In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

The recent production of major treatises devoted to elaborating normative ethical theories and the eruption of lively debates concerning the merits of opposed normative systems have been greeted with applause. This reaction is an historical about-face, since for forty or fifty years “ethical” treatises had been attacking the pretensions of traditional moral philosophy, calling for its demise or at the least severely limiting its claims. These skeptical attacks had succeeded in seriously undermining the academic status of moral philosophy and consequently (...) moral philosophy was transformed into “metaethics,” a highly abstract and technical discipline considered much less necessary to the general education of students than what it replaced and with a diminished role in the curriculum. The recent resurgence of interest in normative ethics has generally been lauded as a sign that philosophy has rededicated itself to its proper and time-honored tasks. There is a widespread feeling that the overblown claims of twentieth century skepticism have been whittled down to innocuous proportions and thus that nothing stands in the way of proceeding to construct ethical theories. The study of normative ethical theory now enjoys such respectability and popularity that it is difficult to raise once more the uncomfortable ideas that the ideal of normative ethical theory is a false one, that vanquishing the spectre of noncognitivism is not sufficient for legitimizing it, and that the popular new justifications for the enterprise fail in mischievous ways. (shrink)

Health promotion involves social and environmental interventions designed to benefit and protect health. It often harmfully impacts the environment through air and water pollution, medical waste, g...

An unlinked seroprevalence study of HIV and other viruses was conducted on pregnant women on the Caribbean island of Grenada in 1994. Investigators were from both the developed world and the Grenadian Ministry of Health . There was then no board on Grenada to protect research subjects or review ethical aspects of studies. Nurses from the MOH were asked to verbally inform their patients about the study, and request that patients become subjects of the study and give blood for screening. (...) If consent was given nurses took blood and administered a survey about each subjects' knowledge of HIV transmission routes. Nurses shared a spoken dialect and cultural heritage with prospective subjects and were probably more effective than foreign researchers at informing subjects. Informed consent was obtained with a simplified consent form supplemented by conversation with each prospective research subject. Facilitating discussion between people with common cultural backgrounds helps apply the Western approach to informed consent to communities in the developing world. Researchers must disclose all information to nurses or other mediators, and ensure that nurses disclose as much information as possible to prospective subjects. So modified, informed consent maintains respect for persons and becomes applicable and relevant to various cultures. (shrink)

An unlinked seroprevalence study of HIV and other viruses was conducted on pregnant women on the Caribbean island of Grenada in 1994. Investigators were from both the developed world and the Grenadian Ministry of Health . There was then no board on Grenada to protect research subjects or review ethical aspects of studies. Nurses from the MOH were asked to verbally inform their patients about the study, and request that patients become subjects of the study and give blood for screening. (...) If consent was given nurses took blood and administered a survey about each subjects' knowledge of HIV transmission routes. Nurses shared a spoken dialect and cultural heritage with prospective subjects and were probably more effective than foreign researchers at informing subjects. Informed consent was obtained with a simplified consent form supplemented by conversation with each prospective research subject. Facilitating discussion between people with common cultural backgrounds helps apply the Western approach to informed consent to communities in the developing world. Researchers must disclose all information to nurses or other mediators, and ensure that nurses disclose as much information as possible to prospective subjects. So modified, informed consent maintains respect for persons and becomes applicable and relevant to various cultures. (shrink)

For those with advanced life-limiting illness, the optimization of quality of life and avoidance of nonbeneficial treatments at the end of life are key ethical concerns. This article evaluates the efficacy of an Interdisciplinary Ethics Panel (IEP) approach to decision making at the end of life for unbefriended nursing home residents who lack decisional capacity and have advanced life-limiting illness, through the use of a ninestep algorithm developed for this purpose. We reviewed the outcomes of three quality-of-care phased initiatives conducted (...) in our facility, a large public nursing home in New York City, between June 2016 and February 2020, which indicated that this IEP approach promoted advance-care planning, as palliative measures were endorsed to optimize quality of life for this vulnerable population at the end of life. We also examined another quality-of-care initiative when this IEP approach was applied to end-of-life decision making for nursing home residents who had a surrogate during the COVID-19 pandemic. This application appeared to be beneficial in adding more residents to our Palliative Care Program while it improved rates of advance-care planning. When all of the above findings are considered, we believe this novel IEP approach and algorithm have the potential to be applied elsewhere after appropriate assessment. (shrink)

Globally, one of every eight nurses is a migrant, but few studies have focused on the healthcare experiences of migrant nurses (MNs) as consumers or recipients of healthcare. We address this gap by examining MNs and their acculturation, barriers to healthcare access, and perceptions of healthcare encounters as consumers. For this mixed‐methods study, a convenience sample of MNs working in Europe and Israel was recruited. The quantitative component's methods included testing the reliability of scales contained within the questionnaire and using (...) Hayes Process Model #4 to test for mediation. The qualitative component's methods included analyzing interviews with iterative inductive thematic analysis. Quantitative findings on MNs (n = 73) indicated that the association between acculturation and perception of the healthcare encounter, which MNs experienced as healthcare consumers, was mediated by barriers to healthcare access, even after adjusting for age and gender (p = 0.03). Qualitative interviews with MNs (n = 13) provided possible explanations for the quantitative findings. Even after working in the host country's healthcare system for several years, MNs reported difficulties with their healthcare encounters as healthcare consumers, not only due to their limited knowledge about the culture and healthcare resources but also due to the biased responses they received. (shrink)

Human service managers are called on to make a variety of difficult decisions that often involve fundamental conflicts in values. Such conflicts constitute ethical dilemmas. This qualitative exploratory study examines how human service managers (N = 40), from the United States, identify and resolve ethical dilemmas. The dilemmas identified by the managers tended to result in the restriction of missions, programs, services and practice methods. The resolution of these ethical problems often rested on following the very rules that created the (...) dilemmas. Additional strategies included consultations and reliance on abstract principles, specifically those of one's spiritual faith. Missing, however, were systematic or evidence-based procedures for resolving challenges that often threatened the very goals of the human service agencies. The need for more careful training in the area of ethical problem solving that maintains the vision of human services is presented. (shrink)

This article provides current Schwartz Values Survey data from samples of business managers and professionals across 50 societies that are culturally and socioeconomically diverse. We report the society scores for SVS values dimensions for both individual- and societallevel analyses. At the individual- level, we report on the ten circumplex values sub- dimensions and two sets of values dimensions. At the societal- level, we report on the values dimensions of embeddedness, hierarchy, mastery, affective autonomy, intellectual autonomy, egalitarianism, and harmony. For each (...) society, we report the Cronbach' s? statistics for each values dimension scale to assess their internal consistency as well as report interrater agreement analyses to assess the acceptability of using aggregated individual level values scores to represent country span sp. (shrink)

The explicit objective for the 2014 Symposium hosted by the University of North Florida, which serves as the basis for this collection of papers, was to explore the relationship and potential for mutual support between the disciplines of child rights and pediatric bioethics in advancing the health and well-being of children in the United States and around the world. The U.N. Convention on the Rights of the Child served as the locus for this discussion. A significant question emerged in the (...) Symposium about whether the CRC could serve any beneficial purpose in the United States, where it has not yet been ratified. Further, there was.. (shrink)

In this article, we examine how the U.N. Convention on the Rights of the Child can be useful in pediatric bioethics. Adopted in 1989, the CRC reflects norms that have been deliberated upon for a long period of time and endorsed by most nations. The United States is now the only country that has not ratified the CRC.1 International human rights law shares many key moral concepts with clinical pediatric bioethics, and the CRC provides a considered language common to many (...) jurisdictions that can assist bioethicists in their daily practice and help health-care organizations in their policy development and international interactions. There may, however, be practical challenges with using the CRC in the practice of.. (shrink)

The purpose of this study was to describe the extent to which nurses perceive the ethical dimensions of clinical practice situations involving patients, families and health care professionals. Using the composite theory of basic moral principles and the professional standard of care established by legal custom as a framework, situations involving ethical dilemmas were gleaned from the nursing literature. They were reviewed for content validity, clarity and representativeness in a two-stage process by expert panels. The situations were presented in a (...) written format to a convenience sample of nurses (n = 125), who were primarily staff nurses (65.6%). Respondents' judgements about whether the main issue of each situation concerned ethics ranged from a low of 0.8% to a high of 40%. From analyses of the categories into which the majority of subjects placed each situation, it was concluded that these nurses generally perceived ethics as the main issue in situations that directly involve patients' autonomy. Analysis yielded unanticipated findings about the themes in ethical situations to which nurses in practice may respond. (shrink)

In this paper we track the ‘body positivity’ movement from its origins, promoting radical acceptance of marginalized bodies, to its co-optation as a push for self-love for all bodies, including those bodies belonging to socially dominant groups. We argue that the new focus on the ‘body positivity’ movement involves a single-minded emphasis on beauty and aesthetic adornment, and that this undermines the original focus of social and political equality, pandering instead to capitalism and failing to rectify unjust institutions and policies. (...) As such, we argue that the ‘body positivity’ movement ultimately marginalises further the bodies for which it initially sought justice and acceptance. (shrink)

In this article I defend an account of beauty labor as a form of resistance that can enable individuals and communities to combat body oppression. Focusing on the “Fuck Flattering!” movement, a social-media-driven movement in which fat people purposefully wear unflattering clothing to resist antifat fashion and oppressive body standards, I first set three criteria necessary for an act of beauty labor to count as one of resistance. I argue that (1) the agent in question must be situated as a (...) less ideal candidate for attributions of beauty, (2) the agent must have some level of knowledge or awareness of the norms (defined in light of dominant groups) and their harms, and (3) that knowledge or awareness of the harms of said norms must inform the agent's act of beauty labor. Based on this account of beauty labor as resistance, I argue that beauty labor can combat larger systems of oppression and incite meaningful change insofar as it enables individuals to claim and reclaim space (both digital and physical) from which fat people have been historically excluded, while affording an opportunity for education and unpacking of oppression and bias, and expanding the fashion industry. (shrink)

Some animal ethicists argue that eating roadkill is permissible because salvaging and consuming already dead animals doesn’t cause harm to anyone. Moreover, some argue that eating roadkill is actually obligatory, insofar as a diet that includes some roadkill is less harmful than a diet that consists of protein (animal or plant) obtained only from grocery stores and restaurants. Against this view, Abbate argues that eating roadkill is wrong for at least two reasons: (1) better consequences would be produced if roadkill (...) were either left in surrounding habitats for scavenger animals or given to other would-be meat eaters (such as meat-eating friends, family, and/or neighbors), and (2) those who salvage and consume roadkill both benefit from and are involved in wrongdoing, insofar as the animals who are killed by motor vehicles are killed as a result of injustice. (shrink)

Multidisciplinary critiques of the notion of rape as an evolutionary adaptation.

Because factory-farmed meat production inflicts gratuitous suffering upon animals and wreaks havoc on the environment, there are morally compelling reasons to become vegetarian. Yet industrial plant agriculture causes the death of many field animals, and this leads some to question whether consumers ought to get some of their protein from certain kinds of non factory-farmed meat. Donald Bruckner, for instance, boldly argues that the harm principle implies an obligation to collect and consume roadkill and that strict vegetarianism is thus immoral. (...) But this argument works only if the following claims are true: all humans have access to roadkill, roadkill would go to waste if those who happen upon it don’t themselves consume it, it’s impossible to harvest vegetables without killing animals, the animals who are killed in plant production are all-things-considered harmed by crop farming, and the best arguments for vegetarianism all endorse the harm principle. As I will argue in this paper, each claim is deeply problematic. Consequently, in most cases, humans ought to strictly eat plants and save the roadkill for cats. (shrink)

When fat people are depicted in popular media, we often take their behavior to be representative of all fat people. How one fat person acts becomes representative of a broader pattern of behavior that all fat people are presumed to share, shaping the way we understand fatness. This way of generalizing presents fatness as a singular experience, reducing fat people to a monolithic narrative that often reinforces anti-fat bias. How do we avoid this reduction? How can we responsibly depict fat (...) characters without perpetuating negative stereotypes about real fat people? Using the case of “Fat Thor” from Avengers: Endgame, I propose the beginnings of an account of responsible artistic agency which can be used to improve the ways that marginalized communities are depicted in art, with a particular focus on fat communities. Central to this account are two features: inclusion of and deference to members of the communities depicted from a variety of backgrounds throughout the production process, and mindfulness of the preexisting narrative web built around the communities depicted. I will use this discussion to highlight the need for a drastic shift in how we consider marginalized populations in art—in reimagining both who tells their stories, and what stories are told on their behalf. (shrink)

The issues that Foucault raises about reception and reading are certainly part of the contemporary discussion of literature. However, they are not the only issues with which we, as today’s readers, are concerned. Discussions about the role of the author persist and so we continue to have recourse to the notion of authorship.For instance, in her recent book Sexual / Textual Politics , the feminist critic Toril Moi feels called on to return to these twenty-year-old issues in French theory to (...) tell us what it has meant to speak of the author, when she says: “For the patriarchal critic, the author is the source, origin and meaning of the text. If we are to undo this patriarchal practice of authority, we must take one further step and proclaim with Roland Barthes the death of the author.”3In the course of this essay I wish to reopen the question of whether it is advisable to speak of the author, or of what Foucault calls “the author function,” when querying a text, and I wish to reopen it precisely at the site where feminist criticism and post-structuralism are presently engaged in dialogue. Here in particular we might expect that reasons for rejecting author erasure would appear. However, theoretically informed feminist critics have recently found themselves tempted to agree with Barthes, Foucault, and the Edward Said of Beginnings that the authorial presence is best set aside in order to liberate the text for multiple uses.4 4. See Edward W. Said, Beginnings: Intention and Method , p. 162. Cheryl Walker is professor of English and humanities at Scripps College. She is the author of The Nightingale’s Burden: Women Poets and American Culture before 1900 and Masks Outrageous and Austere: Culture, Psyche, and Persona in Modern Women Poets . She is currently editing an anthology of nineteenth-century women poets and a book of essays about feminist criticism in the wake of post-structuralism. (shrink)

Cheryl Yarek is a Case Manager with a Specialty in Peer Support. She has worked since 1999 with the South Etobicoke Assertive Community Treatment Team . Cheryl writes on recovery in order to help, support and encourage others. She also enjoys working out at the gym, oil painting, making “wish” collages and, most recently, studying ballet.

While Aristotle’s proposition that "Man is by nature a political animal" is often assumed to entail that, according to Aristotle, nonhuman animals are not political, some Aristotelian scholars suggest that Aristotle is only committed to the claim that man is more of a political animal than any other nonhuman animal. I argue that even this thesis is problematic, as contemporary research in cognitive ethology reveals that many social nonhuman mammals are, in fact, political in the Aristotelian sense, as they possess (...) a sense of both general and special justice. Keeping this in mind, I conclude that some nonhuman animal communities very well might be identified as highly political communities, leading us to question whether it is really the case that humans are more political than socially complex, group-living nonhuman animals. (shrink)

This study investigates professional tax practitioners' ethical judgments and behavioral intentions in cases involving client pressure to adopt aggressive reporting positions, an issue that has been identified as the most difficult ethical/moral problem facing public accounting practitioners. The multidimensional ethics scale (MES) was used to measure the extent to which a hypothetical behavior was consistent with five ethical philosophies (moral equity, contractualism, utilitarianism, relativism, and egoism). Responses from a sample of 67 tax professionals supported the existence of all dimensions of (...) the MES other than egoism. Regressions of ethical judgments and behavioral intentions on the MES dimensions indicate that ethical decision making is most heavily influenced by the moral equity dimension, followed by the contractualism dimension. In contrast, the utilitarianism and relativism dimensions were only related to ethical judgments and behavioral intentions in isolated instances. (shrink)

Traditional approaches to animal ethics commonly emerge from one of two influential ethical theories: Regan’s deontology (The case for animal rights. University of California, Berkeley, 1983) and Singer’s preference utilitarianism (Animal liberation. Avon Books, New York, 1975). I argue that both of the theories are unsuccessful at providing adequate protection for animals because they are unable to satisfy the three conditions of a minimally decent theory of animal protection. While Singer’s theory is overly permissive, Regan’s theory is too restrictive. I (...) argue that a minimally decent animal ethic requires a framework that allows for context-dependent considerations of our complex human–animal relationship in a non-ideal world. A plausible theory which exemplifies this new ethic is virtue ethics. (shrink)

In a recent review article, Jeff Popke (2006, p. 510) calls for a ‘more direct engagement with theories of ethics and responsibility’ on the part of human geographers, and for a reinscription of the social as a site of ethics and responsibility. This requires that we also continue to develop ways of thinking through our responsibilities toward unseen others—both unseen neighbours and distant others—and to cultivate a renewed sense of social interconnectedness. Popke suggests that a feminist-inspired ethic of care might (...) be instrumental in developing this expanded, relational and collective vision of the social, which is particularly prescient given the contemporary economic downturn throughout the globe. Thus, as the ‘moral turn’ in geography continues to evolve, this special issue seeks to bring together geographers working within feminist or feminist-inspired frameworks, and with a shared interest in the changing geographies of ethics, responsibility and care. The collection of papers has its origins in conference sessions on Care-full Geographies, organised by the Guest Editors at the Annual Meeting of the Association of American Geographers in 2007. In this editorial we seek to position the papers within broader debates about care, responsibility and ethics that have emerged in geography and the wider social sciences in recent years, and to highlight the key issues that have framed these debates. (shrink)

A growing number of animal ethicists defend new omnivorism--the view that it's permissible, if not obligatory, to consume certain kinds of animal flesh and products. This book puts defenders of new omnivorism and advocates of strict veganism into conversation with one another to further debates in food ethics in novel and meaningful ways. The book includes six chapters that defend distinct versions of new omnivorism and six critical responses from scholars who are sympathetic to strict veganism. The contributors debate whether (...) it's ethically permissible to eat the following: "freegan" meat, roadkill, cultured meat, genetically disenhanced animals, possibly insentient animals such as insects, and fish. The volume concludes with two chapters that examine strict vegan and new omnivore policy. Presenting readers with clear defenses and criticisms of the various dietary proposals, this book draws attention to the most important ethical challenges facing traditional animal agriculture and alternative systems of food production. New Omnivorism and Strict Veganism will appeal to scholars and students interested in food ethics, animal ethics, and agricultural ethics. (shrink)

Recent discussions in the just war literature suggest that soldiers have a duty to assume certain risks in order to protect the lives of all innocent civilians. I challenge this principle of risk by arguing that it is justified neither as a principle that guides the conduct of combat soldiers, nor as a principle that guides commanders in the US military. I demonstrate that the principle of risk fails on the first account because it requires soldiers both to violate their (...) strict duty of obedience and loyalty and to exceed their special obligations to protect their fellow comrades, the state, the state's constituents and other protected civilians. I then illustrate that the principle of risk fails on the second account since it conflicts with the commander's primary obligation to protect and promote the welfare and lives of his or her soldiers. I conclude by arguing that we cannot reasonably expect soldiers and commanders to adhere to the principle of risk until there is a radical, institutional-level transformation of militaristic goals, values, strategies, policies, warrior codes and expectations of service members in the US Armed Forces. (shrink)

Interruptions are often inevitable and occur many times in daily life (Ratwani & Trafton, 2010). Interruptions at work can disrupt progress on tasks and result in costly mistakes (Brumby, Cox, Back...

ABSTRACT Self-efficacy is the assessment of one’s capacity to perform tasks. Previous research has demonstrated that self-efficacy impacts ethical behavior and attitudes but its effect on ethical cognition and perceptions has not been studied. For the present study, participants analyzed an ethical dilemma after either high or low self-efficacy was induced. Participants analyzed the dilemma using one of two cognitive problem-solving techniques versus a third, control group, and what participants wrote about the problem was content-analyzed to determine how ethical cognition (...) is impacted by self-efficacy. Additionally, perceptions of the ethical problem were examined. Results revealed that differences in self-efficacy did not lead to changes in ethical cognition, but they did lead to changes in perceptions of ethical problems. Implications of these findings are discussed. (shrink)

Convinced of the importance of framing, many environmentalists have begun emphasizing positive visions of a happy and healthy green future rather than gloomy pictures of deprivation and sacrifice. ?Gloom and doom? discourses foster despair and resistance, they worry, instead of hope and motivation to change. While positive visions are crucial, though, it is ineffective to deny that living more sustainably will involve any loss. Since people value many incompatible things, living more sustainably will inevitably entail both sacrifice and reward. Environmentalists (...) must help articulate new possibilities of a greener future without dismissing the value of what must be given up. (shrink)

In Black Skin, white masks, Franz Fanon uses a psychoanalytic framework to theorize the inferiority-dependency complex of Black men in response to the colonial racism of white men. Applying his framework in reverse, this theoretical article psychoanalyzes the white psyche and emotionality with respect to the racialization process of whites and their racial attachment to Blackness. Positing that such a process is interconnected with narcissism, humanistic emptiness, and psychosis, this article presents how racial attachment becomes racial fetish. Such a fetish (...) reifies whiteness by accumulating fictive kinships with friends of color; hence, the common parlance of ‘But I have a Black friend!’ The article, then, overlays this theoretical interpretation onto the subject of teacher education in the US, specifically urban teacher education programs that are predominantly comprised of white middle-class females who claim a desire to ‘save’ urban students of color. Ending with the dangers and hopes of a more humanistic friendship, this article offers emotional ways one can self-actualize the racialization process. (shrink)