a contemporary struggle about politically stability and traditional moral concepts, which is problematized, first and foremost, via the figure of Dietrich, caught in a conflict between the heroic glorification of violence and the protection of courtly interests. (shrink)