Migrating Minds contributes to the prominent interdisciplinary domain of Cosmopolitan Studies with twenty innovative essays by humanities scholars from all over the world that re-examine theories and practices of cosmopolitanism from a variety of perspectives.

We discuss the role of practical costs in the epistemic justification of a novice choosing expert advice, taking as a case study the choice of an expert statistician by a lay politician. First, we refine Goldman’s criteria for the assessment of this choice, showing how the costs of not being impartial impinge on the epistemic justification of the different actors involved in the choice. Then, drawing on two case studies, we discuss in which institutional setting the (...) class='Hi'>costs of partiality can play an epistemic role. This way we intend to show how the sociological explanation of the choice of experts can incorporate its epistemic justification. (shrink)

Cost effectiveness. Economics. This is an introduction, accessible to non-economists as well as to economists, to the practice of cost benifit analysis. It begins from a discussion of financial appraisal. The distinguishing features of cost benifit analysis are then introduced progressively. Practical examples are used whenever possible to aid the exposition. Economic theory is introduced only where it is immediately relevant to practice. Nonetheless the approach is firmly grounded in economic principles and considerable space is devoted to those ideas (...) that are central to practical cost benefit analysis - shadow prices, consumers' surplus, and valuation of unmarked goods. The additional needs of economically trained readers are catered for by a number of appendices which relate the ideas expounded in the book to mainstream economic theory. (shrink)

This study investigated effects of codes of ethics on perceptions of ethical behavior. Respondents from companies with codes of ethics (n = 465) rated role set members (top management, supervisors, peers, subordinates, self) as more ethical and felt more encouraged and supported for ethical behavior than respondents from companies without codes (n = 301). Key aspects of the organizational climate, such as supportiveness for ethical behavior, freedom to act ethically, and satisfaction with the outcome of ethical problems were impacted by (...) the presence of an ethics code. The mere presence of a code of ethics appears to have a positive impact on perceptions of ethical behavior in organizations, even when respondents cannot recall specific content of the code. (shrink)

This paper examines and contrasts two closely related evolutionary explanations in human behaviour: signalling theory, and the theory of Credibility Enhancing Displays. Both have been proposed to explain costly, dangerous, or otherwise ‘extravagant’ social behaviours, especially in the context of religious belief and practice, and each have spawned significant lines of empirical research. However, the relationship between these two theoretical frameworks is unclear, and research which engages both of them is largely absent. In this paper we seek to address this (...) gap at the theoretical level, examining the core differences between the two approaches and prospects and conditions for future empirical testing. We clarify the dynamical and mechanistic bases of signalling and CREDs as explanatory models and contrast the previous uses to which they have been put in the human sciences. Because of idiosyncrasies regarding those uses, several commonly supposed differences and comparative advantages are actually misleading and not in fact generalisable. We also show that signalling and CREDs theories as explanatory models are not interchangeable, because of deep structural differences. As we illustrate, the proposed causal networks of each theory are distinct, with important differences in the endogeneity of various phenomena within each model and their explanatory targets. As a result, they can be seen as complementary rather than in competition. We conclude by surveying the current state of the literature and identifying the differential predictions which could underpin more comprehensive empirical comparison in future research. (shrink)

Using four examples of cost-effectiveness analyses, I argue that discussions of and research on cost-effectiveness in medical practice should clearly delineate between protocol and practice cost-effectiveness analyses. Failure to do so risks confusing conclusions that warrant substantial confidence and limited applicability with conclusions with broader applicability but more limited confidence. Further, these different types of analyses incorporate different sets of values. I argue that some favor should be shown for those analyses that include a wider array of values.

This paper presents a conceptual link among green marketing, environmental justice, and industrial ecology. It argues for greater awareness of environmental justice in the practice of green marketing. In contrast with the type of costs commonly discussed in the literature, the paper identified another type of costs, termed "costs with positive results," that may be associated with the presence of environmental justice in green marketing. A research agenda is finally suggested to determine consumers'' awareness of environmental justice, (...) and their willingness to bear the costs associated with it. (shrink)

The diversity in agronomic practices being used by sugarcane producers in Brazil determines differences in economic performance and cost structure. The purpose of this study is to evaluate the cost of six systems of agronomic practices using fixed or variable rates for soil amendment, fertilizer, and defensive applications and assess the profitability of these systems at three scales of sugarcane production. We then describe the data sample related to the 2019–2020 harvest season and collected from fifty-five sugarcane producers in the (...) central-south region of Brazil. Thereafter, using a quantitative approach, a cost analysis was performed, and the cumulative frequency of the net revenue for the three scales of production (small, medium, and large), was calculated using a Monte Carlo simulation. The cost analysis indicated that fertilizer had the highest cost considering the agronomic practices adopted at the three scales of production analyzed. The cumulative frequency analysis results from the Monte Carlo simulation showed the highest net revenue per hectare for medium sugarcane producers. In addition, the presence of economies of scale was not confirmed because the lowest cost was found in small-scale sugarcane producers and the highest net revenue was obtained by medium-scale sugarcane producers. (shrink)

Risk is the probability that within a certain time some expected negative event will take place. In medicine risk can be related to a decision or to some intrinsic factors which are associated with the probability of the occurrence of a disease. Decisions can be necessary in the individual life with respect to the question of visiting a physician or performing a certain diagnostic or therapeutic procedure. The introduction of new pharmaceutical or technical products into medical use are another set (...) of decisions which can generate certain risks. Intrinsic or inherent risk factors are a set of variables or signs and symptoms which indicate the presence of a certain probability that some disease or event, e.g., arteriosclerosis or sudden infant death syndrome, may occur. Risk is always related to judgement. In a decision process cost, effectiveness and profit can be used to estimate the magnitude of the risk to be taken. In a similar way the problems in connection with an inherent risk are primarily related to the recognition of the magnitude of risk and to the possibility of prophylactic measures.In our own area of research, the sudden infant death syndrome (SIDS) is an event where only risk factors can be observed. We point at two facts in this context: Highly complex patterns of symptoms like behaviour can better be classified by intuitive Gestalt perception. A medical procedure like induction of labour can itself become a risk factor. (shrink)

According to evidentialist views, credence in a proposition p should be proportional to the degree of evidential support that one has in favor of p. However, empirical evidence suggests that our credences are systematically sensitive to practical factors. In this article, I provide a cost–benefit analysis of credences' practical sensitivity. The upshot of this analysis is that credences sensitive to practical factors fare better than practically insensitive ones along several dimensions. All things considered, our credences should be (...) sensitive to practical factors. (shrink)

Progress in medicine and the subsequent extension of health coverage has meant that health expenditure has increased sharply in Western countries. In the United States, this rise was precipitated in the 1980s, compounded by an increase in drug consumption which prompted the government to re-examine its financial support to care delivery, most notably in hospital care and emergencies services. In California for example, 50 emergency service providers were closed between 1990 and 2000, and nine in 1999–2000 alone. In that State, (...) only 355 hospitals (out of 568) have maintained emergency services departments (Darves, WebMB, 2001). Reforming hospital Emergency Department (ED) operations requires caution not only because the media pay a lot of attention to ED operations, but also because it raises ethical issues: this became more apparent with the enactment of the EMTALA which stipulates that federally funded hospitals are required to give emergency aid in order to “stabilize” a patient suffering from an “emergency medical condition” before discharging or transferring that patient to another facility. While in essence the law aims to preserve patient access to care, physicians assert that the EMTALA leads to more patients seeking care for non-urgent conditions in EDs (GAO, Report to Congressional Committees, 2001), leading to overcrowding, delayed care for patients with true emergency needs, and forcing hospitals to divert ambulances to other facilities resulting in further delays in urgent care. Also, fewer physicians are willing to be on-call in emergency departments because the EMTALA law requires on-call physicians to provide uncompensated care. Thus there is a need to find a balance between appropriate care to be provided to ED patients, and low costs since uncompensated care is not covered by state or federal funds. This concerns, first and foremost, hospitals that provide a greater amount of uncompensated care (e.g. hospitals serving communities with a higher population of illegal immigrants). Looking at the intrinsic causes of high ED costs, the paper first explains why costs of care provided in EDs are high, and look at a major cause of high ED costs: overcrowding and ED users’ characteristics. This is followed by a discussion on a much-debated factor: the use of EDs for non-emergency conditions, a practice which has often been accused of disproportionately raising costs. We look at various mechanisms used either to divert or prevent the patient from using ED: these include triage services; and the role of HMOs in the ED chain of care: though the US government has increasingly relied on Managed Care organizations to contain costs (e.g. Medicaid and Medicare Managed Care), do HMOs make a difference when it comes to ED costs? Of particular interest is the family physician acting as a gatekeeper, and the legislation that was enacted to protect those who bypass the referral system. We then look at the other end of the ED chain (i.e. the recipient): the financial responsibility of ED users has increased. Alternative providers such as walk-in clinics are increasingly common. EDs also attempt to reengineer their operations to curb costs. While the data are mostly applicable to a private health care system (e.g. the US), the article, using a critical assessment of the existing literature, has implications for other EDs generally, wherever they operate, since every ED faces similar funding problems. (shrink)

The FASB in its Conceptual Framework has set high principles in the ethics of standard-setting in accounting. This paper concentrates on what the FASB calls the cost/benefit constraint, i.e., the commitment to setting an accounting standard only when the benefits of the standard exceeds the costs of that standard toall stakeholders. This constraint is supposed to take precedence over other concerns, such as neutrality (freedom from bias) of account information.The major conclusion of this paper is that a conflict exists (...) between the FASB's commitment and its practice. There is no evidence that the FASB has always made a costs and benefits judgement with respect to proposed standards. In the cases when such a judgement is made, the FASB discounts social costs; therefore, it is not considering costs to all stakeholders. At the same time the FASB discounts social costs, it seems to have an undue concern for standards that do not increase the volatility of net income. The Conceptual Framework explicitly defines costs as the costs to society as a whole. (shrink)

Taxation of residential property is difficult to be implemented in many jurisdictions and in this respect Lithuania is not an exception. Many taxpayers do not comprehend why property should be levied by the government. Indeed, any owner of real estate would usually resist to any attempts to increase this tax burden. However, even when the threshold is once overstepped and a new unpopular statutory framework is introduced, the government still faces new dilemmas regarding the administration of this tax. Sometimes weak (...) tax administration but not the tax itself undermines the credibility of the public. Commercial premises as well as land have been continuously levied in the Republic of Lithuania since 1990. Thus, the taxes paid by enterprises and the land tax were not a big issue of public debate in Lithuania. The burden of this tax was not very significant in the light of all taxes paid by enterprises or land owners. The most problematic issue remains the taxation of residential property. (shrink)

Decision theorists generally object to “honoring sunk costs” – that is, treating the fact that some cost has been incurred in the past as a reason for action, apart from the consideration of expected consequences. This paper critiques the doctrine that sunk costs should never be honored on three levels. As background, the rationale for the doctrine is explained. Then it is shown that if it is always irrational to honor sunk costs, then other common and uncontroversial (...) practices are also irrational. Second, it is argued that there is no satisfactory way to make a distinction between the two kinds of cases. Third, a proposal is developed which would explain how it could be rational, under certain circumstances, to honor sunk costs. (shrink)

We highlight how Corporate Social Responsibility can be strategically used against the negative perception from earnings management. Using international data, we analyse the effect of CSR and EM on the cost of capital and corporate reputation. Results confirm that CSR strategy is positively valued by investors and other stakeholders. Contrary to EM, CSR has a positive effect on corporate reputation and lowers the cost of capital. In addition, we also find that the favourable effect of CSR on cost of capital (...) is consistently more intense in firms that show signs of EM indicating that the market does not identify when CSR practices are used as a strategy to mask EM. We also demonstrate how institutional factors influence the above relationship. (shrink)

A recurring question about cost - benefit analysis concerns its scope. CBA is a decision-making method frequently employed in environmental policy-making, in which things which have no market price are treated as if they were commodities. They are given a monetary value, a form of price. But it is widely held that some things cannot be meaningfully priced, thus substantially limiting the scope of CBA. The aim of this paper is to test some aspects of this broad claim, focusing on (...) problems of incomparability and incommensurability. In particular, the role of rough equality as a putative form of comparison is investigated. I argue that while an assessment of the full significance of rough equality for practical decision-making awaits resolution of a number of important technical questions, it does not provide a strong enough form of comparison to support CBA. (shrink)

Kerr coined the term ‘HARKing’ to refer to the practice of ‘hypothesizing after the results are known’. This questionable research practice has received increased attention in recent years because it is thought to have contributed to low replication rates in science. The present article discusses the concept of HARKing from a philosophical standpoint and then undertakes a critical review of Kerr’s twelve potential costs of HARKing. It is argued that these potential costs are either misconceived, misattributed to HARKing, (...) lacking evidence, or that they do not take into account pre- and post-publication peer review and public availability to research materials and data. It is concluded that it is premature to conclude that HARKing has led to low replication rates. (shrink)

Cost containment by means of prospective payment and other mechanisms is widely seen as a challenge to modern medicine; but the challenge is seldom articulated clearly in terms of core professional values and the moral content of a claim to professionalism. Medical ethics, as it has evolved as a field of study in the past twenty years, has contributed little to the concept of professionalism in medicine. For an investigation of professionalism in the face of cost containment to evolve fruitfully, (...) several things must occur. The true nature of today's challenge to medicine must be appreciated. The balance between tradition and response to social change in defining a professional value system must be appreciated. Physician income must be explicitly addressed as a moral issue. And practical strategies for investigating and affirming core professional values must be developed for health delivery systems and medical education settings. (shrink)

This paper discusses the practice of cost-benefit analyses of transportation infrastructure investment projects from the meta-theoretical perspective of critical realism. Such analyses are based on a number of untenable ontological assumptions about social value, human nature and the natural environment. In addition, main input data are based on transport modelling analyses based on a misleading `local ontology' among the model makers. The ontological misconceptions translate into erroneous epistemological assumptions about the possibility of precise predictions and the validity of willingness-to-pay investigations. (...) Accepting the ontological and epistemological assumptions of cost-benefit analysis involves an implicit acceptance of the ethical and political values favoured by these assumptions. Cost-benefit analyses of transportation investment projects tend to neglect long-term environmental consequences and needs among population groups with a low ability to pay. Instead of cost-benefit analyses, impact analyses evaluating the likely effects of project alternatives against a wide range of societal goals is recommended, with quantification and economic valorisation only for impact categories where this can be done in an ontologically and epistemologically defensible way. (shrink)

Many people who claim to genuinely care about nature still seem reluctant to ascribe intrinsic value to it. Environmentalists, nature friendly people in general, and even environmental activists, often hesitate at the idea that nature possesses value in its own right—value that is not reducible to its importance to human or other sentient beings. One crucial explanation of this reluctance is probably the thought that such value—at least when attached to nature—would be mysterious in one way or another, or at (...) least very difficult to account for. In addition, Bryan Norton’s influential convergence hypothesis states that, from a practical point of view, it makes no or little difference whether we ascribe intrinsic value to nature, given the depth and variety of instrumental value it possesses. In this paper, I argue that people who genuinely care about nature cannot avoid ascribing intrinsic value (in a certain sense) to it, if they want to be able to consistently defend the kind of claims about protecting nature they arguably want to make, i.e., claims to the effect that we ought to protect for instance nature areas and species. The cost of denying intrinsic value in nature is the cost of giving up a crucial resource to philosophically defend such claims. (shrink)

Interest shown on the environmental impact of operations of multinational enterprises in developing countries has grown significantly recently, and has fuelled a heated public policy debate. In particular, there has been interest in the environmental degradation of host communities and nations resulting from the operations of multinational oil companies in developing countries. This article examines the issue of environmental costs and responsibilities resulting from oil exploitation and production in the Niger Delta region of Nigeria. The case study is based, (...) in part, upon series of interviews with key stakeholders in the Nigerian oil industry. The article further examines the implications of the current practice and policies of multinational oil companies with respect to environmental impact of oil exploitation. The study’s findings illustrates that it is becoming increasingly apparent to oil companies that pollution prevention pays while pollution does not and under pressure from stakeholder groups, oil companies now routinely incorporate environmental impact assessments into their corporate strategy. (shrink)

Whistleblowers are a vital means of protecting society because they provide information about serious wrongdoing. And yet, people who speak up can suffer. Even so, debates on whistleblowing focus on compelling employees to come forward, often overlooking the risk involved. Theoretical understanding of whistleblowers’ post-disclosure experience is weak because tangible and material impacts are poorly understood due partly to a lack of empirical detail on the financial costs of speaking out. To address this, we present findings from a novel (...) empirical study surveying whistleblowers. We demonstrate how whistleblowers who leave their role as a result of speaking out can lose both the financial and temporal resources necessary to redevelop their livelihoods post-disclosure. We also show how associated costs involving significant legal and health expenditure can rise. Based on these insights, our first contribution is to present a new conceptual framing of post-disclosure experiences, drawing on feminist theory, that emphasizes the bodily vulnerability of whistleblowers and their families. Our second contribution repositions whistleblowing as a form of labour defending against precarity, which involves new expenses, takes significant time, and often must be carried out with depleted income. Bringing forth the intersubjective aspect of the whistleblowing experience, our study shows how both the post-disclosure survival of whistleblowers, and their capacity to speak, depend on institutional supports or, in their absence, on personal networks. By reconceptualizing post-disclosure experiences in this way—as material, embodied and intersubjective—practical implications for whistleblower advocacy and policy emerge, alongside contributions to theoretical debates. Reversing typical formulations in business ethics, we turn extant debates on the ethical duty of employees to speak up against wrongdoing on their heads. We argue instead for a responsibility to protect whistleblowers exposed to vulnerability, a duty owed by those upon whose behalf they speak. (shrink)

Japan has one of the highest numbers of high-cost medical devices installed relative to its population. While evaluations of the distribution of these devices traditionally involve simple population-based assessments, an indicator that includes the demand of these devices would more accurately reflect the situation. The purpose of this study was to develop an indicator of the supply–demand balance of such devices, using examples of magnetic resonance imaging scanners (MRI) and extracorporeal shockwave lithotripters (ESWL), and to investigate the relationship between this (...) indicator, personnel distribution statuses and operating statuses at the prefectural level. -/- Using data from nation-wide surveys and claims data from 16 hospitals, we developed an indicator based on the ratio of the supplied number of device units to the number of device units in demand for MRI and ESWL. The latter value was based on patient volume and utilization proportion. Correlation analyses were conducted between the supply–demand balances of these devices, personal distribution and operating statuses. -/- Comparisons between our indicator and conventional population-based indicators revealed that 15% and 30% of prefectures were at risk of underestimating the availability of MRI and ESWL, respectively. The numbers of specialist personnel/device units showed significant, negative correlations with our indicators in both devices. -/- Utilization-based analyses of health care resource placement and utilization status provide a more accurate indication than simple population-based assessments, and can assist decision makers in reviewing gaps between health policy and management. Such an indicator therefore has the potential to be a tool in helping to improve the efficiency of the allocation and placement of such devices. (shrink)

How do engineers respond to ethical dilemmas that occur in practice? How do they view their individual and collective responsibilities? How do they make decisions before all the facts are in? Using the space shuttle programme as the framework, this book examines the role of ethical decision making in the practice of engineering. In particular, the book considers the design and development of the main engines of the space shuttle as a paradigm for how individual engineers perceive, articulate, and resolve (...) ethical dilemmas in a large, complex organisation. A series of in-depth case studies show engineers at work on various stages of the project as they balance budgets, deadlines and risks. By documenting the historical development of a single system, the book provides a unique opportunity to explore the complex interactions between political, organisational and technical pressures and engineering and management decisions. (shrink)

Although the standard theory and actual practice of cost-benefit analysis are seriously defective, the general idea of making social policy in accord with an aggregative, maximizing, consequentialist criterion is a sensible one. Therefore it is argued, against Bantz, that interpersonal utility comparisons can be meaningful, and, against both Bantz and MacLean, that quantitative overall assessments of expected value provide a presumptively rational basis for social choice. However, it does not follow that introducing cost-benefit tests into the political or legal process (...) would always be optimal: recognizing some quite stringent legal rights against involuntary exposure to pollution or risk may actually promote cost-beneficial results more reliably than cost-benefit tests employed in very imperfect circumstances. (shrink)

Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find only relatively (...) weak reasons to restrict rationing to withholding treatment. On the contrary, resource allocation provides a strong argument in favour of equivalence: non-equivalence causes preventable death in critically ill patients. We outline two proposals for increasing equivalence in practice: (1) reduction of the mortality threshold for treatment withdrawal, (2) time-limited trials of intensive care. These strategies would help to move practice towards more rational treatment limitation decisions. (shrink)

Predatory pricing is one of the forms of the abuse of a dominant position. Judicial institutions of the European Union and Commission during analysis of predatory pricing devote main attention to the relationship between costs and prices of the dominant undertaking. Moreover, attention is paid also to various cost benchmarks: average variable costs, average avoidable costs, average total costs and long run average incremental costs. European judicial institutions should pay less attention to the costs (...) of a dominant undertaking than to evaluation of the effect of the actions of a dominant undertaking to consumers and competition in the market. Moreover, proposition of the Commission to use average avoidable costs in predation cases does not correspond to the practice of the Court of Justice and the General Court. The Commission should stipulate more clearly how average avoidable costs and long-run average incremental costs should be calculated in order to increase legal certainty of the undertakings. Establishment of prices higher than average total costs by the dominant undertaking should not be recognized as predatory pricing. (shrink)

Should India build a new steel mill, or London an urban motorway? Should higher education expand, or water supplies be improved? These are typical questions about which cost-benefit analysis has something to say. It is the main tool that economics provides for analysing problems of social choice. It also provides a useful vehicle for understanding the practical value of welfare economics. This new book of readings covers all the main problems that arise in a typical cost-benefit exercise. It is (...) entirely up-to-date, reflecting the most recent research in the area. Part I covers the main theoretical issues affecting cost-benefit analysis. Part II considers the problem of ascribing a monetary value to things. The third part covers six separate case studies drawn from real-life examples. The book begins with an extended elementary introduction written by the editors. (shrink)

This article considers some different views of fairness and whether they conflict with the use of a version of Cost Effectiveness Analysis (CEA) that calls for maximizing health benefits per dollar spent. Among the concerns addressed are whether this version of CEA ignores the concerns of the worst off and inappropriately aggregates small benefits to many people. I critically examine the views of Daniel Hausman and Peter Singer who defend this version of CEA and Eric Nord among others who criticize (...) it. I come to focus in particular on the use of CEA in allocating scarce resources to the disabled. (shrink)

This series of articles by Charles Dougherty, Robert Berenson, and Kathleen Powderly and Elaine Smith, as well as “Cost Containment: Challenging Fidelity and Justice” by E. Haavi Morreim (Hastings Center Report, December 1988), result from a Hastings Center project, “Ethics and Prospective Payment Systems: DRGs.” The two-year project was jointly funded by The General Electric Foundation and the American Medical Association Education and Research Foundation.The project tried to gauge the systematic effects of the introduction of cost containment strategies, prospective payment (...) by Diagnostic Related Groups in particular, on the provision of health care and the ethical practice of medicine. Cost containment strategies, no matter how necessary in curbing spiraling medical costs, leave no sector or participants in the health care system untouched—hospitals and other health care institutions; doctors, nurses, social workers and other health care professionals; patients, their families, and the thirty-six to forty million medically indigent. The articles discuss the several and interrelated ethical issues raised by the DRG prospective payment system (Dougherty); its particular affect on the doctor-patient relationship and how it is transforming the ethical practice of medicine (Berenson and Morreim); and its specific impact on the professions and professional ethics of nursing and social work (Powderly and Smith). The overall message of the articles is that the health professions, their provision of care, and the ethics of their practices—as driven by economic considerations and realities—are in the midst of a more or less radical sea change. (shrink)

Cost–benefit analysis (CBA) is much more philosophically interesting than has in general been recognized. Since it is the only well-developed form of applied consequentialism, it is a testing-ground for consequentialism and for the counterfactual analysis that it requires. Ten classes of philosophical problems that affect the practical performance of cost–benefit analysis are investigated: topic selection, dependence on the decision perspective, dangers of super synopticism and undue centralization, prediction problems, the indeterminateness of our control over future decisions, the need to (...) exclude certain consequences for moral reasons, bias in the delimitation of consequences, incommensurability of consequences, difficulties in defending the essential requirement of transferability across contexts, and the normatively questionable but equally essential assumption of interpersonal compensability. (Published Online July 31 2007). (shrink)

This paper discusses the practice of cost-benefit analyses of transportation infrastructure investment projects from the meta-theoretical perspective of critical realism. Such analyses are based on a number of untenable ontological assumptions about social value, human nature and the natural environment. In addition, main input data are based on transport modelling analyses based on a misleading `local ontology' among the model makers. The ontological misconceptions translate into erroneous epistemological assumptions about the possibility of precise predictions and the validity of willingness-to-pay investigations. (...) Accepting the ontological and epistemological assumptions of cost-benefit analysis involves an implicit acceptance of the ethical and political values favoured by these assumptions. Cost-benefit analyses of transportation investment projects tend to neglect long-term environmental consequences and needs among population groups with a low ability to pay. Instead of cost-benefit analyses, impact analyses evaluating the likely effects of project alternatives against a wide range of societal goals is recommended, with quantification and economic valorisation only for impact categories where this can be done in an ontologically and epistemologically defensible way. (shrink)

The new Hungarian Labour Code allows informal payments to be accepted, subject only to the prior permission of the employer. In Hungary, the area most affected is Health Care, where informal payments to medical staff are common. The article assesses the practice on ethical terms, focusing on organisational justice. It includes an analysis of distributional injustice, that is, of non-equitable payments to professionals, on the distribution of payments depending on the specialisation and status of the doctor, on his or her (...) rights to allocate Health Care resources and/or on how assertive he or she is. We show, by means of a content analysis of internet postings and of interviews with physicians, the feelings and attitudes of both patients and doctors—thus enabling us to trace interactional and procedural injustice and portray the main driving forces of informal payment with causal loops. We use a new approach (a system dynamics computer simulation) to demonstrate how informal payments influence therapy procedures. The example of treating the common skin disease of psoriasis examines the specific behaviour of doctors in their everyday practice and estimates the extent to which the prescription of unnecessary or more expensive therapy increases the costs. With this multi-method approach, we demonstrate that the legislation allowing informal payment represents bad ethics, since it enforces organisational injustice, creates mistrust between physicians and patients, decreases performance and increases the total costs paid both by society and the Health Insurance Fund. Informal payments distort the allocation of resources, enforce discrimination based solely on money, violate the concept of solidarity and limit Human Rights in terms of health. (shrink)

Goal-setting has become a popular and effective motivational tool, utilized by practitioners and substantiated with decades of empirical research. However, the potential for goal-setting to enhance performance may come at the cost of ethical behavior. I propose a theoretical model linking attributes of goals and goal-setting practices to unethical behavior through two psychological mechanisms – ethical recognition and moral disengagement; and addressing the moderating role of individual differences (e.g., goal-commitment and conscientiousness), as well as the broader organizational ethical context.

In evaluating difficult decisions which have a wide social impact, consequentialist ethics offers the most reliable footing. Consequentialism is necessary, for that matter, in order to make room for scientific input which will in turn endeavour to provide accurate and objective predictions of the effects of the decisions in question. In the final analysis, we are dealing with value-laden choices and consequentialism should not be, and in fact cannot be, reduced to one specific ethical option. For this reason a political (...) process is necessary for negotiating between the diversity of perspectives. Such a process will proceed in a more structured manner if techniques to make our ethical evaluation more explicit are used, and the furthest that can be gone in this regard is to try to reduce the various effects, as far as is possible, to one common denominator.Socio-economic cost-benefit analysis is often presented as an objective instrument for evaluating governmental decisions. As a matter of fact, however, it departs from a quite specific utilitarian option , and one which is not easy to accept. From this perspective, decisions are evaluated exclusively on the basis of the subjective advantage they bring to individuals in society. The idea of evaluating the various effects involvedin monetary terms can, nevertheless, remain of value, even when we are inclined to resist the technocratic illusion fostered by some supporters of SCBA. Monetary evaluation should certainly not be considered the last word in the discussion. On the contrary, it should be seen as a necessary reference point for the structuring of a wider ethical and political debate.In this paper I have focused exclusively on difficult governmental decisions which have significant economic aspects, i.e. where many of the effects involved can easily be evaluated in market terms. Of course, when this is not the case, the practical advantages of monetary evaluation techniques disappear. When decisions take place at a more personal level, even consequentialism will lose much of its ethical appeal. (shrink)

Women currently earn 77 cents for every dollar earned by men. Explanations abound for why, exactly, this wage gap exists. One of the more potent justifications attributes this pay differential to the unequal effects of marriage on the sexes: the marital asymmetry hypothesis. However, even when marital status is accounted for, a small but significant residual gap remains. This article argues that this is the result of social factors. Entrenched societal sexism causes all of us to harbor unconscious bias about (...) the capabilities and proper gender roles of women. This bias, in turn, leads us to discount work completed by females, especially in professional environments. Employers are not immune from this effect, and the undervaluation of female ability affects hiring practices, leading to the residual wage gap. (shrink)

This article discusses ethical issues which are raised as a result of the introduction of economic evidence in mental health care in order to rationalise clinical practice. Cost effectiveness studies and guidelines based on such studies are often seen as impartial, neutral instruments which try to reduce the influence of non-scientific factors. However, such rationalising instruments often hide normative assumptions about the goals of treatment, the selection of treatments, the role of the patient, and the just distribution of scarce resources. (...) These issues are dealt with in the context of increased control over clinical practice by third parties. In particular, health insurers have a great interest in economic evidence in clinical care settings in order to control access to and quality of health care. The authors conclude that guideline setting and cost effectiveness analysis may be seen as important instruments for making choices in health care, including mental health care, but that such an approach should always go hand in hand with a social and political debate about the goals of medicine and health care. This article is partly based on the results of a research project on the normative aspects of guideline setting in psychiatry and cardiology which was conducted under the guidance of the Royal Dutch Medical Association. (shrink)

The purpose of this paper is to describe the nature of dental practice and to identify some recent innovations which have effect on cost containment in dentistry. The first of these innovations is dental insurance or prepaid dental services. Dental insurance has only recently emerged as a significant economic factor. The chronic and prevalent nature of dental disease mandates that the management of these programs incorporate insurance devices which limit demand and utilization. These devices amount to cost containment measures. The (...) second factor to be discussed is advertising. Advertising has been foisted on the dental profession by recent rulings of the Federal Trade Commission in an effort to promote competition. The Reagan administration, despite a market oriented approach to health care, had attempted to blunt some of the FTC actions. Advertising, nevertheless, has the potential to stimulate competition and restrain price escalation. The third factor includes a discussion of alternative delivery systems. These commercially oriented dental enterprises have the potential to compete with established practices as well as increase the demand for services. (shrink)

Since the advent of the women's movement, women have made unprecedented gains in almost every field, from politics to the professions. Paradoxically, doctors and mental health professionals have also seen a staggering increase in the numbers of young women suffering from an epidemic of depression, eating disorders, and other physical and psychological problems. In The Cost of Competence, authors Brett Silverstein and Deborah Perlick argue that rather than simply labeling individual women as, say, anorexic or depressed, it is time to (...) look harder at the widespread prejudices within our society and child-rearing practices that lead thousands of young women to equate thinness with competence and success, and femininity with failure. They argue that continuing to treat depression, anxiety, anorexia and bulimia as separate disorders in young women can, in many cases, be a misguided approach since they are really part of a single syndrome. Furthermore, their fascinating research into the lives of forty prominent women from Elizabeth I to Eleanor Roosevelt show that these symptoms have been disrupting the lives of bright, ambitious women not for decades, but for centuries. Drawing on all the latest findings, rare historical research, cross-cultural comparisons, and their own study of over 2,000 contemporary women attending high schools and colleges, the authors present powerful new evidence to support the existence of a syndrome they call anxious somatic depression. Their investigation shows that the first symptoms usually surface in adolescence, most often in young women who aspire to excel academically and professionally. Many of the affected women grew up feeling that their parents valued sons over daughters. They identified intellectually with their successful fathers, not with their traditional homemaker mothers. Disordered eating is one way of rejecting the feminine bodies they perceive as barriers to achievement and recognition. Silverstein and Perlick uncover medical descriptions matching their diagnosis in Hippocratic texts from the fourth century B.C., in anthropological studies of Africa, Asia, and Latin America, and in case studies of many noted psychologists and psychiatrists, including the "hysteric" patients Freud used to develop his theories on psychoanalysis. They have also discovered that statistics on disordered eating, depression, and a host of other symptoms soared in eras in which women's opportunities grew--particularly the 1920s, when record numbers of women entered college and the workforce, the boyish silhouette of the flapper became the feminine ideal, and anorexia became epidemic, and again from the 1970s to the present day. The authors show that identifying this devastating syndrome is a first step toward its prevention and cure. The Cost of Competence presents an urgent message to parents, educators, policymakers, and the medical community on the crucial importance of providing young women with equal opportunity, and equal respect. (shrink)

According to the Samaritan principle, we have a duty to rescue others from perils when we can do so at no unreasonable cost to ourself or others. Candice Delmas has argued that this principle generates a duty to engage in civil disobedience, when laws and practices expose people to ‘persistent Samaritan perils’: by engaging in this form of protest, she claims, citizens can contribute to the rescue of the victims of serious injustice. In this article, I contend that her argument (...) confuses duties of rescue with duties of justice. Furthermore, I point out that two central features of civil disobedience, namely, communicativeness and conscientiousness, make it unsuitable as a strategy for ‘rescue operations’. On the one hand, communicative constraints make civil disobedience time-consuming, and dependent on others’ willingness to engage in the communicative exchange. On the other, conscientiousness often requires agents to accept costs well beyond the threshold warranted by the Samaritan principle. Treating civil disobedients akin to ‘good Samaritans’ trivialises the selflessness of their sacrifices. (shrink)

This report is about ethical thinking in the field of health and health care. But it is no abstract philosophical tract. It is designed to be of practical help to those struggling with the complex questions of allocating resources in health care and to encourage a wider involvement at all levels in health debates. The questions it raises stimulate new thinking about today's institutional structures. As we proceeded with our work, we became aware that it is easier to state (...) problems than to solve them. However, we were also aware of the opposite danger of oversimplification implicit in the view that there was a moral calculus to which decisionmakers could turn when they were confronted by an ethical problem in the allocation of resources, and which would yield mechanical solutions to human problems. (shrink)

Analytical techniques for determining the net worth of the consequences of alternative choices are increasingly used to motivate decisions about public projects and policies, especially where risks are prevalent. What information do these techniques provide, and what are the grounds for using them in decision making? It is argued that the apparent similarities of cost-risk-benefit analyses to decision theory are in some ways misleading, and that the true basis of such analyses in welfare economics suggests some inherent limitations to their (...) use. The limitations described arise from the practice of aggregating individual preferences as determined by economic valuations; they restrict (but do not invalidate) the application of such analyses. (shrink)

This research proposes a modified metaheuristic optimization algorithm, named as improved stochastic fractal search, which is formed based on the integration of the quasiopposition-based learning and chaotic local search schemes into the original SFS algorithm for solving the optimal capacitor placement in radial distribution networks. The test problem involves the determination of the optimal number, location, and size of fixed and switched capacitors at different loading conditions so that the network total yearly cost is minimized with simultaneous fulfillment of operating (...) constraints. Also, the hourly on/off scheduling plans of switched shunt capacitors considering a modified cost objective function are obtained. The proposed ISFS algorithm has been tested on two IEEE 69-bus and 119-bus RDNs and a practical 152-bus RDN. For clarifying the effectiveness and validation of the ISFS, the simulated results have been compared with those of other previously utilized solution approaches in the literature as well as the original SFS. From result comparison, the proposed ISFS outperforms other previous approaches regarding solution quality and statistical performance for the compared cases, especially in the complex and large-scale networks. Notably, compared with the original SFS, the proposed ISFS shows a significantly better performance in all the tested cases. (shrink)