The concept of moral distress comes from nursing ethics, and was initially defined as ‘…when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. There is a large body of literature associated with moral distress, yet multiple definitions now exist, significantly limiting its usefulness. We undertook a systematic review of the argument-based bioethics literature on this topic as the basis for a critical appraisal, identifying 55 papers for analysis. (...) We found that moral distress is most frequently framed around individual experiences of distress in relation to local practices and constraints, and understood in terms of power relations and workplace hierarchies. This understanding is directly derived from, and often still seen as specific to, nursing. Frequently the perspective of the morally distressed individual is privileged. Understandings of moral distress have evolved towards an ‘occupational health approach’, with the assumption that moral distress should be measured and prevented. Counter-perspectives were identified, highlighting conceptual problems. Based on our review, we propose a redefinition of moral distress: ‘Ethical unease or disquiet resulting from a situation where a clinician believes they have contributed to avoidable patient or community harm through their involvement in an action, inaction or decision that conflicts with their own values’. This definition is specific enough for research use, anchored in clinicians’ professional responsibilities and concerns about harms to patients, framed relationally rather than hierarchically, and amenable to multiple perspectives on any given morally distressing situation. (shrink)

This paper provides a systematic account of how artificial intelligence (AI) technologies could harm nonhuman animals and explains why animal harms, often neglected in AI ethics, should be better recognised. After giving reasons for caring about animals and outlining the nature of animal harm, interests, and wellbeing, the paper develops a comprehensive ‘harms framework’ which draws on scientist David Fraser’s influential mapping of human activities that impact on sentient animals. The harms framework is fleshed out with examples inspired by both (...) scholarly literature and media reports. This systematic account and framework should help inform ethical analyses of AI’s impact on animals and serve as a comprehensive and clear basis for the development and regulation of AI technologies to prevent and mitigate harm to nonhumans. (shrink)

The Open Corporation, originally published in 2002, set out a blueprint for effective corporate self-regulation, offering practical strategies for managers, stakeholders and regulators to build successful self-regulation management systems. Christine Parker examined the conditions under which corporate self-regulation of social and legal responsibilities were likely to be effective, covering a wide range of areas - from consumer protection to sexual harassment to environmental compliance. Focusing on the features that make self-regulation or compliance management systems effective, Parker argued (...) that law and regulators needed to focus much more on 'meta-regulating' corporate self-regulation if democratic control over corporate action was to be established. (shrink)

Many are calling for transformative food systems changes to promote population and planetary health. Yet there is a lack of research that considers whether current food policy frameworks and regulatory approaches are suited to tackle whole of food systems challenges. One such challenge is responding to the rise of ultra-processed foods (UPF) in human diets, and the related harms to population and planetary health. This paper presents a narrative review and synthesis of academic articles and international reports to critically examine (...) whether current food policy frameworks and regulatory approaches are sufficiently equipped to drive the transformative food systems changes needed to halt the rise of UPFs, reduce consumption and minimise harm. We draw on systems science approaches to conceptualise the UPF problem as an emergent property of complex adaptive food systems shaped by capitalist values and logics. Our findings reveal that current food policy frameworks often adjust or reform isolated aspects of food systems (e.g., prices, labels, food composition), but under-emphasise the deeper paradigms, goals and structures that underlie the rise of UPFs as a systems phenomenon, and its socio-ecological implications. We propose that a ‘leverage points’ framework illuminates where to intervene in food systems to generate multi-level changes, while the theory of ecological regulation highlights how to respond to complex multi-factorial problems, like the rise of UPFs, in diverse ways that respect planetary boundaries. More research is needed to better understand the transformative potential of ecological regulation to advance food systems transformation and attenuate whole of food systems challenges. (shrink)

Since the 1990s there have been a number of government and market led initiatives to improve the welfare of layer hens in the United Kingdom, Australia and the USA. The focus of these regulatory and market initiatives has been a shift away from the dominant battery-cage system to enriched cages, barn/aviary and free-range production systems. Government regulations have played an important role in setting some minimum welfare standards and the banning of battery cages in the UK and in some US (...) states. However the commodification and market segmentation of higher welfare standards has also seen the growth in production and demand of cage-free and free-range eggs in all three countries. This paper maps and compares the developments in government regulation and market segmentation of layer-hen welfare in the UK, Australia and the USA. The role of labelling and certification in facilitating commodification and market segmentation will be examined, including the public controversies and legal conflicts over egg labelling. The key state, market and civil society actors in each country will also be identified, and their role in driving or resisting higher standards examined, including the increasingly influential role of animal welfare organizations and food corporations. (shrink)

Ethical discussions about Artificial Intelligence (AI) often overlook its potentially large impact on nonhuman animals. In a recent commentary on our paper about AI’s possible harms, Leonie Bossert argues for a focus not just on the possible negative impacts but also the possible beneficial outcomes of AI for animals. We welcome this call to increase awareness of AI that helps animals: developing and using AI to improve animal wellbeing and promote positive dimensions in animal lives should be a vital ethical (...) goal. Nonetheless, we argue that there is some value in focusing on technology-based harms in the context of AI ethics and policy discourses. A harms framework for AI can inform some of our strongest duties to animals and inform regulation and risk assessment impacts designed to prevent serious harms to humans, the environment, and animals. (shrink)

At the International Legal Ethics Conference IV held at Stanford Law School between 15 and 17 July 2010, one of the two opening plenary sessions consisted of a panel who debated the proposition that legal ethics should be mandatory in legal education. The panel included leading legal ethics academics from jurisdictions around the world—both those where legal ethics is a compulsory part of the law degree and those where it is not. It comprised Professors Andrew Boon, Brent Cotter, Christine (...) Parker, Stephen L Pepper and Richard Wu, and was organised and chaired by Professor Kim Economides. This is an edited version of the panel's discussion. It provides a useful summary of the state of legal ethics teaching in the jurisdictions represented as well as a marshalling of the arguments for and against legal ethics as a required course in the university law degree. (shrink)

This Article examines normative arguments for legal pluralism in regulation. First I briefly set out what we know in fact about how plural regulatory orderings interact and compete with state agency regulatory action. Second, I sketch, and reject, a simple legal pluralist response to regulatory pluralism. In the third part of the Article I show that "responsive" and "reflexive" approaches to intentional pluralization in the design of law should be seen as providing different but complementary pictures of pluralized law. Finally (...) I argue that this pluralized view of law might provide us with the conceptual tools to identify a type of emergent, pluralistic law, without or beyond the state, which would be relevant to thinking about both transnational regulation and multiculturalism. (shrink)

IntroductionResponsible investment, in which environmental, social and governance considerations are incorporated into investment decision making, is a potentially powerful tool for increasing corporate accountability and improving corporate practices to address broad societal challenges. Whilst the RI sector is growing, there is limited understanding of the extent to which pressing social issues, such as obesity and unhealthy population diets, are incorporated within RI decision making. This study aimed to investigate the extent to which obesity prevention and population nutrition are considered by (...) Australian institutional investors engaged in responsible investment.MethodsA desk-based review was conducted of investment approaches of prominent Australian asset managers and superannuation funds identified as engaged in responsible investment. Relevant information on the incorporation of ESG issues related to obesity and population nutrition was extracted for each investor, drawing on websites, published policy documents and annual reports. Strategies were categorized as: negative/exclusionary screening; positive/best-in-class screening; norms-based screening; ESG integration; sustainability-themed investing; impact/community investing; and corporate engagement and shareholder action. These strategies were compared across investors and by themes related to obesity and population nutrition.ResultsEighteen of the 35 investors indicated that they applied investment strategies that considered issues related to obesity and population nutrition. The most commonly identified strategy was ESG integration, followed by sustainability-themed investing, and positive screening. The ways in which obesity and population nutrition were considered as part of these approaches included relatively high-level general health considerations, considerations around the healthiness of food company product portfolios, and consideration of specific company nutrition policies and practices. The specificity and depth to which RI strategies were disclosed varied.ConclusionThere is significant potential for investment decisions to contribute to efforts to address key social issues, such as obesity and unhealthy diets. Some institutional investors in Australia have recognized the potential importance of incorporating obesity- and population nutrition-related issues into decision-making processes. However, the extent to which these considerations translate into investment decisions and their impact on companies in the food sector warrant further exploration. (shrink)

This paper investigates what “free-range” eggs are available for sale in supermarkets in Australia, what “free-range” means on product labelling, and what alternative “free-range” offers to cage production. The paper concludes that most of the “free-range” eggs currently available in supermarkets do not address animal welfare, environmental sustainability, and public health concerns but, rather, seek to drive down consumer expectations of what these issues mean by balancing them against commercial interests. This suits both supermarkets and egg producers because it does (...) not challenge dominant industrial-scale egg production and the profits associated with it. A serious approach to free-range would confront these arrangements, and this means it may be impossible to truthfully label many of the “free-range” eggs currently available in the dominant supermarkets as free-range. (shrink)

Alternative proteins, including plant-based and cell-based meat and dairy analogues, are discursively positioned as a new form of meat and dairy and as a solution to the myriad of issues associated with conventional animal agriculture. Animal agricultural industries across various nations have resisted this positioning in regulatory spaces by advocating for laws that restrict the use of meat and dairy terms on the labels of alternative proteins products. Underlying this contestation are differing understandings of, and vested interests in, desirable futures (...) for animal agriculture. In Australia, this broader contestation led to a national-level inquiry by a Senate parliamentary committee entitled _Definitions of meat and other animal products_ (the Inquiry). This paper reports findings from a study of the problematizations developed through the Inquiry using a framework for policy discourse analysis referred to as Bacchi’s ‘What’s the Problem Represented to be’ methodology. It shows how the dominant discourse throughout the Inquiry moved away from the initial problematization of alternative proteins as a threat to animal agriculture. Instead, both industries were ultimately positioned as not in competition and only labelling laws were problematized with the solution being amendments to ensure ‘consumer clarity’. This outcome ignored a range of alternative problematizations related to the ethical, environmental, health, social and economic issues raised by animal agriculture and by alternative proteins. This lack of scrutiny benefits both industries, by closing off the policy discourse to consideration of a range of alternative interests, voices, and potential solutions, such as stricter health and welfare regulation. (shrink)

Practice guidelines are an increasingly relevant feature of health insurance. One hundred and seventy-eight million people in the United States have some form of private health insurance coverage; coverage for 150 million of them is employment-related. Traditionally, this coverage was provided by employers purchasing a group contract under which an insurance carrier provided indemnity coverage for employees—that is, the insurance company paid all usual, customary, and reasonable charges incurred by an employee for medical care, subject in some cases to an (...) annual deductible and to a percentage of covered expenses, co-paid by the employee, for each service. In recent years, however, employers in greater numbers have switched to so-called self-insurance plans in which employees’ health care claims are paid directly by the employer. (shrink)

Practice guidelines are an increasingly relevant feature of health insurance. One hundred and seventy-eight million people in the United States have some form of private health insurance coverage; coverage for 150 million of them is employment-related. Traditionally, this coverage was provided by employers purchasing a group contract under which an insurance carrier provided indemnity coverage for employees—that is, the insurance company paid all usual, customary, and reasonable charges incurred by an employee for medical care, subject in some cases to an (...) annual deductible and to a percentage of covered expenses, co-paid by the employee, for each service. In recent years, however, employers in greater numbers have switched to so-called self-insurance plans in which employees’ health care claims are paid directly by the employer. (shrink)

Just Lawyers proposes a model for the regulation and organization of lawyers, guided by an ideal of access to justice. It is grounded in empirical analysis of why people complain about lawyers, the nature of existing legal institutions, and the ethical ideals of the profession. Parker weaves the normative theory of deliberative democracy with the empirical law and society tradition of research on the limits and possibilities of law. She shows that access to justice can only occur in the (...) interaction between courtroom justice, informal everyday justice, and social movementpolitics. Lawyers' justice should educate people's justice to improve the justice quality of everyday relationships and transactions, while community concerns (including community access to justice concerns) should reshape lawyers' regulation, organization, andpractices to improve substantive justice. Just Lawyers shows how legal proffesionalism can only be revitalized through the reform of access to justice beyond lawyers. (shrink)

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Many companies are now implementing ethics and regulatory compliance programs. The growth of employment of both lawyers and specialist "compliance professionals" to advise on and facilitate implementation of these programs has expanded concomitantly. This paper examines the ethical role that should be played by these advisors. Traditional ways of conceptualising corporate lawyers' ethics are shown to be inadequate because they see the legal advisor as an autonomous adversarial advocate or an independent and aloof counsellor. Instead interviews with compliance practitioners are (...) used to show that a superior conceptualisation of the compliance advisor's role is emerging. Compliance practitioners identify explicitly with business and, at the same time, identify with a broader ethical community of other compliance professionals, regulators and stakeholders in order to play a transformative role within the organisation. This conception recognises the interdependence between compliance advisor and corporate client. (shrink)

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics (...) revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health. (shrink)

Julian Savulescu argues for two principles of reproductive ethics: reproductive autonomy and procreative beneficence, where the principle of procreative beneficence is conceptualised in terms of a duty to have the child, of the possible children that could be had, who will have the best opportunity of the best life. Were it to be accepted, this principle would have significant implications for the ethics of reproductive choice and, in particular, for the use of prenatal testing and other reproductive technologies for the (...) avoidance of disability, and for enhancement. In this paper, it is argued that this principle should be rejected, and it is concluded that while potential parents do have important obligations in relation to the foreseeable lives of their future children, these obligations are not best captured in terms of a duty to have the child with the best opportunity of the best life. (shrink)

Clinical geneticists are increasingly confronted with ethical tensions between their responsibilities to individual patients and to other family members. This paper considers the ethical implications of a “familial” conception of the clinical genetics role. It argues that dogmatic adherence to either the familial or to the individualistic conception of clinical genetics has the potential to lead to significant harms and to fail to take important obligations seriously.Geneticists are likely to continue to be required to make moral judgments in the resolution (...) of such tensions and may find it useful to have access to ethics training and support. (shrink)

The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, (...) we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints. (shrink)

Christine Battersby rethinks questions of embodiment, essence, sameness and difference, self and "other", patriarchy and power. Using analyses of Kant, Adorno, Irigaray, Butler, Kierkegaard and Deleuze, she challenges those who argue that a feminist metaphysics is a a contradiction in terms. This book explores place for a metaphysics of fluidity in the current debates concerning postmodernism, feminism and identity politics.

BackgroundCommunity engagement is increasingly promoted as a marker of good, ethical practice in the context of international collaborative research in low-income countries. There is, however, no widely agreed definition of community engagement or of approaches adopted. Justifications given for its use also vary. Community engagement is, for example, variously seen to be of value in: the development of more effective and appropriate consent processes; improved understanding of the aims and forms of research; higher recruitment rates; the identification of important ethical (...) issues; the building of better relationships between the community and researchers; the obtaining of community permission to approach potential research participants; and, the provision of better health care. Despite these diverse and potentially competing claims made for the importance of community engagement, there is very little published evidence on effective models of engagement or their evaluation.MethodsIn this paper, drawing upon interviews with the members of a Community Advisory Board on the Thai-Myanmar border, we describe and critically reflect upon an approach to community engagement which was developed in the context of international collaborative research in the border region.Results and conclusionsDrawing on our analysis, we identify a number of considerations relevant to the development of an approach to evaluating community engagement in this complex research setting. The paper also identifies a range of important ways in which the Community Advisory Board is in practice understood by its members to have morally significant roles and responsibilities beyond those usually associated with the successful and appropriate conduct of research. (shrink)

The development of human genetics raises a wide range of important ethical questions for us all. The interpersonal dimension of genetic information in particular means that genetics also poses important challenges to the idea of patient-centredness and autonomy in medicine. How ought practical ethical decisions about the new genetics be made given that we appear, moreover, no longer to be able to appeal to unquestioned traditions and widely shared communitarian values? This paper argues that any coherent ethical approach to these (...) questions must be able both to uphold the moral status of the individual and at the same time recognise the communitarian, interpersonal dimensions both of the world in which we live and of personal autonomy itself. The paper then goes on to propose an approach to the resolution of the ethical questions raised by the use of the new genetics in reproductive choice through the development of a coherent and principled process of public reason and justification oriented towards the support and development of personal autonomy. (shrink)

Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the (...) range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and tim.. (shrink)

The internet is becoming increasingly important in health care practice. The number of health-related web sites is rising exponentially as people seek health-related information and services to supplement traditional sources, such as their local doctor, friends, or family. The development of e-medicine poses important ethical challenges, both for health professionals and for those who provide clinical ethics support for them. This paper describes some of these challenges and explores some of the ways in which those who provide clinical ethics support (...) might respond creatively to them. By offering ways of responding to such challenges, both electronically and face-to-face, the providers of clinical ethics support can show themselves to be an indispensable part of good quality health care provision. (shrink)

Some theorists argue that moral bioenhancement ought to be compulsory. I take this argument one step further, arguing that if moral bioenhancement ought to be compulsory, then its administration ought to be covert rather than overt. This is to say that it is morally preferable for compulsory moral bioenhancement to be administered without the recipients knowing that they are receiving the enhancement. My argument for this is that if moral bioenhancement ought to be compulsory, then its administration is a matter (...) of public health, and for this reason should be governed by public health ethics. I argue that the covert administration of a compulsory moral bioenhancement program better conforms to public health ethics than does an overt compulsory program. In particular, a covert compulsory program promotes values such as liberty, utility, equality, and autonomy better than an overt program does. Thus, a covert compulsory moral bioenhancement program is morally preferable to an overt moral bioenhancement program. (shrink)

Epistemic burdens – the nature and extent of our ignorance (that and how) with respect to various courses of action – serve to determine our incentive structures. Courses of action that seem to bear impossibly heavy epistemic burdens are typically not counted as options in an actor’s menu, while courses of action that seem to bear comparatively heavy epistemic burdens are systematically discounted in an actor’s menu relative to options that appear less epistemically burdensome. That ignorance serves to determine what (...) counts as an option means that epistemic considerations are logically prior to moral, prudential, and economic considerations: in order to have moral, prudential, or economic obligations, one must have options, and epistemic burdens serve to determine our options. One cannot have obligations without doing some epistemic work. We defend this claim on introspective grounds. We also consider how epistemic burdens distort surrogate decision-making. The unique epistemology of surrogate cases makes the priority of the epistemic readily apparent. We then argue that anyone who accepts a principle similar to ought implies can is committed to the logical priority of the epistemic. We also consider and reject several possible counterarguments. -/- . (shrink)

There is recent empirical evidence that personal identity is constituted by one’s moral traits. If true, this poses a problem for those who advocate for moral enhancement, or the manipulation of a person’s moral traits through pharmaceutical or other biological means. Specifically, if moral enhancement manipulates a person’s moral traits, and those moral traits constitute personal identity, then it is possible that moral enhancement could alter a person’s identity. I go a step further and argue that under the right conditions, (...) moral enhancement can constitute murder. I then argue that these conditions are not remote. (shrink)

The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute. For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other, human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why particular beliefs are held, and the epistemological status of claims based in wisdom or experience. The paper critically appraises a number of claims and distinctions, (...) and attempts to clarify the connections between EBM, clinical experience and judgement, and the objective and evaluative categories of medicine. I conclude that to demystify clinical wisdom is not to devalue it. EBM ought not be conceived as needing to be limited or balanced by clinical wisdom, since if its language is translatable into terms comprehensible and applicable to individuals, it helps constitute clinical wisdom. Failure to appreciate this constitutive relation will help perpetuate medical paternalism and delay the adoption of properly evidence-based practice, which would be both unethical and unwise. (shrink)

This paper provides evidence for a contrastive account of explanation that is motivated by pragmatic theories that recognize the contribution that context makes to the interpretation of a prompt for explanation. This study replicates the primary findings of previous work in explanation-based category learning, extending that work by illustrating the critical role of the context in this type of learning. Participants interacted with items from two categories either by describing the items or explaining their category membership. We manipulated the feature (...) overlap between the categories and examined both the explanations generated and acquired knowledge of the categories. Explanations for membership in a given category were influenced by the unprompted contrast category, indicating an important role for contrastive processing in the generation of explanations. The influence of the contrast category was similarly seen in the transfer performance of the participants. (shrink)

Orr and Siegler have recently defended a restrictive view concerning posthumous sperm retrieval and conception, which would limit insemination to those cases where the deceased man has provided explicit consent for such a procedure. The restrictive view dominates current law and practice. A permissible view, in contrast, would allow insemination and conception in all but those cases where the posthumous procedure has been explicitly refused, or where there is no reasonable evidence that the deceased person desired children. I describe a (...) phenomenology of procreative desires which supports the permissible view, and which is compatible with requirements concerning the interests of the decedent, concepts of medical infertility, and the welfare of the future child. The account illustrates how our current obsession with individual rights and autonomy can be self-defeating and repressive. (shrink)