While temporal preparation has frequently been examined through the manipulation of foreperiods, the role of force level during temporal preparation remains underexplored. In our study, we propose to manipulate mental training of attentional control in order to shed light on the role of the force level and autonomic nervous system in the temporal preparation of an action. Forty subjects, divided into mental training group (n = 20) and without mental training group (n = 20), participated in this study. The influence (...) of the attentional control and force levels on the autonomic nervous system were measured using the skin conductance response and the heart rate variability; the accuracy of the motor responses was measured using a method derived from machine learning. Behaviorally, only the mental training group reinforced its motor and attentional control. When using short foreperiod durations and high force level, motor and attentional control decreased, consistent with the dominant sympathetic system. This resulted in an increased anticipation rate of responses with a higher reaction time compared to the long foreperiods duration and low force level, in which the reaction time significantly decreased, with enhancement of the expected force level, showing consistency with the dominant parasympathetic system. Interestingly, results revealed a predictive relationship between the sympathovagal balance and motor and attentional control during the long foreperiods and low force level. Finally, results demonstrate that attentional mental training leads to the reinforcement of interactions between the autonomic nervous system and attentional processes which are involved in the temporal preparation of a force task. (shrink)

There is a familiar problem in moral theories that recognize positive obligations to help others related to the practical room these obligations leave for ordinary life, and the risk that open-ended obligations to help others will consume our lives and resources. Responding to this problem, Kantians have tended to emphasize the idea of limits on positive obligations but are typically unsatisfactorily vague about the nature and extent of these limits. I argue here that aspects of Kant’s discussion of duties of (...) virtue owed to ourselves suggest a useful metric we can use in discussing these limits and that generalizing this account and combining it with elements of Barbara Herman’s view, offers us an attractive model of moral deliberation with the resources we need to engage the critic’s challenge properly. (shrink)

I defend a novel way of working out the Balancing View of Ought, that is, the view that whether one ought to take some action depends on nothing but the balance of the reasons for the action and those against it or for its alternatives. I show that the Balancing View needs to be complemented by certain principles of reason transmission, at least one of which might seem rather surprising. The result is an attractive theoretical package that allows for (...) compelling explanations of noteworthy normative phenomena, including ones that the Balancing View has been claimed to be at odds with. (shrink)

The debate and implementation of Clinical Ethics Consultation is still in its beginnings in Europe and the issue of the patient's perspective has been neglected so far, especially at the theoretical and methodological level. At the practical level, recommendations about the involvement of the patient or his/her relatives are missing, reflecting the general lack of quality and practice standards in CEC. Balance of perspectives is a challenge in any interpersonal consultation, which has led to great efforts to develop “technical”approaches, (...) e.g., in psychological counseling or psychotherapeutic treatment. In ethics, unbalance or partiality is a matter of justice and has provoked significant theoretical work, also relevant for practical medical ethics. A lack of balance seems to be particularly serious in those situations, where ethical conflict is triggering a consultation and where the “parties” involved may try to persuade the consultant that their particular opinion is the most convincing; but to our knowledge the connection between patient/relatives involvement and balance has not yet been discussed in the context of CEC. Central questions of access and involvement of the patient and his/her relatives will be analysed and discussed regarding the challenge of balance and the adequate role or attitude of a Clinical Ethics Consultant. It is argued that the Clinical Ethics Consultant should have a methodological awareness regarding the concepts of “neutrality” versus “advocacy” in his/her role and try to achieve a balanced procedure that allows for an optimum of change of perspectives. The argumentation is developed along the narrative of a real case study. Recommendations concerning the involvement of the patient or the relatives are formulated for the practice of CEC. (shrink)

The notion that it is useful to specify norms progressively in order to resolve doubts about what to do, which I developed initially in a 1990 article, has been only partly assimilated by the bioethics literature. The thought is not just that it is helpful to work with relatively specific norms. It is more than that: specification can replace deductive subsumption and balancing. Here I argue against two versions of reliance on balancing that are prominent in recent bioethical discussions. Without (...) meaning to address the substance or the overall merits of either view I criticize, I attack Gert, Culver and Clouser's implicit reliance on some overall dimension of balancing as a basis of resolving conflicts among norms and Beauchamp and Childress's residual acceptance of 'justified balancing'. The former authors' description of resolving conflicts depends upon a type of value commensurability that (as they otherwise seem to admit) does not obtain, while the latter authors' role for justified balancing would be better served by continued specification. (shrink)

We all have moral beliefs. But what if one beleif conflicts with another? DePaul argues that we have to make our beliefs cohere, but that the current coherence methods are seriously flawed. It is not just the arguments that need to be considered in moral enquiry. DePaul asserts that the ability to make sensitive moral judgements is vital to any philosophical inquiry into morality. The inquirer must consider how her life experiences and experiences with literature, film and theatre have influenced (...) her capacity for making moral judgments and attempt to ensure that this capacity is neither naive nor corrupted. (shrink)

The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework (...) that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff. There are no data in this work. (shrink)

The aim of this paper is to provide a detailed characterisation of some ways in which our preferences reflect our reasons. I will argue that practical reasons can be characterised along two dimensions that influence our preferences: their balance and their weight. This is analogous to a similar characterisation of the way in which probabilities reflect the balance and weight of evidence in epistemology. In this paper, I will illustrate the distinction between the balance and weight of (...) reasons, and show how this is crucial for an adequate account of preference and choice. The upshot is a more complete picture of a particular kind of decision, labelled by Isaac Levi and, more recently, Ruth Chang as ‘hard choices’. These are choices in which one option is better than another in some ways, the other is better than the first in some ways, but neither seems better overall. The distinction between the balance and weight of reasons presents a new way of understanding how hard choices vary by degree and what it is that makes them so hard. (shrink)

In this article, we explain the mechanisms that allow social enterprises to balance their missions, and the risk of mission drift as organizations grow. We empirically explore Incubator-BUS (I-BUS), a student organization within a private Brazilian university, which sought to incubate cooperatives for vulnerable groups. Although initially successful in balancing its missions, I-BUS then failed. We show how scaling-up can complicate the balancing of different missions within the same organization. We propose that, to balance their missions, social enterprises—especially (...) recently formed and democratically managed enterprises—need not only “spaces of negotiation,” as suggested in the literature, but also “herding spaces” that connect an organization to its institutional context. We indicate why herding spaces are critical, but then show how scaling-up can result in organizational “compartmentalization” that undermines them. (shrink)

If we had a balance of reasons, where the arguments presented in favor and against the case were weighed precisely and the verdict could be pronounced in favor of the most inclined scale ... [we would have] a more valuable art than that miraculous science of producing gold.

I claim that the balance of nature metaphoris shorthand for a paradigmatic view of natureas a beneficent force. I trace the historicalorigins of this concept and demonstrate that itoperates today in the discipline of populationecology. Although it might be suspected thatthis metaphor is a pre-theoretic description ofthe more precisely defined notion ofequilibrium, I demonstrate that balance ofnature has constricted the meaning ofmathematical equilibrium in population ecology.As well as influencing the meaning ofequilibrium, the metaphor has also loaded themathematical term (...) with values.Environmentalists and critics use thisconflation of meaning and value to theiradvantage. This interplay between the balanceof nature and equilibrium fits aninteractionist interpretation of the role ofmetaphor in science. However, it seems theinteraction is asymmetric, and the balance ofnature metaphor has had a larger influence onmathematical equilibrium than vice versa. Thisdisproportionate influence suggests that themetaphor was and continues to be a constitutivepart of ecological theories. (shrink)

Democratic theorists often distinguish between two views of democratic procedures. ‘Outcomes theorists’ emphasize the instrumental nature of these procedures and argue that they are only valuable because they tend to produce good outcomes. In contrast, ‘proceduralists’ emphasize the intrinsic value of democratic procedures, for instance, on the grounds that they are fair. In this paper. I argue that we should reject pure versions of these two theories in favor of an understanding of the democratic ideal that recognizes a commitment to (...) both intrinsically valuable democratic procedures and democratic outcomes. In instances in which there is a conflict between these two commitments, I suggest they must be balanced. This balancing approach offers a justification of judicial review on the grounds that it potentially limits outcomes that undermine democracy. But judicial review is not justifiable in any instance in which a bad democratic outcome results from democratic procedures. When the loss that would result from overturning a democratic procedure is greater than the gain to democracy that would result from ensuring against an undemocratic outcome; judicial review is not justifiable. Loss or gain to democracy is defined by the negative or positive impact of each action on the core democratic values of equality and autonomy, aspects of the democratic ideal. Even when judicial review is justified, the fact that it overturns intrinsically valuable procedures suggests that such review is never ideal from the standpoint of democracy. (shrink)

It has long been taken for granted that the immune system’s capacity to protect an individual from infection and disease depends on the power of the system to distinguish between self and nonself. However, accumulating data have undermined this fundamental concept. Evidence against the self/nonself discrimination model left researchers in need of a new overarching framework able to capture the immune system’s reactivity. Here, I highlight that along with the self/nonself model, another powerful representation of the immune system’s reactivity has (...) been developed in the twentieth century immunology. According to this alternative view, the immune system is not a killer of nonself strangers but a peace-maker helping to establish harmony with the environment. The balance view of the system has never become part of the dominant paradigm. However, it is gaining more and more currency as new research develops. Advances in mucosal immunology confirm that instead of distinguishing between self and foreign the immune system reacts to microbial, chemical and self-induced alterations to produce responses that counterbalance effects of these changes. (shrink)

Most non-consequentialists “let the numbers count” when one can save either a lesser or greater number from equal or similar harm. But they are wary of doing so when one can save either a small number from grave harm or instead a very large number from minor harm. Limited aggregation is an approach that reconciles these two commitments. It is motivated by a powerful idea: our decision whom to save should respect each person who has a claim to our help, (...) including those whom we fail to save. However, it has recently been argued that it is open to decisive objections. I develop a new limitedly aggregative view:Hybrid Balance Relevant Claims. This view is well grounded in the reasons we have to be skeptical of aggregation and resolves all recent challenges by paying careful attention to the rationale for limited aggregation. (shrink)

In spite of a renewed interest in the relationship between spirituality and managerial thinking, the literature covering the link between Islam and management has been sparse – especially in the area of ethics. One potential reason may be the cultural diversity of nearly 1.3 billion Muslims globally. Yet, one common element binding Muslim individuals and countries is normative Islam. Using all four sources of this religion’s teachings, we outline the parameters of an Islamic model of normative business ethics. We explain (...) how this ethics model seeks to balance the needs of multiple stakeholders, and discuss its enforcement mechanisms. This Islamic approach to business ethics is centered around criteria that are in common with stakeholder theory such as justice and balance, and includes unique additional criteria such as trust and benevolence. (shrink)

The notion of whether people focus on the past, present or future, and how it shapes their behaviour is known as Time Perspective. Fundamental to the work of two of its earliest proponents, Zimbardo and Boyd (2008), was the concept of balanced time perspective and its relationship to wellness. A person with balanced time perspective can be expected to have a flexible temporal focus of mostly positive orientations (past-positive, present-hedonistic, and future) and much less negative orientations (past-negative and present-fatalistic). This (...) study measured deviation from balanced time perspective (DBTP: Zhang, Howell, and Stolarski, 2013) in a sample of 243 mature adults aged 45 to 91 years and explored relationships to Retirement Planning, Depression, Anxiety, Stress, Positive Mood, and Negative Mood. Results indicate that DBTP accounts for unexplained variance in the outcome measures even after controlling for demographic variables. DBTP was negatively related to Retirement Planning and Positive Mood and positively related to Depression, Anxiety, Stress and Negative Mood. Theoretical and practical implications regarding balanced time perspective are discussed. (shrink)

In Balanced Wonder, Jan B. W. Pedersen digs deep into the alluring topic of wonder, in dialogue with Neo-Aristotelian philosophers, arguing that the experience of wonder, when balanced, serves as a strong contributor to human flourishing.

This paper looks at standard arguments for freedom in the academy that go back to John Stuart Mill and Oliver Wendell Holmes and finds them to be poor arguments for their conclusion. It then elaborates what are the most subtle and the most entrenched forms of threat to freedom in the academy, and concludes with an argument for imbalance rather than balance in the extra-mural sphere.

Experimental balance is usually understood as the control for the value of the conditions, other than the one under study, which are liable to affect the result of a test. We will discuss three different approaches to balance. ‘Millean balance’ requires to identify and equalize ex ante the value of these conditions in order to conduct solid causal inferences. ‘Fisherian balance’ measures ex post the influence of uncontrolled conditions through the analysis of variance. In ‘efficiency (...) class='Hi'>balance’ the value of the antecedent conditions is decided ex ante according to the efficiency they yield in the estimation of the treatment outcome. Against some old arguments by John Worrall, we will show that in both Fisherian and efficiency balance there are good reasons to randomize the allocation of treatments, in particular when there is no agreement among experimenters as to the antecedent conditions to be controlled for. (shrink)

The widely cited Nuffield Council on Bioethics ‘Intervention Ladder’ structurally embodies the assumption that personal autonomy is maximized by non-intervention. Consequently, the Intervention Ladder encourages an extreme ‘negative liberty’ view of autonomy. Yet there are several alternative accounts of autonomy that are both arguably superior as accounts of autonomy and better suited to the issues facing public health ethics. We propose to replace the one-sided ladder, which has any intervention coming at a cost to autonomy, with a two-sided ‘Balanced Intervention (...) Ladder,’ where intervention can either enhance or diminish autonomy. We show that not only the alternative, richer accounts of autonomy but even Mill’s classic version of negative liberty puts some interventions on the positive side of the ladder. (shrink)

Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs to (...) abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one’s family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW’s role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in ‘frontline’ roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles. (shrink)

In this contribution, I will argue that the image of a balance is often used to defend the idea of a trade-off. To understand the drawbacks of this line of thought, I will explore the relationship between online security technologies and fundamental rights, notably privacy, nondiscrimination, freedom of speech and due process. After discriminating between three types of online security technologies, I will trace the reconfiguration of the notion of privacy in the era of smart environments. This will lead (...) to an inquiry into the metaphor of the scale, building on the triple test regarding the justification of the limitation of fundamental rights such as privacy. The conclusion will be that in the case of a trade-off, infringing measures will have to be balanced by effective safeguards. No trade-off without balance. (shrink)

This book contains a cohesive overview of the most important theories and insights in the field of business ethics. At the same time, it further tailors these theories to the situation in which organizations function, presenting criteria that can be used to measure, assess, improve and report on corporate integrity.

Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development (...) of an as-fair-as-possible dispute resolution process that incorporates an appropriated-justified, defensible critical-care obligation threshold. (shrink)

Defining actions in contradistinction to mere happenings runs into the problem of specifying the role of the agent and separating what the agent does from what they exploit or suffer. Traditionally these problems have been approached by starting with a simple act, such as an incidental movement, and considering causality, or by seeking to elucidate the connection between the act and the agent's intentions or reasons. It is suggested here that a promising approach is to shift attention from 'simple' movements (...) and start instead by exploring the general character of acquired skills. Balancing the body is one such skill and serves here as an exemplar. Some remarks made by Reid on balance are used in a Peircean framework for perception to suggest that, at least for humans, an action is always the performance of an acquired skill. Also, while action is constitutive of perception, bodily perception is the basis of action, providing in a feeling of ownership direct knowledge of an asymmetric opposition between the agent and the world. (shrink)

Truth-telling in healthcare practice can be regarded as a universal communicative virtue; however, there are different views on what consequence it has for giving or diminishing hope. The aim of this article is to explore the relationship between the concepts of truth-telling and hope from a relational ethics approach in the context of healthcare practice. Healthcare staff protect themselves and others to preserve hope in the care of seriously sick patients and in end-of-life care. This is done by balancing truth-telling (...) guided by different conditions such as the cultural norms of patients, family and staff. Our main conclusion is that the balancing of truth-telling needs to be decided in a mutual understanding in the caring relationship, but hope must always be inspired. Instead of focusing on autonomy as the only guiding principle, we would like to propose that relational ethics can serve as a meaningful perspective in balancing truth-telling. (shrink)

Using data obtained during a retrospective interview study of 30 women who had undergone genetic testing—BRCA1/2mutation searching—this paper describes how women, previously diagnosed with breast/ovarian cancer, perceive their role in generating genetic information about themselves and their families. It observes that when describing their motivations for undergoing DNA testing and their experiences of disclosing genetic information within the family these women provide care based ethical justifications for their actions. Finally, it argues that generating genetic information and disclosing this information to (...) kin raise different types of ethical issues. The implications of these findings for ethical debates about informed choice in the context of genetic testing are discussed. (shrink)

Issues of balancing data accessibility with ethical considerations and governance of a genomics research biobank, Generation Scotland, are explored within the evolving policy landscape of the past ten years. During this time data sharing and open data access have become increasingly important topics in biomedical research. Decisions around data access are influenced by local arrangements for governance and practices such as linkage to health records, and the global through policies for biobanking and the sharing of data with large-scale biomedical research (...) data resources and consortia. We use a literature review of policy relevant documents which apply to the conduct of biobanks in two areas: support for open access and the protection of data subjects and researchers managing a bioresource. We present examples of decision making within a biobank based upon observations of the Generation Scotland Access Committee. We reflect upon how the drive towards open access raises ethical dilemmas for established biorepositories containing data and samples from human subjects. Despite much discussion in science policy literature about standardisation, the contextual aspects of biobanking are often overlooked. Using our engagement with GS we demonstrate the importance of local arrangements in the creation of a responsive ethical approach to biorepository governance. We argue that governance decisions regarding access to the biobank are intertwined with considerations about maintenance and viability at the local level. We show that in addition to the focus upon ever more universal and standardised practices, the local expertise gained in the management of such repositories must be supported. A commitment to open access in genomics research has found almost universal backing in science and health policy circles, but repositories of data and samples from human subjects may have to operate under managed access, to protect privacy, align with participant consent and ensure that the resource can be managed in a sustainable way. Data access committees need to be reflexive and flexible, to cope with changing technology and opportunities and threats from the wider data sharing environment. To understand these interactions also involves nurturing what is particular about the biobank in its local context. (shrink)

While the United States is an important Asia-Pacific actor, its engagement with the region is complex and often difficult. Not only must US regionalism balance the diverse requirements of an ambitious policy agenda, but also US policy norms and priorities often clash with those of other regional actors. This has important implications for the capacity of the United States to provide regional leadership. Recent years have seen growing policy convergence between the United States and other Asia-Pacific actors, particularly in (...) economic terms, but US regionalism continues to feature competition alongside collaboration. (shrink)

Organs for transplantation are a scarce resource. Markedly, the transplant community’s primary challenge is the stark disparity between the number of patients awaiting deceased donor organ transplants and the rate at which organs become available. However, the allocation of a limited number of organs poses another constant challenge: maintaining an equilibrium between renal transplant utility and equity, that is, striking a balance between the utilitarian argument of medical efficiency and the principle of equity. In this comprehensive overview, the authors (...) delve into the challenge of maintaining an acceptable balance between equity and efficiency and elaborate on some of the factors that might inform a decisionmaker’s evaluation of the extent to which a given allocation scheme is efficient or equitable. (shrink)

Given the primary mandate for institutional review boards (IRBs) to protect potential participants from harm, the egregious history of research abuses, and the fact that there is no mention of incl...

Balancing Change and Tradition in Global Education Reform is an invaluable resource for policymakers, faculty, students, and anyone interested in how decisions made about the education system ultimately affect the quality of education, educational access, and social justice.

This article is critical of “bioethics” as it is widely understood and taught, noting in particular an emphasis given to philosophical justification, reason and rationality. It is proposed that “balancing” bioethics be achieved by giving greater weight to practice and the aesthetic: defined in terms of sensory perception, emotion and feeling. Each of those three elements is elaborated as a non-cognitive capacity and, when taken together, comprise aesthetic sensitivity and responsiveness. This is to recognise the aesthetic as a productive element (...) in bioethics as practice. Contributions from the philosophy of art and aesthetics are drawn into the discussion to bring depth to an understanding of “the aesthetic”. This approach is buttressed by philosophers – including Foucault and 18th century German philosophers – who recognized a link between ethics and aesthetics. The article aims to give substance to a claim that bioethics necessarily comprises a cognitive component, relating to reason, and a non-cognitive component that draws on aesthetic sensibility and relates to practice. A number of advantages of bioethics, understood to explicitly acknowledge the aesthetic, are proffered. Having defined bioethics in conventional terms, there is discussion of the extent to which other approaches to bioethics recognize aesthetic sensitivity in their practice. It is apparent that they do so to varying extents although not always explicitly. By examining this aspect of applied ethics, the paper aims to draw attention to aesthetic sensitivity and responsiveness as integral to ethical and effective health care. (shrink)

Across languages of the world, some grammatical patterns have been argued to be more common than expected by chance. These are sometimes referred to as (statistical) language universals. One such universal is the correlation between constituent order freedom and the presence of a case system in a language. Here, we explore whether this correlation can be explained by a bias to balance production effort and informativity of cues to grammatical function. Two groups of learners were presented with miniature artificial (...) languages containing optional case marking and either flexible or fixed constituent order. Learners of the flexible order language used case marking significantly more often. This result parallels the typological correlation between constituent order flexibility and the presence of case marking in a language and provides a possible explanation for the historical development of Old English to Modern English, from flexible constituent order with case marking to relatively fixed order without case marking. In addition, learners of the flexible order language conditioned case marking on constituent order, using more case marking with the cross‐linguistically less frequent order, again mirroring typological data. These results suggest that some cross‐linguistic generalizations originate in functionally motivated biases operating during language learning. (shrink)

Across languages of the world, some grammatical patterns have been argued to be more common than expected by chance. These are sometimes referred to as language universals. One such universal is the correlation between constituent order freedom and the presence of a case system in a language. Here, we explore whether this correlation can be explained by a bias to balance production effort and informativity of cues to grammatical function. Two groups of learners were presented with miniature artificial languages (...) containing optional case marking and either flexible or fixed constituent order. Learners of the flexible order language used case marking significantly more often. This result parallels the typological correlation between constituent order flexibility and the presence of case marking in a language and provides a possible explanation for the historical development of Old English to Modern English, from flexible constituent order with case marking to relatively fixed order without case marking. In addition, learners of the flexible order language conditioned case marking on constituent order, using more case marking with the cross-linguistically less frequent order, again mirroring typological data. These results suggest that some cross-linguistic generalizations originate in functionally motivated biases operating during language learning. (shrink)

The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their (...) healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships. (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)

In October of 2009, Trevor Keezer was terminated by Home Depot for refusing to remove a pin from his uniform declaring “One Nation under God, Indivisible.” Mr. Keezer, a cashier with Home Depot, contended that the button he had worn for over one year before any action was taken by his employer expressed his support for American troops and his Christian faith. Were the actions taken by his employer warranted or was Mr. Keezer the victim of arbitrary religious discrimination unrelated (...) to job performance? Religion is becoming an increasingly polarizing issue in the workplace, forcing retail managers to balance the respective interests of employees, coworkers, and patrons of retail establishments. And from all indications, if legislation pending in Congress is enacted, maintaining the balance will become more problematic. (shrink)

Utilizing Meilaender's typology of ways of relating universal impartial love to the preferential love of particular special relations, the author agrees with Outka in rejecting the first strategy of "building down" from agape by construing special relations as an application of agape. Considering Gewirth as a representative of the "build around" strategy of using universal regard as the limiting principle that constrains the preferential treatment of special relations, she tracks the internal inconsistencies that haunt this approach. The "build up" strategy (...) of moving from particular to universal love is criticized in the form in which it appears in Plato's "Symposium" but commended in a more phenomenological version, which suggests a model of balance that is supported by the work of Gilligan and Benhabib. (shrink)

Background: Medical confidentiality underpins the doctor–patient relationship and ensures privacy so that intimate information can be exchanged to improve, preserve, and protect the health of the patient. The right to information applies to the patient alone, and, only if expressly desired, can it be extended to family members. However, it must be remembered that one of the primary tenets of family medicine is precisely that patient care occurs ideally within the context of the family. There may be, then, certain occasions (...) when difficulties will arise as to the extent of the information provided to family members.Objectives: This study aimed to describe family doctors’ attitudes to confidentiality and providing patient information to relatives as well as their justifications for sharing information.Method: A descriptive postal questionnaire was self-administered by family doctors.Results: Of 227 doctors, 95.1% provided information to a patient’s family and over a third disclosed information to others without prior patient consent.Conclusions: The findings reveal that family doctors should pay more attention to their patients’ rights to information, privacy, and confidentiality, and reflect very carefully on the fine balance between this and the occasional need for the support and collaboration of family members in delivery of care. Emphasis should be placed on ethics and legal problems during undergraduate education and in-service training of doctors. (shrink)