There has been relatively little empirical research into the causes of research misconduct. To begin to address this void, the authors collected data from closed case files of the Office of Research Integrity (ORI). These data were in the form of statements extracted from ORI file documents including transcripts, investigative reports, witness statements, and correspondence. Researchers assigned these statements to 44 different concepts. These concepts were then analyzed using multidimensional scaling and cluster analysis. The authors chose a solution consisting of (...) seven clusters: (1) personal and professional stressors, (2) organizational climate, (3) job insecurities, (4) rationalizations A, (5) personal inhibitions, (6) rationalizations B and, (7) personality factors. The authors discuss the implications of their findings for policy and for future research. (shrink)

This article explores risk in professional nursing practice. Professional risk refers to the threat of professional discipline if it is found that a registered nurse has violated professional nursing practice standards. We argue professional risk is socially constructed and understood differently by nurse regulatory bodies, unions, professional associations and frontline nurses. Regulatory bodies emphasize professional accountability of nurses; professional associations focus on system problems in health‐care; unions undertake protecting nurses' (...) right to health and safety; and frontline nurses experience fear and uncertainty in their attempt to interpret practice standards to avoid professional discipline. Perspectives of professional risk are investigated by analyzing three professional nursing bodies' views of professional codes governing the right of nurses to refuse unsafe work assignments. The workplace dynamics surrounding work refusal experienced by frontline nurses are illustrated primarily through the lens of the 2003 SARS influenza outbreak in Ontario, Canada. We conclude that frontline nurses in Ontario are required to manage risk by following professional protocols prioritizing patient care and professional accountability which disregard the systemic, unpredictable and hazardous circumstances in their everyday practice. Moreover, we argue professional protocols cannot anticipate every eventuality in clinical practice creating the fear of professional discipline for nurses. (shrink)

Clinicians and administrators have a professional obligation to contribute to improvement of healthcare quality. At the same time, participation in embedded research poses risks to healthcare institutions. Disclosure of an institution’s sensitive information could endanger relationships with patients and undermine its reputation. The existing ethical framework for learning healthcare systems does not address the conflict between the OTC and institutional interests. Ethical guidance and policy regulation are needed to create a safe environment for embedded research. In this article we (...) analyse the EF for LHSs and the concept of professionalism. We suggest that the EF should be supplemented with an obligation to protect provider’s legitimate interests. We define legitimate interests as those that enable providers to discharge their primary duties. We argue that both the OTC and the obligation to protect legitimate interests are grounded in the concept of medical professionalism and can be understood as a matter of contract between a democratic society and medical professionals. The proposed supplemented EF can be implemented into a regulatory system in three different ways: the self-regulating: where providers decide themselves how to balance the ethical claims, the centralised: where a governmental institution decides the right balance between providers’ interests and interests of a health system; and the mediating: where medical professionals, the state and patients negotiate their interests. Our article contributes to the discussion on ethical relevance of providers’ interests and the regulatory model for weighing opposite interests in LHSs. (shrink)

Health care professionals are one of a large group of individuals who are exposed to significant risks by virtue of their occupation, such as the police, mountain rescuers, fire-service. The types of risk to which health care professionals are exposed are numerous, many of which remain largely unrecognised by the public and may even be underestimated by the professionals themselves. Examples of these health risks include fatigue, emotional/psychological trauma, physical injury caused by the use of machinery, back injuries, possible (...) even violent physical assault from a patient or hospital visitor. There is also a very significant risk of acquiring an illness in the course of employment, for example, physical damage caused by the prolonged use of toxic substances, and also infectious diseases which are acquired by various routes, such as air-borne infections, needle-stick injuries. Subjective risk evaluation and the notion of risk in health care from the patients' perspective has been widely considered over many years, and in a number of different areas, including medical research, screening procedures, consent to surgery or other medical intervention. In this paper, however, the moral dilemmas which may arise for health care professionals in relation to health risks are highlighted and specific questions are raised. (shrink)

Advances in genetic diagnostics lead to more patients being diagnosed with hereditary conditions. These findings are often relevant to patients’ relatives. For example, the success of targeted cancer prevention is dependent on effective disclosure to relatives at risk. Without clear information, individuals cannot take advantage of predictive testing and preventive measures. Against this background, we argue that healthcare professionals have a duty to make actionable genetic information available to their patients’ at-risk relatives. We do not try to settle (...) the difficult question of how this duty should be balanced against other duties, such as the duty of confidentiality and a possible duty not to know one’s genetic predisposition. Instead, we argue for the importance of recognising a general responsibility towards at-risk relatives, to be discharged as well as possible within the limits set by conflicting duties and practical considerations. According to a traditional and still dominant perspective, it is the patient’s duty to inform his or her relatives, while healthcare professionals are only obliged to support their patients in discharging this duty. We argue that this perspective is a mistake and an anomaly. Healthcare professionals do not have a duty to ensure that their patients promote the health of third parties. It is often effective and desirable to engage patients in disseminating information to their relatives. However, healthcare professionals should not thereby deflect their own moral responsibility. (shrink)

Abstract Aim: The COVID-19 infection is transmitted either by human-to-human contact, social-physical contact, and respiratory droplets or by touching items touched by the infected. This has triggered some conflicted behaviors such as stigma, violence, and opposite behavior applause. The aim of this study is to explore several newspaper articles about stigma, violence, or insensitive behavior against healthcare professionals and to analyze the reason for these behaviors during these COVID-19 pandemics. Method: The website of the Turkish Medical Association "Press Releases News" (...) and online newspaper articles have been scanned using keywords and have been classified and analyzed according to the content of articles between the periods of March 11 to April 28, 2020. This is a qualitative study with content analysis. No official ethical permission was obtained as the study was conducted through open access internet news sites. Result: 16 reports were selected from online reports that matched the keywords of the study. 13 of these reports included desensitization, violence, lack of precaution, stigmatization, and applause, and 3 reports included doctors’ statements. After being categorized, content analyses were conducted. Conclusion: This study revealed the necessity of a multi-faceted evaluation of the problems faced by healthcare professionals who are at the forefront of the COVID-19 outbreak. This study has a primary role in the detection, diagnosis, and treatment of the pandemic and reveals that doctors are trying to fulfill their duties in an ethical framework despite stigmatized behavior. Authorities should provide various supports to protect healthcare professionals before, during, and after the epidemic for the success of the COVID-19 outbreak struggle. (shrink)

Psychosocial work factors are implicated in the development of stress and job satisfaction. This relationship has been scarcely studied in so-called singular activities, as is the case of professional drivers. This cross-sectional study of 601 professional drivers assesses psychosocial risks and job satisfaction using Copenhagen Psychosocial Questionnaire and Overall Job Satisfaction questionnaire models. The values of the psychosocial scales of professional drivers were compared with thresholds values of the Spanish working population. The relationships of the psychosocial scales (...) with the level of job satisfaction were examined using logistic regression models, adjusted for age, gender, length of driving license and years of experience. In general, professional drivers have an unfavorable psychosocial environment compared to the average Spanish workers. The relationship between psychosocial scales and job satisfaction is observed, with the most influential variables being the meaning and development of work, integration in the company, social relations, esteem and level of psychological demands. (shrink)

In vitro fertilization is now a well-established practice in the field of assisted reproduction. In 1995, over 41,000 IVF cycles were done in the United States, at a cost of more than $300 million. The overall success rate has risen to 22.8 deliveries per 100 egg-retrieval procedures. As the field has matured, the attention of policy-makers has shifted from questions about the ethical and legal status of human embryos to concerns about providing access and protecting consumers.Three such concerns have emerged. (...) One is the danger that IVF programs will disseminate misleading information about their success rates in order to attract patients. This problem, however, may be alleviated by the publication in late 1997 of the first of annual national and clinic specific reports, based on randomly audited data, by the Centers for Disease Control and Prevention, the American Society of Reproductive Medicine, the Society for Assisted Reproductive Technology, and RESOLVE, pursuant to the federal 1992 Fertility Clinic Success Rate and Laboratory Certification Act. (shrink)

In vitro fertilization is now a well-established practice in the field of assisted reproduction. In 1995, over 41,000 IVF cycles were done in the United States, at a cost of more than $300 million. The overall success rate has risen to 22.8 deliveries per 100 egg-retrieval procedures. As the field has matured, the attention of policy-makers has shifted from questions about the ethical and legal status of human embryos to concerns about providing access and protecting consumers.Three such concerns have emerged. (...) One is the danger that IVF programs will disseminate misleading information about their success rates in order to attract patients. This problem, however, may be alleviated by the publication in late 1997 of the first of annual national and clinic specific reports, based on randomly audited data, by the Centers for Disease Control and Prevention, the American Society of Reproductive Medicine, the Society for Assisted Reproductive Technology, and RESOLVE, pursuant to the federal 1992 Fertility Clinic Success Rate and Laboratory Certification Act. (shrink)

In January 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 s before midnight.

There is scarce knowledge about the influence of the professional group, education, and age on public perspectives on the risks and benefits of forensic DNA databases. Based on data collected through an online questionnaire applied to 628 individuals in Portugal, this research fills that gap. More than three quarters of the respondents believed that the Portuguese forensic DNA database can help fight crime more efficiently and develop a swifter and more accurate justice, whereas only approximately half thought that it (...) could deter and prevent crime. Lack of security and control over access to data and the future unforeseen misuses of genetic information were the most relevant risks selected by the participants. Health care and life sciences professionals were more likely to agree with all the benefits, as opposed to those working in the field of law enforcement. More educated and older participants disagreed with benefits more often. Concerns with the risks increased with age. (shrink)

Alpine climbing in the US has increased in popularity since the 1970s and despite the high objective risk involved it has continued to find new devotees. For professionals involved in this sport, the risks are encountered through near‐death experiences and the real deaths of close friends. This essay uses interviews with climbers in the state of Washington, discussing their experiences with death, and uses written accounts. First, I discuss the many risks involved in climbing and how these risks are (...) perceived and accepted by climbers. Next, 1 look at the immediate reaction to alpine deaths, and finally, to the long term effects on the lives and climbing practices of this group. Despite repeated confrontations with death, all informants continue exposing themselves to these risks. Every year more and more acquaintances die while the ideas and values that these climbers hold allow them to resist the fear of their own death and continue to climb. Keywords: death, risk‐taking, sports. (shrink)

The rash of high-profile accounting frauds involving internal corporate accountants calls into question the individual accountant’s perceptions of the ethical climate within their organization and the limits to which these professionals will tolerate unethical behavior and/or accept it as the norm. This study uses social cognitive theory to examine the antecedents of individual corporate accountant’s perceived personal fit with their organization’s ethical climate and empirically tests how these factors impact organizational attitudes. A survey was completed by 203 corporate accountants to (...) assess their perception of relevant variables. The results of the structural equation model indicate three significant antecedents relating to ethical climate fit: higher internal levels of locus of control; greater numbers of prior job changes; and higher perceptions of an increasingly better fit with the firm’s ethical climate. Our results also indicate that higher levels of perceived fit to the ethical climate of a firm are associated with higher levels of perceived job satisfaction and organizational commitment. We also theorize that perceptions of an organization’s ethical climate may be reflections of client narcissism and serve a potential indicator of fraud risk. This is an important topic of study, since current auditing standards call for auditors to examine organizational attitudes toward fraud, but offer minimal guidance in doing so. (shrink)

With each novel infectious disease outbreak, there is scholarly attention to healthcare providers’ obligation to assume personal risk while they care for infected patients. While most agree that healthcare providers have a duty to assume some degree of risk, the extent of this obligation remains uncertain. Furthermore, these analyses rarely examine healthcare institutions’ obligations during these outbreaks. As a result, there is little practical guidance for healthcare institutions that are forced to weigh whether or when to exclude healthcare (...) providers from providing care or allow them to opt out from providing care to protect themselves. This article uses the COVID-19 pandemic to examine the concept of risk and the professional duties of both healthcare providers and healthcare institutions, and proposes a framework that can be used to make concrete institutional policy choices. This framework should be a useful tool for any hospital, clinic, or health agency that must make these choices during the current pandemic and beyond. (shrink)

Although there have been numerous studies on mental wellbeing impairment or other negative consequences of Workplace Violence against healthcare professionals, however, the effects of WPV are not limited to those who experience WPV in person, but those who exposed to WPV information indirectly. In the aftermath of “death of Dr. Yang Wen,” a cross-sectional study was conducted to explore the psychological status of healthcare professionals. A total of 965 healthcare professionals from 32 provinces in China participated in our research. The (...) prevalence rates of Post-Traumatic Stress Disorder symptoms, depression, anxiety among healthcare professional in the current study were 25.60, 46.01, and 27.88%, respectively. Moreover, our research suggested that the awareness of WPV-incident had a significant association with PTSD symptoms. In addition, risk perception was shown to mediate the effect of WPV awareness on PTSD symptoms. Furthermore, the present research also found a U-shaped relationship between issue salience and PTSD symptoms, and the relationship between issue salience and anxiety, indicating that higher awareness of WPV issue was negatively related to mental health status but only to the points at which there were no additional effects of more issue salience. This study highlighted that more protective measures for healthcare professionals need to be implemented in response to potential WPV events. More importantly, risk perception was found to mediate the effect of WPV issue salience on PTSD symptoms, it is critical to reduce the mental health burden through intervening in risk perception. (shrink)

Six decades after his death, there is still no scholarly consensus regarding whether C.S. Lewis should be considered an important theologian of the twentieth century. This paper investigates where the belief that Lewis was not a theological writer worth taking seriously originated. Then it evaluates two approaches that have been introduced in recent scholarship, by P.H. Brazier and Alister McGrath, that seek to affirm Lewis as a modern theologian of distinction. The final and central part of this paper nuances McGrath's (...) argument by surveying seven reasons Lewis had for not doing theology the way academics did – reasons that have often been overlooked in the relevant literature. I argue that Lewis's decision to remain ‘outside the inner ring’ of academic theologians was based on a set of risks he perceived were involved in doing theology professionally. In so doing, I suggest that Lewis's writings about religious topics deserve to be taken seriously by professional theologians and other readers. Besides Lewis scholarship in particular, this discussion matters for Christian theology in general because it explores what it means to be a theologian in an era of professionalisation and the conditions under which religious writers like Lewis can become theologians, both of which cast light on how we understand the nature of theology. (shrink)

Risk management is certainly one of the most important professional responsibilities of an engineer. As such, this activity needs to be combined with complex ethical reflections, and this requirement should therefore be explicitly integrated in engineering education. In this article, we analyse how this nexus between ethics and risk management is expressed in the engineering education research literature. It was done by reviewing 135 articles published between 1980 and March 1, 2016. These articles have been selected from (...) 21 major journals that specialize in engineering education, engineering ethics and ethics education. Our review suggests that risk management is mostly used as an anecdote or an example when addressing ethics issues in engineering education. Further, it is perceived as an ethical duty or requirement, achieved through rational and technical methods. However, a small number of publications do offer some critical analyses of ethics education in engineering and their implications for ethical risk and safety management. Therefore, we argue in this article that the link between risk management and ethics should be further developed in engineering education in order to promote the progressive change toward more socially and environmentally responsible engineering practices. Several research trends and issues are also identified and discussed in order to support the engineering education community in this project. (shrink)

William F. Doverspike, PhD, is a licensed psychologist who holds a Diplomate in Clinical Psychology (ABPP) and he is also board certified in Neuropsychology (ABPN). He is an Associate Faculty member of the Georgia School of Professional Psychology, where he teaches graduate courses in professional ethics. As an independent practitioner, he maintains privileges at several local hospitals. He is a member of the Ethics Committee of the Georgia Psychological Association. Dr. Doverspike is Editor of the Georgia Psychologist magazine (...) and has authored over 50 articles and chapters. He conducts seminars on ethics, risk management, and diagnostic consultation. (shrink)

The excellent article by Daniel J. Benedetti, Mithya Lewis-Newby, Joan S. Roberts, and Douglas S. Diekema draws strength by dealing both with micro ethical (personal) and macro ethical (institutional policies and structures) considerations. One should further note that often, the macro factors are even stronger than the article implies, although individuals can affect the macro context. A particularly important macro factor for all matters concerning healthcare, indeed all human services, is the tension between the profit motive and ethical decisions.

In this article, we explore how sub-Saharan African immigrant populations in France have been constructed as risk groups by media sources, in political rhetoric, and among medical professionals, drawing on constructs dating to the colonial period. We also examine how political and economic issues have been mirrored and advanced in media visibility and ask why particular populations and the diseases associated with them in the popular imagination have received more attention at certain historical moments. In the contemporary period we (...) analyze how the bodies of West African women and men have become powerful metaphors in the politics of discrimination prevalent in France, in spite of Republican precepts that theoretically disavow cultural and social difference. (shrink)

Research highlights several risk and resilience factors at multiple ecological levels that influence individuals’ mental health and wellbeing in their everyday lives and, more specifically, in disaster or outbreak situations. However, there is limited research on the role of these factors in the early days of the COVID-19 crisis. The present study examined if and how potential risk factors and resilience factors are associated with mental health and well-being outcomes, and whether these resilience factors buffer the associations between (...) risk factors and said outcomes. One to two weeks after the government recommended preventative measures, 1,122 Canadian workers completed an online questionnaire, including multiple wellbeing outcome scales in addition to measures of potential risk and resilience factors. Structural equation models were tested, highlighting that overall, the considered risk factors were associated with poorer wellbeing outcomes, except social distancing which was associated with lower levels of stress. Each of the potential resilience factors was found to have a main effect on one or more of the wellbeing outcomes. Moderation analysis indicated that in general these resilience factors did not, however, buffer the risk factors. The findings confirm that the COVID-19 crisis encompasses several stressors related to the virus as well as to its impact on one’s social, occupational, and financial situation, which put people at risk for lower wellbeing as early as one to two weeks after the crisis began. While several resilience factors emerged as positively related to wellbeing, such factors may not be enough, or sufficiently activated at that time, to buffer the effects of the numerous life changes required by COVID-19. From an ecological perspective, while mental health professionals and public health decision-makers should offer/design services directly focused on mental health and wellbeing, it is important they go beyond celebrating individuals’ inner potential for resilience, and also support individuals in activating their environmental resources during a pandemic. (shrink)

In this article, I argue that professional healthcare organizations such as the AMA and ANA ought not to take controversial stances on professional ethics. I address the best putative arguments in favor of taking such stances, and argue that none are convincing. I then argue that the sort of stance-taking at issue has pernicious consequences: it stands to curb critical thought in social, political, and legal debates, increase moral distress among clinicians, and alienate clinicians from their professional (...) societies. Thus, because there are no good arguments in favor of stance-taking and at least some risks in doing so, professional organizations should refrain from adopting the sort of ethically controversial positions at issue. (shrink)

I read with interest the article by Grill and Hansson1 on epistemic paternalism in public health. It focuses on the important issue of the patient’s right to know and receive information about uncertain threats to public health. However, health and environmental scientists, professional risk managers and the general public strongly disagree about the seriousness of many risks.2 Moreover, risk is an intricate concept to give information about.There are framing effects, ….

There is a dearth of business ethics research on family firms, despite the importance of such firms to the US economy. We answer Vazquez’s call to examine the intersection of family-firm research and business ethics, by investigating whether external auditors assess higher risk of fraud in family firms. We test the contradictory predictions of two dominant theoretical perspectives in family-firm research—entrenchment theory and alignment theory. We conduct an experiment with highly experienced external audit professionals, who assess the risk (...) of fraud and make client acceptance decisions for family firms versus non-family firms with different strength of corporate governance: strong versus weak audit committees. We find that auditors assess the risk of fraud as higher for family firms than for non-family firms, consistent with the predictions of entrenchment theory. Auditors are also less likely to make client acceptance recommendations for family firms. The strength of the AC moderates the family-firm effect, whereby auditors assess family firms with weak ACs to have the highest fraud risk and to be the least desirable audit clients. Our findings suggest that auditors perceive more severe agency conflicts to be present in family firms than in non-family firms, consistent with entrenchment theory, according to which family members may behave opportunistically to extract rents and potentially expropriate the firm’s resources at the expense of minority shareholders. (shrink)

IntroductionLittle is known about risk factors for both Long COVID and somatic symptoms that develop in individuals without a history of COVID-19 in response to the pandemic. There is reason to assume an interplay between pathophysiological mechanisms and psychosocial factors in the etiology of symptom persistence.ObjectiveTherefore, this study investigates specific risk factors for somatic symptom deterioration in a cohort of German adults with and without prior SARS-CoV-2 infection.MethodsGerman healthcare professionals underwent SARS-CoV-2 IgG antibody testing and completed self-rating questionnaires (...) at baseline and 21 months later between April 2020 and February 2022. Differences in variables between the time points were analyzed and a regression analysis was performed to predict somatic symptom deterioration at follow-up.ResultsSeven hundred fifty-one adults completed both assessments. Until follow-up, n = 58 had contracted SARS-CoV-2 confirmed by serology. Between baseline and follow-up, signs of mental and physical strain increased significantly in the sample. Symptom expectations associated with COVID-19 and a self-reported history of COVID-19, but not serologically confirmed SARS-CoV-2 infection, significantly predicted somatic symptom deterioration at follow-up. A further predictor was baseline psychological symptom burden.ConclusionsThis study supports a disease-overarching biopsychosocial model for the development of burdensome somatic symptoms during the COVID-19 pandemic and supports research findings that symptom burden may be more related to the psychosocial effects of the pandemic than to infection itself. Future studies on Long COVID should include SARS-CoV-2 negative control groups and consider symptom burden prior to infection in order to avoid an overestimation of prevalence rates. (shrink)

Since the nineteenth century, the debate around the process of professionalization of higher education has been characterized by two extreme positions. For some critics the process carries the risks of instrumentalizing knowledge and of leading the university to succumb under the demands of the market or the state; for other theorists it represents a concrete opportunity for the university to open up to the real needs of society and for reorienting theoretical and fragmented disciplines towards the resolution of concrete and (...) challenging problems. This article pursues three objectives. Firstly, we show that the debate is usefully informed not only by ideas of what a university is, but also by ideas of a profession. We suggest that both ideas help to overcome the conflict between the two afore-mentioned antagonist perspectives. Secondly, we demonstrate that a certain understanding of a profession can prevent the risk of viewing knowledge exclusively as scientific expertise and reducing training to the acquisition of technical skills. The position on professions adopted here is inspired by the Scottish philosopher Alasdair MacIntyre, whose work is instructive in understanding professions as “rational practical activities”, embedded in a social context with their own internal goods. Our third objective, therefore, is to argue, with MacIntyre, that the presence of professions within the university opens up the opportunity to rescue forms of rationality that are oriented towards action and, by implication, promotes spaces of training that are resistant to exclusively corporate or governmental interests and criteria of mere effectiveness. (shrink)

In his paper, ‘Patients, doctors and risk attitudes,’ Nicholas Makins1 argues that healthcare professionals should defer to a patient’s higher-order risk attitudes (ie, the risk attitudes they desire to have or endorse within themselves upon reflection) when making medical decisions. We argue against Makins’ deference to higher-order risk attitudes on the basis that (1) there are significant practical concerns regarding our ability to easily and consistently access and verify the higher-order risk attitudes of patients, (2) (...) there is a lack of a theoretical limit on higher-order risk attitudes (eg, second, third, fourth order), and (3) the consideration of higher-order risk attitudes is actually more paternalistic than Makins suggests because it narrows what counts as an autonomous preference to the limited occasions in which an individual actually reflects on his or her own risk attitude. On the issue of practicality, we can reasonably expect that healthcare professionals would find difficulty eliciting the higher-order risk attitudes of their patients. Take for example the patient who has never expressed his higher-order desire to be more risk adverse and who is not willing nor comfortable expressing this desire. What is the healthcare professional expected to do in this situation? This is even more of a concern for the incapacitated patient, to which Makins seems to imply that …. (shrink)

The key concept in Business Ethics has changed from ‘corporate social responsibility’ to ‘integrated risk‐management’. This change, first wrought by American laws, has been extended to other countries through globalization. The most important laws concern corruption, anti‐trust, consumer safety, environmental protection and insider‐trading. The ‘Federal Corporate Sentencing Guidelines’ have particularly been helpful in identifying and valuing business risks. The author proposes a ‘next‐generation’ Business Ethics integrating personal, professional and organizational ethics in the context of an institutionalized, country‐sensitive ‘corporate (...) culture’. (shrink)

Healthcare professionals who feel psychologically safe believe it is safe to take interpersonal risks such as voicing concerns, asking questions and giving feedback. Psychological safety is a complex phenomenon which is influenced by organizational, team and individual level factors. However, it has primarily been assessed as a team-level phenomenon. This study focused on understanding healthcare professionals' individual experiences of psychological safety. We aim to gain a fuller understanding of the influence team leaders, interpersonal relationships and individual characteristics have on individuals' (...) psychological safety and their decisions to engage in voice or silence behavior. Thirty-four interviews were conducted with healthcare professionals from across five teams working within an acute, suburban hospital. Hybrid inductive-deductive thematic analysis focused on identifying themes which captured the complexities of individuals' varied experiences of psychological safety. The themes identified were: “Personal Characteristics,” “Past Experiences,” “Individual Perceptions of Being Valued,” and “Judged Appropriateness of Issues/Concerns.” These themes are explored within the context of motivating and inhibiting factors associated with the influence of leadership, interpersonal relationships and individual characteristics on experiences of psychological safety and voice behavior. These results extend existing theoretical frameworks guiding our understanding of psychological safety by accounting for the variation in individuals' experiences and studying these significant influences on voice behavior. Important considerations for the development of interventions to enhance psychological safety are discussed. (shrink)

The complexities of professional ethics are best understood and interpreted within their sociohistorical context. This paper focuses on the experience of 20 rural psychologists from across Canada, a context rife with demographic and practice characteristics that may instigate ethical issues. Employing hermeneutic phenomenology, these qualitative research results are indicative of professional struggles that impacted the participants’ experience of professional ethics and raised key questions about policy and practise. Concerns regarding competition highlight potential professional vulnerability, beget the (...) idea of fostering general psychological practice, and question the role of professional bodies in addressing rural shortages. Dependency on government funding models and decisions highlights the benefits and medical cost-offset effect of psychological services’ role in funded medical care. The controversial prescriptive authority debate for psychologists raises myriad concerns that are particularly salient to rural practitioners. These include changes to training and practice, with risks of psychopharmacology gaining prominence over behavioural health interventions. National inconsistencies in level of registration add to the growing shortage of practitioners. Finally, the results illuminate the need for advocacy to move beyond the literature and into public policy to increase public awareness, decrease the stigma of mental illness, and develop rural Canadian psychology. Although limited to this study, these results allowed for a fuller and more robust understanding of rural practice in consideration of professional ethics, which may inform policy, science, or ethical clinical practice. (shrink)

The key concept in Business Ethics has changed from ‘corporate social responsibility’ to ‘integrated risk‐management’. This change, first wrought by American laws, has been extended to other countries through globalization. The most important laws concern corruption, anti‐trust, consumer safety, environmental protection and insider‐trading. The ‘Federal Corporate Sentencing Guidelines’ have particularly been helpful in identifying and valuing business risks. The author proposes a ‘next‐generation’ Business Ethics integrating personal, professional and organizational ethics in the context of an institutionalized, country‐sensitive ‘corporate (...) culture’. (shrink)

This paper discusses the current initiatives on error and adverse events within healthcare, with a particular focus on the NHS, within the context of health policy. One of the key features of the paper is the proposal for an emergent taxonomy of the medical error literature, developed from the ideologies and rationales that underpin their approaches. This taxonomy provides details of three categories—empiricists, organisational rationalists and reformers of professional culture—and these act as an organising framework for the exploration of (...) the potential consequences of current policy on errors and adverse events. This discussion highlights the tension between optimising health outcomes for patients and managing the health system as effectively as possible. In particular, the inherent tension between explicit managerial formulations of risk and implicit risk management strategies associated with medical professionalism are considered. (shrink)

Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the pathways (...) that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others’ perspective, and have a dialogue with each other, taking the life narrative of clients into account. (shrink)

Abstract:Shareholders’ relationship to the firm is a central theme in corporate governance, yet the investors’ perspective has been virtually ignored in governance research. This paper attempts to explain the previously unexplored role of trust in the investor decision-making process. The proposed model suggests that trust acts as the antecedent of the risk variable in existing investor decision-making models. Stock ownership involves both financial and ethical risk, which by definition requires some level of implicit trust in management and the (...) market. (shrink)

Abstract:Shareholders’ relationship to the firm is a central theme in corporate governance, yet the investors’ perspective has been virtually ignored in governance research. This paper attempts to explain the previously unexplored role of trust in the investor decision-making process. The proposed model suggests that trust acts as the antecedent of the risk variable in existing investor decision-making models. Stock ownership involves both financial and ethical risk, which by definition requires some level of implicit trust in management and the (...) market. (shrink)

As the pressure on available health care resources grows, an increasing moral challenge in intensive care is to secure a fair distribution of nursing care and medical treatment. The aim of this article is to explore how limited resources influence nursing care and medical treatment in intensive care, and to explore whether intensive care unit clinicians use national prioritization criteria in clinical deliberations. The study used a qualitative approach including participant observation and in-depth interviews with intensive care unit physicians and (...) nurses working at the bedside. Scarcity of resources regularly led to suboptimal professional standards of medical treatment and nursing care. The clinicians experienced a rising dilemma in that very ill patients with a low likelihood of survival were given advanced and expensive treatment. The clinicians rarely referred to national priority criteria as a rationale for bedside priorities. Because prioritization was carried out implicitly, and most likely partly without the clinician's conscious awareness, central patient rights such as justice and equality could be at risk. (shrink)

A philosophical account of risk, such as this book provides, states what risk is, which attitudes to it are rational, and which acts affecting risks are rational. Attention to the nature of risk reveals two types of risk, first, a chance of a bad event, and, second, an act’s risk in the sense of the volatility of its possible outcomes. The distinction is normatively significant because different general principles of rationality govern attitudes to these two (...) types of risk. Rationality strictly regulates attitudes to the chance of a bad event and is more permissive about attitudes to an act’s risk. Principles of rationality governing attitudes to risk also justify evaluating an act according to its expected utility given that the act’s risk, if any, belongs to every possible outcome of the act. For a rational ideal agent, the expected utilities of the acts available in a decision problem explain the agent’s preferences among the acts. Maximizing expected utility is just following preferences among the acts. This view takes an act’s expected utility, not just as a feature of a representation of preferences among acts, but also as a factor in the explanation of preferences among acts. The view extends to evaluations of combination of acts, either simultaneous or in a sequence. It takes account of an agent’s attitudes to an act’s risk without weakening the standard of expected-utility maximization. The book’s theory of risk also grounds a justification of the risk-return evaluation of investments that finance advances, and a generalized version of this type of evaluation that a professional may use to advise clients about risks and that a government regulatory agency may use to make decisions about risks on behalf of the public. (shrink)

The global public health threat posed by infectious disease is well recognised. The obligation to treat whilst exposed to risk, and its limits, is debated with each novel serious and communicable pathogen. Within national jurisdictions, different responses are forthcoming. Some, like France in 2009, give government the power to require healthcare staff to work, and even to requisition staff, including retired professionals. Others rely on notions of solidarity and professional duty, with scope for individual discretion. Our research with (...) staff in the West Midlands in 2008/2009– including non-professionals – suggested a strong correlation between feeling a duty to work and willingness to work during a pandemic. This was more influential than removing other barriers to working. Medical military personnel can already be ordered into risky situations. Our research in 2015/16 with those who worked in the Ebola treatment unit in Sierra Leone suggested that their concerns about risk were complex: the perceived magnitude of the risk was only one factor, even though tolerance was high. The type of risk and circumstances requiring that risk to be taken were also influential.Against this background, it will be argued, with caveats, that:military medical personnel should be willing to accept greater risk than civilian medical staff;and that to maintain national health services during a communicable disease emergency:civilian medical staff ought to accept greater risks than they currently appear willing to tolerate;conscription – from civilian or military populations – is permissible, even though it may elevate personal risk. (shrink)

The 2015 UK Supreme Court judgment in Montgomery v Lanarkshire reinforces the importance of informed consent to medical treatment. This paper suggests that Montgomery recognises the challenge faced by vulnerable individuals in choosing between treatment options and making decisions with appreciation of information about material risks. The judgment endorses a form of weak paternalism to safeguard such persons, which is not disrespectful of the aggregate principles of the Mental Capacity Act 2005. But ethical practice requires professionals to tread carefully between (...) weak and hard paternalism in the context of therapeutic interactions with vulnerable patients, while ensuring their awareness of material risks. (shrink)

Ethnic minority patients face challenges concerning communication and are at higher risk of experiencing health problems and consuming fewer healthcare services. They are also exposed to disparaging societal discourses about migrants which might undermine healthcare institutions’ ambitions of equitable health care. Therefore, healthcare professionals need to critically reflect on their practices and processes related to ethnic minority patients. The aim of this article is to explore healthcare professionals’ experiences of working with ethnic minority patients by using the critical incident (...) (CI) technique. In two focus group sessions, participants discussed challenging events in their encounters with patients. The critical incidents show that healthcare professionals may experience unfamiliar situations related to their work performance, prejudice toward patients, and labeling by patients the professionals do not identify with. The professionals’ reflections are discussed in relation to social discourses on migration and their work conditions, and the possible influence on the professionals’ preconceptions and the patient–professional relationship in health care. Reflections about work experiences with ethnic minority patients and aligned societal discourses should be included in healthcare workers’ professional development. Critical incident reflections at work may contribute to better‐coping strategies for healthcare professionals and improved patient–professional relationships with ethnic minority patients. (shrink)

This paper investigates whether accounting professionals’ ethical judgment is influenced by the disciplinary system established by the accounting profession in France and the United States. Our study first attempts to determine whether there is a link between the EJ of accounting professionals and the disciplinary context, in each country. It then performs a comparative analysis of the two nations. Our findings indicate that the judgment of American accounting professionals is correlated with the disciplinary decisions of the accountancy board. By contrast, (...) the judgment of French accounting professionals is independent of the disciplinary context. Whereas cross-national studies have thus far attributed differences among nations mainly to cultural distance, current research shows that non-cultural national factors should also be considered. In line with this perspective, our study suggests that institutional factors, in particular the disciplinary system, may also account for the differences between French and American accounting professionals’ ethical perceptions. We support these results by highlighting some characteristics of the countries’ respective legal systems, which may explain the divergences observed. We conclude by identifying implications for the independence of accounting professionals’ EJ and the risks associated with dissuasive disciplinary systems. (shrink)

In this paper we present six criteria for assessing proposed solutions to environmental risk problems. To assess the final criterion-the criterion of ethical responsibility-we suggest another series of criteria. However, before these criteria can be used to address ethical problems, business persons must be wiIling to discuss the problem in ethical terms. Yet many decision makers are unwilling to do so. Drawing on research by James Waters and Frederick Bird, we discuss this “moral muteness”-the inability or unwillingness to use (...) morallanguage to solve moral problems-and suggest some underlying causes of moral muteness. (shrink)

The article examines the professional threats experienced by journalists working in Lithuanian newsrooms. The analysis is based on a representative survey of Lithuanian journalists conducted from October 2022 to February 2023 (N = 302). The study revealed that physical attacks against Lithuanian journalists are quite rare, but psychological threats related to the profession are relatively common. The results of the study show that male journalists face different threats more often than female journalists, and journalists working in regional or local (...) media experience more various forms of insecurity compared to those working in national media. However, no differences were found between private commercial and public media regarding the frequency of professional threats among journalists. The results show a statistically significant correlation between the insecurity experienced by journalists and the stress they experience when performing journalistic work. Additionally, the research results indicate a significant correlation between experienced insecurity and journalists’ concerns about their psychological and physical well-being. Finally, the analysis identified a statistically significant relationship between the use of self-censorship by journalists and the frequency and intensity of professional threats experienced. The article was prepared as part of Project No. S-MIP-22-19 ‘Lithuanian Journalism in the Contexts of Political, Economic and Social Risks’ (2022–2024) funded by the Research Council of Lithuania. (shrink)

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally (...) grounded in a decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

It has been argued that the inherent risks of advance directives made by healthy people are disproportionate to the potential benefits, particularly if the directive is implementable in cases of reversible mental incapacity. This paper maintains that the evidence for such a position is lacking. Furthermore, respect for the principle of autonomy requires that individuals be permitted to make risky choices about their own lives as long as these do not impinge on others. Even though health professionals have an obligation (...) to try and ensure that patients have appropriate information about possible future treatment options, they cannot predict and describe every eventuality but nor can they disregard firm decisions knowingly made on the basis of incomplete information by competent adults. To attempt to do so would be to reinstate notions of medical paternalism which are contrary to current public expectations. (shrink)