We report the results of a vignette study with an online sample of the German adult population in which we analyze the interplay between need, equity, and accountability in third-party distribution decisions. We asked participants to divide firewood between two hypothetical persons who either differ in their need for heat or in their productivity in terms of their ability to chop wood. The study systematically varies the persons’ accountability for their neediness as well as for their productivity. (...) We find that participants distribute significantly fewer logs of wood to persons who are held accountable for their disadvantage. Independently of being held accountable or not, the needier person is partially compensated with a share of logs that exceeds her contribution, while the person who contributes less is given a share of logs smaller than her need share. Moreover, there is a domain effect in terms of participants being more sensitive to lower contributions than to greater need. (shrink)

Background Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. Aim To describe ambulance clinicians’ understanding of older patients’ self-determination when the patient’s decision-making ability is impaired. Research design A qualitative (...) design with an inductive approach, guided by descriptive phenomenology. Participants In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. Findings The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination. Conclusion The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous. (shrink)

A growing body of theory has focused on privacy as being contextually defined, where individuals have highly particularized judgments about the appropriateness of what, why, how, and to whom information flows within a specific context. Such a social contract understanding of privacy could produce more practical guidance for organizations and managers who have employees, users, and future customers all with possibly different conceptions of privacy across contexts. However, this theoretical suggestion, while intuitively appealing, has not been empirically examined. This (...) class='Hi'>study validates a social contract approach to privacy by examining whether and how privacy norms vary across communities and contractors. The findings from this theoretical examination support the use of contractual business ethics to understand privacy in research and in practice. As predicted, insiders to a community had significantly different understandings of privacy norms as compared to outsiders. In addition, all respondents held different privacy norms across hypothetical contexts, thereby suggesting privacy norms are contextually understood within a particular community of individuals. The findings support two conclusions. First, individuals hold different privacy norms without necessarily having diminished expectations of privacy. Individuals differed on the factors they considered important in calculating privacy expectations, yet all groups had robust privacy expectations across contexts. Second, outsiders have difficulty in understanding the privacy norms of a particular community. For managers and scholars, this renders privacy expectations more difficult to identify at a distance or in deductive research. The findings speak directly to the needs of organizations to manage a diverse set of privacy issues across stakeholder groups. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A (...) home-sent questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)

Construction process stages are argued to be vulnerable to the prevalence of corrupt practices. However, the validity of this argument has not been empirically explored in the extant literature of construction management. Therefore, this study examines the stages of the construction process susceptibility to corruption and its most prominent forms of corrupt activities. A total of forty-four project-related professionals were involved in an expert survey to assess such susceptibilities and the criticality of the identified corrupt activities at each stage. (...) A comparative study of expert views from developing regions against experts from developed regions is conducted. Expert scoring results revealed that three stages are most susceptible, namely: project execution, pre-qualification and tender stages. Such results were confirmed by application of the Mann–Whitney U test statistics tool, showing wide disparities in seven out of eleven identical stages. This study is intended to incite polemic discussions and greater empirical, evidence-based research from scholars in both developed and developing countries. This study adds to the extant literature corruption-related works on the construction process through deeper understanding of the dynamic nature of corrupt practices involved in the stages of the construction process in developing countries. Practically, it intends to offer a veritable plethora of information on the critical stages of the construction process for industry practitioners, policymakers and anti-corruption bodies to careen their attention towards the fight against corruption. (shrink)

Care staff in Norway usually work in the private homes of people with intellectual disabilities. Staff experience ethical challenges daily in their interactions with their clients. The aim of this paper is to introduce a vignette validation procedure for selection of practice-close vignettes that can be used to elicit and explore staff reflections on ethical challenges in their work. Staff participants were recruited from different municipalities in one county of Norway. To develop vignettes with good internal validity, the validation (...) process consisted of (1) a field study to identify situations to be included as vignettes, (2) a six-step categorization process to select vignettes with good internal validity, (3) transforming the situations into vignettes, including removal of elements that were too leading or constricting, (4) testing the familiarity and relevance of the preliminary sample of vignettes (external validation), (5) final selection of four vignettes to be included in the investigation, and (6) a validation of the four vignettes? familiarity and practical relevance as ethical challenges by the final sample of interviewees. Our preliminary experience indicates that the validation procedure enhanced the selection of vignettes to elicit staff perceptions and reflections on daily ethical challenges. (shrink)

Debates about the genuine disease status of controversial diseases rely on intuitions about a range of factors. Adopting tools from experimental philosophy, this paper explores some of the factors that influence judgments about whether low sexual desire should be considered a disease and whether it should be medically treated. Drawing in part on some assumptions underpinning a divide in the literature between viewing low sexual desire as a genuine disease and seeing it as improperly medicalized, we investigate whether health and (...) disease judgments are affected by factors such as an individual’s gender, the cause of the low desire, whether the desire is high or low, and both personal and societal valuations of the condition. Our main findings indicate that (a) the cause of a condition influences whether it is judged a disorder, (b) how the individual values the condition influences whether the condition is seen as a proper target of medical intervention, and (c) perceived dysfunction influences judgments regarding health, disorder classification, medicalization, and medical intervention. Our findings help further illuminate the intricate interplay of factors that influence judgments about health and disease in controversial conditions. (shrink)

For Newman the Roman Catholic, the Oratorian way of life resonated with his experience as a fellow of Oriel College, Oxford: the Oratory was a place of stability that provided an opportunity for scholarship. This article examines three aspects of the Oratorian idea of scholarship: the spiritual formation of the intellect; the role of the laity in a Catholic university; and the importance of personal influence inevangelization—educational ideals that are as fundamentally important today as they were in Newman’s time.

For Newman the Roman Catholic, the Oratorian way of life resonated with his experience as a fellow of Oriel College, Oxford: the Oratory was a place of stability that provided an opportunity for scholarship. This article examines three aspects of the Oratorian idea of scholarship: the spiritual formation of the intellect; the role of the laity in a Catholic university; and the importance of personal influence inevangelization—educational ideals that are as fundamentally important today as they were in Newman’s time.

There has been an increase in recent years in the use of empirical methods in healthcare ethics. Appeals to empirical data cannot answer moral questions, but insights into the knowledge, attitudes, experience, preferences and practice of interested parties can play an important part in the development of healthcare ethics. In particular, while we may establish a general ethical principle to provide explanatory and normative guidance for healthcare professionals, the interpretation and application of such general principles to actual practice still requires (...) interpretation and judgement. And many situations in healthcare practice are complex and may involve a variety of principles, each of which may conflict with the others. Simple surveys or interview studies may not be sufficient if we wish to develop a nuanced approach to ethical practice that can be set out in guidelines, codes or directives. We do not resolve moral questions by plebiscite. In this paper, the authors argue for the use of consensus methods to develop shared understanding of ethical practice, and they argue further for the combination of the Delphi method with the use of vignettes to illustrate the kind of situations that may occur in practice. They develop their argument in part by reference to their experience of using this approach in their recent research. (shrink)

In this paper we will propose a simple linguistic approach to the Knobe effect, or the moral asymmetry of intention attribution in general, which is just to ask the felicity judgments on the relevant sentences without any vignette at all. Through this approach we were in fact able to reproduce the Knobe effects in different languages, with large effect sizes. We shall defend the significance of this simple approach by arguing that our approach and its results not only tell (...) interesting facts about the concept of intentional action, but also show the existence of the linguistic default, which requires independent investigation. We will then argue that, despite the recent view on experimental philosophy by Knobe himself, there is a legitimate role of the empirical study of concepts in the investigations of cognitive processes in mainstream experimental philosophy, which suggests a broadly supplementary picture of experimental philosophy. (shrink)

As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by (...) the patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)

This research presents findings from a study of gender-based differences in an ethical decision situation. The study focuses on gender as it relates to situational factors and accounting experience. The primary element of interest is how the gender of the actor (the person described in each vignette) influences the evaluation/assessment of the ethical/unethical decisions. While previous research has provided evidence of ethical differences relating to the gender of the responding subjects, limited evidence has been presented relating to (...) situational issues that may influence assessments of ethical decisions.This research uses four accounting environment vignettes to survey the responses of accountants and accounting students to the ethical/unethical nature of the actions that are taken. In addition, how likely the accountants believe they are to take the same actions is also surveyed. The subjects are a representative sample of practicing accountants in the U.S. and senior/graduate accounting majors at a state university in the southwestern United States. (shrink)

Background Over the last decades, the neurosciences, behavioral sciences, and the social sciences have all seen a rapid development of innovative research methods. The field of bioethics, however, has trailed behind in methodological innovation. Despite the so-called “empirical turn” in bioethics, research methodology for project development, data collection and analysis, and dissemination has remained largely restricted to surveys, interviews, and research papers. We have previously argued for a “Design Bioethics” approach to empirical bioethics methodology, which develops purpose-built methods for investigation (...) of bioethical concerns. In this paper we compare a research tool created using a design bioethics approach to a “methods-as-usual” approach in empirical bioethics.Methods Our study compared dimensions of engagement with a digital game we created, called “Tracing Tomorrow,” to a standard vignette survey. The two tools investigated the same subject matter, digital phenotyping for mental health, in a sample of 301 UK adolescents.Results Participants who played the game reported a greater sense of presence, emotional engagement, cognitive absorption, and mental health ethics insight, compared to participants who completed the vignette survey. Perceived authenticity and curiosity/motivation to learn more was equivalent for both methods.Conclusion The results of this study highlights the importance of purpose-built methodology for empirical bioethics research. (shrink)

Drawing on findings from an original national survey experiment, we unpack Americans’ views on the employment of mothers and fathers with young children. This study provides a fuller account of contemporary attitudes than is available from surveys such as the General Social Survey. After seeing vignettes that vary the circumstances in which married mothers, single mothers, and married fathers make decisions about paid work and caregiving, the respondents’ views swing from strong support to deep skepticism about a parent’s work (...) participation, depending on the parent’s specific job conditions and family circumstances. When a mother, whether married or single, is satisfied with her job and her family depends on her income, respondents overwhelmingly support the option to work. Conversely, when a father is dissatisfied with his job and the family does not depend on his income, respondents generally support the option to stay home. These findings provide insight regarding the “gender stall” thesis by showing that Americans’ views depend heavily on the circumstances they believe parents are facing. This more nuanced view highlights the importance of social context in the allocation of paid work and caregiving for both mothers and fathers. (shrink)

One of the most beloved passages in the Zhuang-Zi text is a dialogue between Hui Zi and Zhuang Zi at the end of the “Qiu-shui” chapter. While this is one of many vignettes involving Hui Zi and Zhuang Zi in the text, this particular vignette has recently drawn attention in Chinese and comparative philosophy circles. The most basic question concerning these studies is whether or not the passage represents a substantial philosophical dispute, or instead idle chitchat between two friends. (...) This vignette has not only received much attention as of late, but commentators from at least Guo Xiang onward have taken the conversation as substantial rather than merely charming. Of the traditional readings that take the passage as substantial, there are two main strategies for taking Zhuang Zi as “winning” a substantial dispute: One that argues Zhuang Zi is undermining Hui Zi’s position without offering a positive position, and another that argues that Zhuang Zi is undermining Hui Zi’s position by offering a positive position. Guo Xiang’s “official commentary” is paradigmatic of the first “negative” strategy, while Wang Fuzhi’s reading is paradigmatic of the second “positive” strategy. The goal in the present article is to present these two strategies for reading the passage by translating and analyzing Guo’s and Wang’s annotations, thereby showing how the passage might be and has been taken as more than frivolous chitchat. (shrink)

Background Decision making when patients ask a dentist for fee reduction is a real ethical dilemma at dental settings. The aim of this study was to evaluate how dental students and tutors think about their position for, or against fee reduction at dental offices. Method It was a questionnaire-based survey, which examined the ethical attitudes of students and tutors of an Iranian Dental School. The questionnaire included a vignette about an ethical dilemma at a dental office. Different ethical (...) approaches, i.e. duty-based, virtue-oriented and consequentialist arguments, for or against fee reduction at dental office were suggested. Respondents were asked to rank those ethical options. Data was entered and analyzed in SPSS 16.0. Result 121 dental students and thirty-six faculty members participated in this study. It revealed that a majority of dental students and tutors are in favor of charging patients less, when facing an imagined request at dental office, using either virtue-oriented or consequentialist argument for fee reduction. The difference between rankings of four options was statistically significant, while no statistically significant difference exists neither between male and female respondents, nor students and tutors. Conclusion This case study provides a basis for fruitful discussions in ethics courses for dental students. Our study suggests that financial issues should be considered as a part of ethical training within the dental student's curriculum. (shrink)

Overtreatment is when medical or dental services are provided with a higher volume or cost than is appropriate. This study aimed to investigate how a group of dentists in Switzerland, a wealthy country known to have high standards of healthcare including dentistry, evaluated the meaning of unnecessary treatments from an ethical perspective and, assessed the expected frequency of different possible behaviors among their peers.

BackgroundImportance of awareness of medical ethics and its integration into medical curriculum has been frequently highlighted. Study 1 aimed to assess the knowledge, attitude, and reported practices of medical ethics among clinicians at Patan Academy of Health Sciences, a tertiary care teaching hospital in Nepal. Study 2 was conducted to assess whether there was a difference in knowledge, attitude, and reported practices of medical ethics among doctors who received formal medical ethics education during undergraduate studies and those who (...) did not.MethodsTwo cross-sectional surveys using self-administered questionnaires were conducted. Study 1 included 72 participants; interns, medical officers, and consultants working at Patan Academy of Health Sciences. Study 2 was a comparative study conducted among 54 medical officers who had received formal medical ethics education (Group 1) and 60 medical officers who did not (Group 2).ResultsParticipants who had completed post-graduate education had higher knowledge (p = 0.050), practice (p < 0.001), and overall combined scores (p = 0.011). Participants with ethics education had higher knowledge (p < 0.001), attitude (p = 0.001), practice (p < 0.001), and overall score (p < 0.001). Most participants preferred consulting colleagues if an ethical dilemma arose. Fewer participants had heard of the Declaration of Helsinki. Most participants thought doctors to be most capable of judging what is best for the patient (Study 1: 70.42%, Study 2 Group 1: 42.59%, Group 2: 80%). Case scenarios in which participants demonstrated poor practice were ethical issues concerning truth-telling, end-of-life decisions, treating HIV/aids patients, treating a minor, and reporting colleague’s errors.ConclusionsThis study found that participants who have received medical ethics education have higher knowledge, attitude, and practice scores. The results further justify the need for medical ethics education to be a part of the core medical curriculum. A blame-free environment where seniors can be approached for advice should be created. Research ethics should also be given attention. During medical ethics training, ethical issues where doctors perform poorly should be given more priority and should be discussed in a country-specific context. (shrink)

Using a two-part instrument consisting of eight vignettes and twenty character traits, the study sampled 141 employees of a mid-west financial firm regarding their predispositions to prefer utilitarian or formalist forms of ethical reasoning. In contrast with earlier studies, we found that these respondents did not prefer utilitarian reasoning. Several other hypotheses were tested involving the relationship between people's preferences for certain types of solutions to issues and the forms of reasoning they use to arrive at those solutions; the (...) nature of the relationship between utilitarian and formalist categories ; and the possibility of measuring ethical predispositions using different methods. (shrink)

This study provides a comparison of the ethical perceptions of managers and non-managers, including professionals, teachers, sales persons and clerks, as well as technical and plant workers. Data of working individuals were collected in Hong Kong in the form of questionnaires which contain vignettes of questionable ethical issues. Factor analysis was used to identify the major ethical dimensions which were then used as the basis of comparison. Regression analyses were used to study the effect of various variables on (...) ethical perceptions in terms of the identified dimensions. Our study reviews that managers tend to possess deontological views that are more ethical than that found in other occupations. The gap between managers and professionals in perceiving unethical behavior is narrower compared to that between the former and individuals in other occupations. The acceptability of unethical behavior tends to decline with income. Besides, there are indications that people working in non-profit organizations tend to have higher ethical standards. Based on our results, recommendations are made to improve the ethical culture of organizations. (shrink)

This study provides a comparison of the ethical perceptions of managers and non-managers, including professionals, teachers, sales persons and clerks, as well as technical and plant workers. Data of working individuals were collected in Hong Kong in the form of questionnaires which contain vignettes of questionable ethical issues. Factor analysis was used to identify the major ethical dimensions which were then used as the basis of comparison. Regression analyses were used to study the effect of various variables on (...) ethical perceptions in terms of the identified dimensions. Our study reviews that managers tend to possess deontological views that are more ethical than that found in other occupations. The gap between managers and professionals in perceiving unethical behavior is narrower compared to that between the former and individuals in other occupations. The acceptability of unethical behavior tends to decline with income. Besides, there are indications that people working in non-profit organizations tend to have higher ethical standards. Based on our results, recommendations are made to improve the ethical culture of organizations. (shrink)

The purpose of this exploratory study is to examine the use of an ethical intervention strategy – counterexplanation – on individuals’ ethical decision-making. As opposed to providing reasons to support a decision in the case of explanation, counterexplanation is the provision of reasons that either speak against or provide evidence against a chosen course of action. The number of explanations and/or counterexplanations provided by the participants is expected to have a significant effect on ethical evaluation and intention. The number (...) of explanations is expected to be negatively related to ethical decision-making while the number of counterexplanations is expected to be positively related to ethical decision-making. The experiment, that made use of five ethical vignettes, manipulated four treatment groups – explanation, counterexplanation, explanation/counterexplanation, and counterexplanation/explanation. Participants were randomly assigned to one of the four reatments. They performed the requirements of their treatment before recording their ethical evaluations and intentions. As expected, larger numbers of explanations led to less ethical decision-making and larger numbers of counterexplanations led to more ethical decision-making. However, when both types of explanations are required, the order of counterexplaining before explaining is more desirable as it leads to more ethical decision-making. The study also reports that individuals with high social desirability bias (a tendency to present oneself in a culturally acceptable manner) may generate less counterexplanations. Implications of the findings are explained in the paper. (shrink)

Several studies have shown that people are more likely to attribute intentionality and blame to agents who perform actions that have harmful consequences. This kind of bias has problematic implications for jury decisions because it predicts that judgment in juries will malfunction if an action has a blameworthy effect. Most of these studies include in their design a vignette in which it is clear that agents have foreknowledge of the effects of their actions. This kind of design fails to (...) replicate trial situations where, in most cases, it is impossible to know with certainty whether agents have foreknowledge of the effects of their actions. In the present study, we adopt an alternative design that includes vignettes in which there is no direct evidence of foreknowledge to investigate the relationship between intentionality and blame in actions that have harmful and helpful effects. We find that people are still more likely to attribute intentionality to actions that produce harmful effects than actions that produce good effects. However, we find that people tend to attribute more blame when they have direct evidence of foreknowledge than when presented with an alternative design that does not include foreknowledge. Results indicate the relevant role that evidence of foreknowledge plays in experimental designs that study blame attribution. (shrink)

The purpose of this exploratory study is to examine the use of an ethical intervention strategy - counterexplanation - on individuals' ethical decision-Making. As opposed to providing reasons to support a decision in the case of explanation, counterexplanation is the provision of reasons that either speak against or provide evidence against a chosen course of action. The number of explanations and/or counterexplanations provided by the participants is expected to have a significant effect on ethical evaluation and intention. The number (...) of explanations is expected to be negatively related to ethical decision-making while the number of counterexplanations is expected to be positively related to ethical decision-making. The experiment, that made use of five ethical vignettes, manipulated four treatment groups - explanation, counterexplanation, explanation/counterexplanation, and counterexplanation/explanation. Participants were randomly assigned to one of the four reatments. They performed the requirements of their treatment before recording their ethical evaluations and intentions. As expected, larger numbers of explanations led to less ethical decision-making and larger numbers of counterexplanations led to more ethical decision-making. However, when both types of explanations are required, the order of counterexplaining before explaining is more desirable as it leads to more ethical decision-making. The study also reports that individuals with high social desirability bias may generate less counterexplanations. Implications of the findings are explained in the paper. (shrink)

In this paper, we propose and justify the cross‐linguistic study of the concept of truth through empirical studies of truth predicates, with results of such studies. We first conceptually explore the possibility of cross‐linguistic disagreement about truth purely due to linguistic norms governing truth predicates, which may imply a kind of pluralism about the concept of truth. We then consider the conditions under which we would be justified in inferring this sort of pluralism from the fact of such cross‐linguistic (...) disagreement. Next, we report results of three studies on the use of English “is true” and Japanese two truth predicates, as well as “is correct” and its Japanese counterpart. We then report another set of studies using a different vignette, where the radical cross‐linguistic difference observed in earlier studies disappeared. These data together suggest that the moral‐political factor in the truth‐bearer (utterance) strongly affects the uses of Japanese truth predicates but not those of English. Finally, we will discuss the implications of the studies and results reported here, and the empirical possibility of what we call lexical alethic pluralism, for debates over relativism, theories of meaning, and the deflationary and inflationary theories of truth. (shrink)

The challenge of teaching classic religious texts with flawed moral messages from a contemporary point of view is examined in the case of the Beautiful Captive of War (Deuteronomy 21:10–14). A moral dilemma is generated by contradictory ethical stands within the Jewish tradition, between which students have to choose. This dilemma is explored in the context of a kind of religious education which strives for critical commitment to sacred tradition. That kind of education is analysed for its roots in self‐persuasion, (...) moral agency in complex social settings and an educational philosophy based on norms and conscience. Other issues explored are sexual education, international human rights, the relationship of abstract moral vignettes to real‐life situations and behaviour and the relationship of religious to moral education. (shrink)

This review considers ethical challenges to research design and informed consent in biomedical and behavioral studies conducted in resource-poor settings. A review of the literature explores relevant social, cultural, and ethical issues in the conduct of biomedical and social health research in developing countries. Ten case vignettes illustrate ethical challenges that arise in international research with culturally diverse populations. Recommendations for researchers and policy-makers concerned about ethical practices in multinational studies conducted in resource-poor settings are also listed.

Purpose: There is a widespread recognition that biomedical explanations offer benefits to those diagnosed with a mental disorder. Recent research points out that such explanations may nevertheless have stigmatizing effects. In this study, this ‘mixed blessing’ account of biomedical explanations is investigated in a case of philosophical interest: Tourette Syndrome. Method: We conducted a vignette survey with 221 participants in which we first assessed quantitative attributions of blame as well as the desire for social distance for behavior associated (...) with Tourette Syndrome. Results: In our study, it is confirmed that in the case of biomedical explanations, less blame is attributed than in the case of psychosocial explanations. When presented with a mixed explanation stressing an entanglement of biological and psychosocial factors this did not increase blame attribution. The desire for social distance is unaffected by the type of explanation but the participants’ free text feedback indicates this might obfuscate an underlying dilemma between stigma and blame revealed in recent research. Conclusion: There seems to be potential for blame reduction in explanations where biological and psychosocial factors are entangled. However, dynamic, ‘epigenetic’, explanations require further qualitative research to be performed as well as a philosophical framework to account for the ‘mixed blessings’ account. (shrink)

Several authors in bioethics literature have expressed the view that a whole brain conception of death is philosophically indefensible. If they are right, what are the alternatives? Some authors have suggested that we should go back to the old cardiopulmonary criterion of death and abandon the so-called Dead Donor Rule. Others argue for a pluralist solution. For example, Robert Veatch has defended a view that competent persons should be free to decide which criterion of death should be used to determine (...) their death. However, there is very little data on people’s preferences about death determination criteria. We conducted online vignette-based survey with Latvian participants (N = 1416). The data suggest that the pluralist solution fits best with the way our study participants think about death determination—widely differing preferences concerning death determination criteria were observed. Namely, most participants choose one of the three criteria discussed in the literature: whole brain, higher brain, and cardiopulmonary. Interestingly, our data also indicate that study participants tend to prefer less restrictive criteria for determination of their own deaths than for determination of deaths of their closest relatives. Finally, the preferences observed in our sample are largely in accord with the Dead Donor Rule for organ procurement for transplantation. (shrink)

The question of transtemporal identity of objects in general and persons in particular is an important issue in both philosophy and psychology. While the focus of philosophers traditionally was on questions of the nature of identity relation and criteria that allow to settle ontological issues about identity, psychologists are mostly concerned with how people think about identity, and how they track identity of objects and people through time. In this article, we critically engage with widespread use of inferring folk judgments (...) of identity from study participants’ use of proper names in response to experimental vignettes. We provide reasons to doubt that using this method one can reliably infer judgments of numerical identity over time and transformations. We also critically examine allegedly-Kripkean justification of this method and find it lacking. Merely assuming that names are rigid designators will not help. A study participant’s use of proper names can be taken to track the participant’s identity judgments only if supported by the participant’s belief that names used in the scenario are used rigidly. (shrink)

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant (...) in a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

Background Whether patients' life-style should involve lower priority for treatment is a controversial question in bioethics. Less is known about clinicians' views. Aim To study how clinical doctors' attitudes to questions of patient responsibility and priority vary over time. Method Surveys of doctors in Norway in 2008, 2014, 2021. Questionnaires included statements about patients' lifestyle's significance for priority to care, and vignettes of priority cases (only in 2014). Results Attitudes were fairly stable between 2008 and 2021. 17%/14% agreed that (...) patients' lifestyle should count, while 19%/22% agreed that it should involve lower priority to scarce organs. 42/44% agreed that smokers should have lower priority. Substantially more agreed in 2014. Regression analyses showed that being male, working in hospital, and younger age increased the likelihood of agreeing. Conclusion A substantial minority of doctors agreed that lifestyle should be a priority criterion, possibly contrary to Norwegian legislation and professional ethics. The finding might be explained by the unspecified meaning of priority, increased scarcity-awareness, or socio-cultural trends towards individualism. The 2014 results indicate a framing effect; the vignettes may have primed the respondents towards accepting lifestyle as a criterion. We conclude that attitudes to normative questions are unstable and depend on context. A substantial minority of doctors seems to be positive to deprioritizing patients allegedly responsible for their illness. However, what deprioritization implies in practice is not clear. (shrink)

In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as (...) well as the reasons provided for this. A random sample of general practitioners and orthopaedic surgeons as well as members of the general public received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy. Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains. There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a “recommendation strategy” vis-à-vis smoking cessation prior to surgery rather than a “requirement strategy”. The normative reasons speak in favour of the “recommendation strategy”. (shrink)

Recent empirical work on the virtue of gratitude raises questions about the limits of that research and its methods to address normative questions about gratitude. I distinguish two kinds of norms for the emotion of gratitude—norms of genuineness and norms of excellence. I examine two kinds of empirical studies that aim to establish or contribute to the norms for gratitude: a so-called “prototype” approach, and a narrative vignettes approach, finding the latter far superior, and suggest various refinements that might improve (...) accuracy. The main emotion types, of which gratitude is an example, have a conceptual structure that must be reflected in any normative analysis, and is far better reflected in the vignettes approach. Ultimately, however, formulation of norms of genuineness and of virtue must come from one or another tradition of careful reflection and debate about such concepts as gratitude; and the representatives of such traditions are philosophers and theologians. (shrink)

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant (...) in a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as ‘completely’ or ‘mostly’ unethical. Participants were also asked to rank-order the (...) value of five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as the least valuable (even less valuable than an anecdote) and 35.7.% viewing it as the most valuable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects. (shrink)

This article is an analysis of the relationship between US hospice structure and the feeling of being a burden to others. A goal of US hospice care is to reduce the FBO. But in America, hospice is limited in its ability to do so because of the high caregiver burden it places on family members of dying people. Through a historical study, I show that this burden was excessive when the hospice system was created and has worsened over time. (...) Through three ethnographic vignettes, I demonstrate how this burden inculcates in dying people the FBO. I then examine the bioethical implications of this finding for the existing US debate about physician-assisted suicide. The presence of FBO due to insufficient hospice care supports arguments made by PAS opponents about the social pressure placed on dying people. This finding is not itself sufficient to resolve the “right to die” debate. But it provides the ground for a compromise, across the debate, to reduce the FBO by changing US hospice structure. The resulting consensus will further the goals of both PAS proponents and opponents. (shrink)

This article is an analysis of the relationship between US hospice structure and the feeling of being a burden to others. A goal of US hospice care is to reduce the FBO. But in America, hospice is limited in its ability to do so because of the high caregiver burden it places on family members of dying people. Through a historical study, I show that this burden was excessive when the hospice system was created and has worsened over time. (...) Through three ethnographic vignettes, I demonstrate how this burden inculcates in dying people the FBO. I then examine the bioethical implications of this finding for the existing US debate about physician-assisted suicide. The presence of FBO due to insufficient hospice care supports arguments made by PAS opponents about the social pressure placed on dying people. This finding is not itself sufficient to resolve the “right to die” debate. But it provides the ground for a compromise, across the debate, to reduce the FBO by changing US hospice structure. The resulting consensus will further the goals of both PAS proponents and opponents. (shrink)