All organizations have ethics programs which consist of both explicit and implicit parts. This paper defines corporate ethics programs and identifies a number of their components. Corporate ethics programs'' structural and behavioral dimensions are proposed which may allow further examination of such program components and their impacts. Finally, fifteen propositions are suggested which describe the influence of founder values, competitive pressures, leadership, and organizational problems on corporate ethics programs and the manageability of such programs.

Various authors advocate consideration of stakeholder value concerns in organizational decision making. Brenner and Cochran (1990, 1991) propose a stakeholder theory of the firm which contains several propositions and a stakeholder value matrix. In order to begin any stakeholder rnodel validation, an approach is needed to measure stakeholder value and influence weights. We propose a multicriteria decision modeling approach, utilizing the analytic hierarchy process, to estimate stakeholder value matrix weights. This approach is illustrated using a simplified example and suggestions (...) are made regarding the process needed to begin to validate the stakeholder theory of the firm. (shrink)

This panel considered the uses of and prospects for the stakeholder theory/approach. After 20 years of popularity, the stakeholder concept has still notemerged as a true theory. However, it offers some unique perspectives on business organizations and there is plenty of room to develop stakeholder theory and research. These session notes are offered to further the scholarly discussion.

This “paper” recalls the events that shaped the first international conference of the International Association for Business and Society. A number of surprises andfortunate circumstances determined the actual nature of our 1992 meeting in Leuven, Belgium. This description provides a brief overview of that conference’s planning and execution.

This article provides a framework for comparing meritocratic and affirmative action admissions policies. The context of the analysis is admissions to public universities; admission rules are evaluated as part of the public investment problem faced by a state government. Meritocratic and affirmative admissions policies are compared in terms of their effects on the level and distribution of human capital. I argue that (a) meritocratic admissions are not necessarily efficient and (b) affirmative action policies may be efficiency enhancing relative to meritocratic (...) ones. Both these claims, as well as their negations, depend on features of individual behavior for which there is little empirical evidence. The implications of this absence of evidence are then explored, with a focus on policy evaluation when equality and efficiency are both desiderata. I argue that standard statistical decision theoretic approaches do not apply to the affirmative action case, even if equality and efficiency are rendered commensurable based on a scalar payoff function. In this context, I suggest that a presumption for equality-enhancing policies leads to support for affirmative action, but I emphasize the contingent nature of this conclusion. Key Words: affirmative action • meritocracy • college admissions • efficiency. (shrink)

This article considers the implications of complex systems models for the study of economics and the evaluation of public policies. I argue that complexity can enhance current approaches to formal economic analysis, but does so in ways that complement current approaches. I further argue that while complexity can influence how public policy analysis is conducted, it does not delimit the use of consequentialist approaches to policy comparison to the degree initially suggested by Hayek and most recently defended by Gaus.

Any empirical claim about the role of genes in socioeconomic outcomes involves successfully addressing the identification problem. This commentary argues that socioeconomic outcomes such as education are sufficiently complex, involving so many mechanisms, that understanding the role genes requires the use of formal theoretical structures.

This article considers the implications of complex systems models for the study of economics and the evaluation of public policies. I argue that complexity can enhance current approaches to formal economic analysis, but does so in ways that complement current approaches. I further argue that while complexity can influence how public policy analysis is conducted, it does not delimit the use of consequentialist approaches to policy comparison to the degree initially suggested by Hayek and most recently defended by Gaus.

A critical analysis of contemporary strategic management theory and practice suggests that modernist, linear thinking has facilitated the development of an abstracted reality which is misleading to managers and fundamentally flawed. It is argued that formulaic strategic tools such as those propounded by Porter fail to capture the reality of the complex environments that confront firms and falsely suggest that an answer can be derived from a predetermined toolbox. As an alternative to this dominant paradigm, the complexity of markets is (...) presented not as something to be feared and ignored, but rather as a truth to be embraced. As a basis of taking this step, current knowledge on how complex environments work, perspectives on how they can be better understood and how people and organizations can engage within them, is presented. Ultimately it is recognised that both theoretical and practical foundations need significant, further development. (shrink)

As part of an ethics course, health professions students were asked to identify ethical issues and to propose resolutions before and after a class discussion of a case involving confidentiality and substance abuse. Students listed an average of 2.4 issues before and 3.6 issues after the discussion. After discussion 50 per cent of students made explicit changes in their proposed resolution. Opinions varied widely on breaching confidentiality and the responsibility for protecting the patient's health. After the discussion almost 20 per (...) cent of the class felt it was acceptable to breach confidentiality as long as the patient was unaware. Many students identified more with the health care provider than with the patient. The presence of substance abuse altered many students' views on confidentiality. In this experience students were less rigorous in their application of principles, creating an excellent opportunity for teaching through exploration of the complexity of ethical decision-making in a specific case. (shrink)

"What is indeed striking is the degree to which the essays reveal a shared set of interests and adopt languages and concerns that reflect back and forth in stimulating ways."--Richard W. Kroll, author of "The Material World".

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

The process by which auditors consider fraud risk in assessing management’s motivation and character remains under-addressed. This is problematic given the rising tide of narcissism, as well as recent research documenting that both self- and other-perceptions of narcissism influence an array of judgments. While a skeptical attitude is fundamental to the auditor’s gatekeeper role, it remains unclear how auditors form and act on perceptions of client narcissism. With a large sample of experienced accountants as participants, we leverage insights from current (...) narcissism and perceiver effects research to predict (and find) that auditor skepticism responds in a divergent manner to both the auditor’s (1) own antagonistic versus agentic narcissism and (2) perceptions of the client’s antagonistic and agentic narcissism. We discuss the observed opposing behavioral externalities related to these distinct forms of grandiose narcissism, particularly in dynamic interactions between clients and auditors. (shrink)

Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. However, using this extreme case, this paper will examine practices of framing and obtaining consent as perceived by medical students. This (...) paper reports findings of an exploratory qualitative study of medical students and junior doctors. Participants described a number of barriers to obtaining informed consent. These related to misunderstandings concerning student roles and experiences and insufficient information on the nature of the examination. Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients’ reasons for refusal. Practices of framing the information used by students, nurses and senior doctors to enable patients to decide about consent are discussed in the context of good ethical practice. In the absence of a clear ethical model, coercion appears likely. We argue for an expanded model of autonomy in which the potential tension between respecting patients’ autonomy and ensuring the societal benefit of well-trained doctors is recognised. Practical recommendations are made concerning information provision and clear delineations of student and patient roles and expectations. (shrink)

Most physicians confront the moral and technical challenges of treating persons who are coming to the natural end of their lives. At the level of the health system, this issue becomes a more pressing area for reform as premature death decreases and more people live a full life span. Well-developed countries and international organizations such as the World Health Organization and the Organisation of Economic Cooperation and Development have made recommendations for improving healthcare problems in aging societies. Turkey belongs to (...) the WHO and the OECD. This article describes end-of-life healthcare in Turkey, the design of the healthcare system to meet this need, challenges that should be addressed, and solutions that would be appropriate to Turkish culture and resources. (shrink)

New brain-computer interface and neuroimaging techniques are making differentiation less ambiguous and more accurate between unresponsive wakefulness syndrome patients and patients with higher cognitive function and awareness. As research into these areas continues to progress, new ethical issues will face physicians of patients suffering from total locked-in syndrome, characterized by complete loss of voluntary muscle control, with retention of cognitive function and awareness detectable only with neuroimaging and brain-computer interfaces. Physicians, researchers, ethicists and hospital ethics committees should be aware of (...) and prepared to handle ethical issues unique to these totally locked-in patients. Several thought experiments are discussed, to highlight potential ethical dilemmas surrounding surrogate decision-making, autonomy, end-of-life care, and pediatric care, which will be unique to total LIS patients. These, along with other ethical problems especially relevant to total LIS patients, merit further discussion among physicians, researchers, ethicists and hospital ethics committees, to facilitate consensus regarding these issues, and improve patient care. (shrink)