Applied Ethics

Mental health chatbots (MHCBs) designed to support individuals in coping with mental health issues are rapidly advancing. Currently, these MHCBs are predominantly used in commercial rather than clinical contexts, but this might change soon. The question is whether this use is ethically desirable. This paper addresses a critical yet understudied concern: assuming that MHCBs cannot have genuine emotions, how this assumption may affect psychotherapy, and consequently the quality of treatment outcomes. We argue that if MHCBs lack emotions, they cannot have (...) genuine (affective) empathy or utilise countertransference. Consequently, this gives reason to worry that MHCBs are (a) more liable to harm and (b) less likely to benefit patients than human therapists. We discuss some responses to this worry and conclude that further empirical research is necessary to determine whether these worries are valid. We conclude that, even if these worries are valid, it does not mean that we should never use MHCBs. By discussing the broader ethical debate on the clinical use of chatbots, we point towards how further research can help us establish ethical boundaries for how we should use mental health chatbots. (shrink)

Context Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids’ risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in (...) which the law permits flexibility for clinicians and health care institutions to adopt best practices. -/- Methods We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. -/- Findings Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions’ requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts’ reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. -/- Conclusions -/- Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician–patient relationships and patient care within the bounds of relevant legal requirements and risks. (shrink)

The book brings together diverse views from around the world and provides a comprehensive overview of academic integrity and how to create the ethical academy. At the same time, the Handbook does not shy away from some of the vigorous debates in the field such as the causes of academic integrity breaches. There has been an explosion of interest in academic integrity in the last 20-30 years. New technologies that have made it easier than ever for students to ‘cut and (...) paste’, coupled with global media scandals of high profile researchers behaving badly, have resulted in the perception that plagiarism is ‘on the rise’. This, in combination with the massification and commercialisation of higher education, has resulted in a burgeoning interest in the importance of academic integrity, how to safeguard it and how to address breaches appropriately. What may have seemed like a relatively easy topic to address – students copying sources without attribution – has in fact, turned out to be a complex, interdisciplinary field of research requiring contributions from linguists, psychologists, social scientists, anthropologists, teaching and learning specialists, mathematicians, accountants, medical doctors, lawyers and philosophers, to name just a few. Because of this broad interest and input, this handbook serves as the single authoritative reference work which brings together the vast, growing, interdisciplinary and at times contradictory body of literature. For both established researchers/practitioners and those new to the field, this Handbook provides a one-stop-shop as well as a launching pad for new explorations and discussions. (shrink)

Environmental ethicists often make claims about the intrinsic value of nature or parts thereof. Advances in intrinsic value theory, most notably Ben Bradley’s ‘Two Concepts of Intrinsic Value,’ successfully cleave the concept of intrinsic value into two: a Moorean and Kantian variety. This paper seeks to classify and organize different environmental theorists within a Bradley-inspired framework, helping to bring clarity and charity to the claims of older and newer environmental ethicists. These two types of intrinsic value help explain why different (...) thinkers have differing intuitions on e.g., culling cases. As well as valuing nature suis generis, the paper considers the value that might accrue from other relational properties in nature, such as beauty, biodiversity, and rarity. (shrink)

Suggestions that academic medicine is systemically racist are increasingly common in the medical literature. Such suggestions often rely upon expansive notions of systemic racism that are deeply controversial. The author argues for an empirical concept of systemic racism and offers a counter argument to a recent suggestion that academic medicine is systemically racist in its treatment of medical trainees: Anderson et al.’s (Academic Medicine, 98(8S), S28–S36, 2023) “The Long Shadow: a Historical Perspective on Racism in Medical Education.” Contra the authors (...) of “The Long Shadow,” the author argues that racial performance disparities in medical education cannot be validly attributed to racism without careful empirical confirmation; he further argues that standards of assessment in medical education cannot be properly deemed racist merely because minority trainees are disproportionately disadvantaged by them. Furthermore, the history of medicine and society in the Anglo-European West is not, as argued by the authors of “The Long Shadow,” best viewed as one long tale of racial oppression culminating in the present day pervasive racism of academic medicine in the United States. Racism is a deplorable stain on our history and our present but it is not the historical essence of Christianity, European civilization, Western medicine, or contemporary academic medical institutions. (shrink)

Background The integration of artificial intelligence (AI) in radiography presents transformative opportunities for diagnostic imaging and introduces complex ethical considerations. The aim of this cross-sectional study was to explore radiographers’ perspectives on the ethical implications of AI in their field and identify key concerns and potential strategies for addressing them. Methods A structured questionnaire was distributed to a diverse group of radiographers in Saudi Arabia. The questionnaire included items on ethical concerns related to AI, the perceived impact on clinical practice, (...) and suggestions for ethical AI integration in radiography. The data were analyzed using quantitative and qualitative methods to capture a broad range of perspectives. Results Three hundred eighty-eight radiographers responded and had varying levels of experience and specializations. Most (44.8%) participants were unfamiliar with the integration of AI into radiography. Approximately 32.9% of radiographers expressed uncertainty regarding the importance of transparency and explanatory capabilities in the AI systems used in radiology. Many (36.9%) participants indicated that they believed that AI systems used in radiology should be transparent and provide justifications for their decision-making procedures. A significant preponderance (44%) of respondents agreed that implementing AI in radiology may increase ethical dilemmas. However, 27.8%expressed uncertainty in recognizing and understanding the potential ethical issues that could arise from integrating AI in radiology. Of the respondents, 41.5% stated that the use of AI in radiology required establishing specific ethical guidelines. However, a significant percentage (28.9%) expressed the opposite opinion, arguing that utilizing AI in radiology does not require adherence to ethical standards. In contrast to the 46.6% of respondents voicing concerns about patient privacy over AI implementation, 41.5% of respondents did not have any such apprehensions. Conclusions This study revealed a complex ethical landscape in the integration of AI in radiography, characterized by enthusiasm and apprehension among professionals. It underscores the necessity for ethical frameworks, education, and policy development to guide the implementation of AI in radiography. These findings contribute to the ongoing discourse on AI in medical imaging and provide insights that can inform policymakers, educators, and practitioners in navigating the ethical challenges of AI adoption in healthcare. (shrink)

Climate cuisine is about eating the future you want into being. In this article, I examine how seaweed recipes can be forms of climate fiction through the way that the reader is invited to participate in sustainable foodways. I examine several popularizations of seaweed aquaculture that imagine practices of eating and growing seaweeds. Their formal similarities center on participation: they include the direct address of the reader through the second person voice, and position themselves as instructional models. Bren Smith’s Eat (...) Like a Fish (Smith, Eat like a fish: My adventures as a fisherman turned restorative ocean farmer, Penguin, 2019) interpellates the reader as eater, invited to cultivate eating habits that, on a societal scale, would produce a more materially sustainable relation with the planet. The vignette “Ghost Bar,” which appears in Holly Jean Buck’s After Geoengineering: Climate Tragedy, Repair, and Restoration (Buck, After geoengineering: Climate tragedy, repair, and restoration, Verso, 2019), sensorily emplaces the reader in a future seaweed farm as a window into the kinds of livelihoods and forms of work that could be part of mitigating global warming. I trace the similarities between Smith's recipes and Buck’s interpellation of a reader, both of which use the second-person mode addressing an unmarked “you,” inviting this “you” to imagine and actualize the future dish or future scenario they sketch. While these texts have their own limitations at the level of the social imagination, such popularizations of seaweed aquaculture model an important way of understanding the intimacies of climate fiction and recipes. Recipes not only popularize the sustainable eating of seaweeds, but actively constitute a form of climate fiction through their intention to actualize more seaweedy futures. (shrink)

One of the most important motifs within (medical) ethics is scarcity: where essential (health) resources are scarce, urgent ethical questions arise. Over the last decade, at least 250 papers addressing the allocation of scarce health resources have been published in the Journal of Medical Ethics alone.1 In the typical set-up, the authors introduce a situation of scarcity and then review and adjudicate the available or recommended courses of action, sometimes through the lens of a pet normative ethical theory. It is (...) much less common for (medical) ethicists to focus their enquiries on the origins of scarcity. Why aren’t there sufficient health resources to go around? Who caused the scarcity, and how should they be held responsible? These questions are also firmly within the remit of the discipline. Discussions of scarcity tend to circumvent these difficult questions by focussing on exceptional cases in Global North settings, where scarcity is relatively rare, and is sometimes defensible or insoluble. For example: it would be wasteful for a hospital to overstock expensive, bulky, energetically intensive, specialist equipment whose supply would only be challenged under the most extreme and unforeseen circumstances (eg, a pandemic), and there may never be sufficient usable donor organs to meet the demand for transplants. Much less attention is given to under-resourced settings, generally in the Global South, where scarcity is common, and is often both indefensible and soluble. The literature appears to favour what is ‘unusual’ and ‘interesting’ in some contexts, rather than what is commonplace, and by that fact more worrying, in others. This division of attention entrenches the idea that scarcity is a fixed feature of certain places and lives. Why do medical ethicists so often fight shy of these meta-questions? They are, of course, harder and messier. More work and greater care are needed to contextualise …. (shrink)

The Preprints of the Ninth International Saga Conference (1994, Akureyri, Iceland) are devoted to the so-called Contemporary Sagas, i.e. the group of Saga narratives written down based on recent events. The contributors discuss philological, historical, ideological, religious and philosophical aspects of Contemporary Sagas. -/- For the citation: Sverrir Tómasson, ed. 1994. Níunda Alþjóðlega Fornsagnaþingið/The Ninth International Saga Conference: Samtíðarsögur/The Contemporary Sagas. Forprent (Preprints). Reykjavík: Stofnun Árna Magnússonar.

Derek Parfit’s view of personal identity raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be self-determining at all. However, rather than accepting that an unknown metaphysical ‘further fact’ underpins agential unity, one can accept Parfit’s view but offer a different account of what it implies morally. Part II of this article argues that contractual obligations provide a moral basis for honoring (...) advance decisions refusing life-saving and/or life-sustaining medical treatment; advance decisions have similarities to contracts, such as life insurance policies and will-contracts, that come into effect when the psychological discontinuity is through death. (shrink)

The study of rare diseases has long been an area of challenge for medical researchers, with agonizingly slow movement towards improved understanding of pathophysiology and treatments compared with more common illnesses. The push towards evidence-based medicine (EBM), which prioritizes certain types of evidence over others, poses a particular issue when mapped onto rare diseases, which may not be feasibly investigated using the methodologies endorsed by EBM, due to a number of constraints. While other trial designs have been suggested to overcome (...) these limitations (with varying success), perhaps the most recent and enthusiastically adopted is the application of artificial intelligence to rare disease data. This paper critically examines the pitfalls of EBM (and its trial design offshoots) as it pertains to rare diseases, exploring the current landscape of AI as a potential solution to these challenges. This discussion is also taken a step further, providing philosophical commentary on the weaknesses and dangers of AI algorithms applied to rare disease research. While not proposing a singular solution, this article does provide a thoughtful reminder that no ‘one-size-fits-all’ approach exists in the complex world of rare diseases. We must balance cautious optimism with critical evaluation of new research paradigms and technology, while at the same time not neglecting the ever-important aspect of patient values and preferences, which may be challenging to incorporate into computer-driven models. (shrink)

We argue that, in certain circumstances, doctors might beprofessionallyjustified to provide abortions even in those jurisdictions where abortion is illegal. That it is at least professionally permissible does not mean that they have an all-things-considered ethical justification or obligation to provide illegal abortions or that professional obligations or professional permissibility trump legal obligations. It rather means that professional organisations should respect and indeed protect doctors’ positive claims of conscience to provide abortions if they plausibly track what is in the best (...) medical interests of their patients. It is the responsibility of state authorities to enforce the law, but it is the responsibility of professional organisations to uphold the highest standards of medical ethics, even when they conflict with the law. Whatever the legal sanctions in place, healthcare professionals should not be sanctioned by the professional bodies for providing abortions according to professional standards, even if illegally. Indeed, professional organisation should lobby to offer protection to such professionals. Our arguments have practical implications for what healthcare professionals and healthcare professional organisations may or should do in those jurisdictions that legally prohibit abortion, such as some US States after the reversal ofRoe v Wade. (shrink)

Several European countries have recently started taking steps to protect access to abortion. France is one of these, with a bill having made its way through the legislature to enshrine the ‘liberté garantie’ (‘guaranteed freedom’) to an abortion in its constitution. It is the first country in the world to explicitly include abortion access in its constitution. Although abortion was decriminalised in France in 1975, proponents of the bill stated that they were motivated by protecting freedom for future generations (rather (...) than any perceived current threats)—the French minister for justice described this as characteristic of constitutional lawmaking.1 Enshrining such a freedom within the constitution was not without opposition. Although the bill passed through the Assemblée in January 2024 with 99 votes in favour and 13 against,2 it followed 8 hours of debate in which a number of issues were discussed. The Sénat (the upper house of Parliament) was initially thought to be more likely to oppose the bill. The bill was carried through the Sénat, however, with its Law Commission indicating prior to debate that it would not oppose making abortion a constitutional freedom, despite ‘some reservations’ about the text of the bill.3 Some of the issues raised in the Assemblée related to the language used, with some parliamentarians preferring to constitutionalise the ‘droit’ (right) to abortion; in line with language used in previous debates on the subject, rather than the term ‘liberté’ that was settled on.4 Other concerns were raised about the appropriateness of ‘preventative constitutionalisation’,5 the potential impact on a clinician’s ability to exercise conscientious objection6 and fears of creating an imbalance more generally between women’s …. (shrink)

It has been argued that our concepts can be disrupted or challenged by technology or normative concerns, which raises the question of whether we can create, design, engineer, or define more robust concepts that avoid counterexamples and conceptual challenges that can lead to conceptual disruption. In this paper, it is argued that we can. This argument is presented through a case study of a definition in the technological domain.

Deepfakes are extremely realistic audio/video media. They are produced via a complex machine-learning process, one that centrally involves training an algorithm on thousands of audio/video recordings of an object or person, S, with the aim of either creating entirely new audio/video media of S or else altering existing audio/video media of S. Deepfakes are widely predicted to have deleterious consequences (principally, moral and epistemic ones) for both individuals and various of our social practices and institutions. In this introduction to the (...) Topical Collection, I first survey existing philosophical research on deepfakes (sections 2 and 3). I then give an overview of the papers that comprise the Collection (section 4). Finally, I conclude with remarks on a line of argument made in a number of papers in the Topical Collection: that deepfakes may cause their own demise (section 5). (shrink)

A life of the mind can be lived only by creatures who know that they have minds. We call these creatures “persons,” and currently, all such persons THAT we know OF are “alive” in the biological sense. But are there, or could there be, either in the future or elsewhere in the universe, creatures with “a life of the mind” that are not “alive” in the sense that we humans usually understand this term today?

Poland has faced two waves of migration: the first was of irregular asylum seekers, which led to the humanitarian crisis on the eastern EU–Belarusian border since 2021; the second was of Ukrainians fleeing the Russian invasion. Although there are noticeable differences between these situations, and between the different reactions of the Polish authorities, it is possible to juxtapose them in terms of the right to health. The normative content of refugee and human rights law is the starting point for reconstructing (...) the meaning of the terms ‘refugee’ and ‘right to health’. A refugee is a person who needs international protection because of a well-founded fear of harm, which is not limited to persecution as defined by the Refugee Convention but also includes situations of international and non-international armed conflict. The right to health, which includes, inter alia, entitlements to a ‘system of health protection’ and ‘underlying determinations of health’, is reconstructed on the basis of human rights law and refugee and migration law. There are no legal and moral grounds to grant the right to health differentially to different groups of refugees. Nondiscriminatory health policy requires that refugees have the same access to health care as nationals, although their specific health needs resulting from past experiences and refugee situation require special treatment, that is, an appropriate refugee health policy. The broad understanding of the underlying determinants of health demonstrates the importance of overall migration policy for refugees’ health, which can jeopardise the fragile good of refugee health. (shrink)

Currently, in the United States, there is no legal obligation for medical professionals or civil courts to uphold patients’ Advance Directives (ADs) regarding end-of-life care. The applicability and standing of ADs prepared by Alzheimer’s patients is a persistent issue in bioethics. Those who argue against giving ADs full status take two main approaches: (1) appealing to beneficence on behalf of the Alzheimer’s patient and (2) claiming that there is no longer any personal equivalence between the AD’s creator and the subject (...) of the AD. In this paper, I present profound arguments against both approaches. Firstly, I argue that the principle of beneficence cannot apply in the case of Alzheimer’s patients, and, secondly, that the moral and legal authority of the AD need not depend on strict equivalence of personal identity. I conclude by arguing that valid ADs protect the dignity and autonomy of Alzheimer’s patients and that, therefore, there are moral obligations to uphold ADs which should be reflected in public policy and legislation. (shrink)

This study investigates why successful companies have pursued creating shared value (CSV) during the COVID-19 pandemic and the immediately ensuing post-COVID-19 era. The paper aims to achieve a better understanding of the triggers that induce companies to pursue CSV initiatives. A qualitative thematic analysis of cases of CSV involving 54 companies honored by Fortune magazine within its 2022 Change the World list was investigated and systematically reviewed. Based on the analysis, we identified and classified the motivators of CSV projects according (...) to various internal and external triggers. The qualitative results revealed seven types of internal triggers for CSV initiatives. These are: (1) following founder/leader philosophy or experience, (2) foreseeing customer growth and profit potential, (3) enhancing employee loyalty and commitment, (4) developing a future talent pool, (5) improving operational efficiency and cutting costs, (6) building differentiation weapons, and (7) becoming an industry pioneer. Seven types of external triggers for CSV initiatives were also identified. These comprise (1) economic benefits, (2) environmental protection, (3) human rights, (4) public health, (5) social justice, (6) partnership availability, and (7) government stimuli. This study contributes to the CSV literature by providing analyses of the motivators that have induced CSV initiatives during the COVID-19 era. We conclude by discussing the implications for business academics and practitioners. (shrink)

“Excited Delirium Syndrome” (ExDS) is a controversial diagnosis. The supposed syndrome is sometimes considered to be a potential cause of death. However, it has been argued that its sole purpose is to cover up excessive police violence because it is mainly used to explain deaths of individuals in custody. In this paper, we examine the epistemic conditions giving rise to the controversial diagnosis by discussing the relation between causal hypotheses, evidence, and data in forensic medicine. We argue that the practitioners’ (...) social context affects causal inquiry through background assumptions that enter inquiry at multiple stages. This analysis serves to better understand the wide usage of the controversial diagnosis of ExDS. (shrink)

Workers in the garment manufacturing industry are often subjected to violations of their rights and are exposed to low wages and difficult working conditions. In response to the exposure of these violations in the media, major fashion brands and retailers subject their suppliers to labour codes of conduct. Despite these codes of conduct being largely ineffective, this comparative case study of garment manufacturers operating from Lesotho and Eswatini illustrates that such codes provide workers and trade unions with access to bargaining (...) leverage that they would otherwise not have. A framework with a synthesis of potential sources of workers’ power is developed and related to global production networks, collective mobilisation, the nature of the state, as well as national and transnational scales of organising. Based on historical case studies of the two countries, this paper illustrates how unions in the two countries followed different approaches to using this source of power in relation to other sources of power. These approaches were shaped by their contexts and strategic choices. Theoretically, it is argued that sources of workers’ power are analytically distinct, but are relational and operate best when seen as mutually reinforcing. The term ‘power resource nexus’ is used to frame this potential mutual reinforcement of sources of power. (shrink)

Family disputes over the diagnosis of brain death have caused much controversy in the bioethics literature over the conceptual validity of the brain death standard. Given the tenuous status of brain death as death, it is pragmatically fruitful to reframe intractable debates about the metaphysical nature of brain death as metalinguistic disputes about its conceptual deployment. This new framework leaves the metaphysical debate open and brings into focus the social functions that are served by deploying the concept of brain death. (...) In doing so, it highlights the epistemic injustice of medicolegal authorities that force people to uniformly accept brain death as a diagnosis of death based on normative considerations of institutional interests, such as saving hospital resources and organ supplies, rather than empirical evidence of brain death as death, which is insufficient at best and nonexistent at worst. In light of this injustice, I propose the rejection of the uniform standard of brain death in favor of a choice-based system that respects families’ individualized views of death. (shrink)

Pecuniary externalities—costs imposed on third parties mediated through the price system—have typically received little philosophical attention. Recently, this has begun to change. In two separate papers, Richard Endörfer (Econ Philos 38, pp. 221–241, 2022) and Hayden Wilkinson (Philos Public Affairs 50: 202–238, 2022) place pecuniary externalities at center stage. Though their arguments differ significantly, both conclude pecuniary externalities are in some sense morally problematic. If the state is not called on to regulate pecuniary externalities, then, at the very least, individuals (...) should be conscious of how their productive and consumptive decisions affect others by changing prices. We disagree. Both arguments fail, in that neither gives us reason to think pecuniary externalities are cause for moral concern. Unless a new argument emerges, pecuniary externalities should be left alone. (shrink)

Despite numerous chief executive officers (CEOs) citing their religious convictions as the primary guiding framework for their decision-making, leadership behavior, business philosophy, and motivation to contribute to society, the impact of CEOs’ religious convictions is relatively limited in the business literature. However, the widespread yet potentially ambiguous impact of CEO religiosity, encompassing both a CEO’s religious denomination and level of religiosity, on individual, organizational, economical, and societal levels remains a neglected area of research. This gap is attributed to challenges in (...) conceptualizing and measuring this multifaceted construct, with existing research scattered and predominantly confined to the ethics domain. Notably, this oversight is significant given the pivotal role that CEOs, as primary decision-makers, play in organizational dynamics. This article aims to address this gap by conducting a systematic literature review of 50 articles focused on CEO religiosity, seeking to enhance the understanding of personal religion in the business world. Through an analysis of publication trends, methodological approaches, theoretical frameworks, and empirical findings, the review not only offers insights for future research and theorizing but also proposes a conceptual framework for understanding and advancing CEO religiosity research. Additionally, this review identifies specific areas warranting further investigation, thereby highlighting existing research gaps and providing explicit starting points for future research. Through these contributions, this article provides a blueprint for future research on CEO religiosity and holds significant implications for management practice. (shrink)

In a time of increasing polarization, how can we address sensitive topics and ensure that university classrooms remain places of healthy discussions and ethical deliberations? This paper addresses this important question by drawing on unique qualitative data from our students’ accounts of their experience in an organizational ethics course. We developed the course using a novel pedagogical strategy centered around the creation of an artistic portfolio. We find that student engagement in an alternative individual space, such as the artistic portfolio, (...) supports them in developing (inter)personal skills in preparation for constructive participation in sensitive discussions and ethical deliberation in the classroom. Additionally, engagement with the artistic portfolio provides them with an alternative means for alleviating tension that arises from these discussions and a space for expressing their opinions. Our findings highlight the role of the portfolio as an individual safe haven that supports teachers in facilitating a positive classroom atmosphere and guides students through challenging discussions and deliberations intrinsic to responsible management education. Considering these new insights, we advocate for a shift from a collective to an individual perspective on safety in academia. This transition liberates the classroom from the constraints and limitations often associated with the establishment of collective safe spaces. (shrink)

In Sahan et al ’s article,1 they present the ethical challenges faced by clinical laboratory scientists in genetic medicine, including labour allocation and responsibility, interpretation and accuracy of results with new technologies, and the need for better standardisation and ethical consistency. At the same time, they also propose a potential solution to the aforementioned challenges: ethical preparedness(EP). Along with their vivid case discussions and insightful analysis, I would like to propose two more points that are worth further examination and discussion (...) to aid stakeholders in better comprehending the ethical issues that clinical laboratory scientists face in the practice of genetic medicine. The case 1 reported by Sahan et al raises concerns about who should be responsible for tracking families or individuals with genetic results, particularly in the absence of mainstream services to track future risks. However, this should not be a factor influencing the decision to inform gene carriers. If there is a clear division of responsibilities in current practice, clinical laboratory scientists can report detected gene carriers without psychological burden. However, the decision to report gene carriers should be based on who is being served when clinical laboratory scientists face genetic problems in clinical practice and who is being considered when …. (shrink)

Owing to technological advances, genomic medicine is moving from specific to broader genetic analyses and from specialised to mainstream services. Sahan et al 1 point to complex ethical cases encountered by clinical laboratory scientists in the context of genomic medicine’s expansion. The authors discuss debates on interpreting and reporting genetic results, offering extended genetic testing and differences in the perceived responsibility of clinical laboratory scientists in different settings. As demonstrated by the case examples in the article, while genomic medicine holds (...) the promise of providing clinical answers, its mainstreaming can introduce a new type of ‘odyssey’ for patients and/or relatives, such as when there are uncertain findings. The integration of genomics in healthcare at large can also impact communication decisions and perceptions of responsibility for clinical laboratory scientists. Clinical laboratory scientists might report less to non-specialists than to genetic/genomic specialists, as they feel responsible for minimising the potential of non-specialists misunderstanding, misinterpreting or miscommunicating the genetic findings to patients.1 In this way, the perceived responsibility affects patients and the type and amount of genetic information they receive. We agree with the authors that current limitations in knowledge and capabilities among non-specialist clinicians necessitate identifying effective ways to communicate outcomes and …. (shrink)

Citing corporate concentration and lax enforcement since the Reagan era, the Biden administration has declared a new era of aggressive antitrust prosecution, bringing antimonopoly actions against tech giants such as Meta, Google, and Amazon. But what’s so bad about monopoly or corporate concentration? The standard answer appeals to economic consequences, such as higher prices or deadweight losses. This paper offers a different framework. It argues monopolizing can be a form of cheating, which is a wrong that attaches to means, not (...) just ends; an athlete who cheats but loses still does wrong. In particular, this paper argues that certain market-controlling strategies constitute a form of cheating I call ‘structural cheating,’ best illustrated by the metaphor of creating an unlevel playing field: rather than compete fairly on merits such as product quality and price, a firm that acquires rivals biases the market in its favor, thereby entrenching a dominant position that effectively forces would-be competitors to compete uphill. By framing (alleged) antitrust violations as cheating, while using the FTC’s lawsuit against Facebook (now Meta) as a test case, this paper provides a needed corrective to those citing market success as evidence of merit or skill. A further upshot is the structural cheating account better explains the distinctively problematic features of social media market concentration than Heath’s Market Failures Approach. More generally, this paper provides a normative lens for analyzing fair market competition and shows why it’s not only winning or losing that counts in capitalism, but how one plays the game. (shrink)

Savulescu and Cameron supported selectively locking down the elderly during the COVID-19 pandemic on two grounds: first, that preserving total lockdown would entail levelling down and, second, that levelling down is wrong. Their first assumption has been thoroughly addressed, but more can be said about their wider antiegalitarian point that levelling down is simply wrong. Egalitarians are not defenceless against the levelling-down objection. Even though some consider it the most serious challenge to supporters of equality, egalitarianism possesses sound reasons to (...) assert, not only that something valuable is preserved when we level down, but also that preserving it may be, in certain circumstances, preferable to pursuing other fundamental moral goals. Although troublesome from a well-being maximising standpoint, levelling down ensures that healthcare policy reflects a commitment with the idea that people are equal in moral worth. That commitment is important enough to trump certain improvements in individual well-being. In the case of pandemic lockdowns, not all the interests protected by free movement are as fundamental as to pursue them at the cost of equality. Savulescu and Cameron’s framework is so reliant on the view that levelling down is wrong that it fails to account for the valuable loss that having the elderly suffer alone represents. (shrink)

Seeking to better understand how nonprofit organizations (NPOs) manage hybridity, we investigated what distinguishes NPOs that combine multiple logics in productive and unproductive ways. We collected and analyzed data from six case studies of NPOs delivering social services in Australia. Our findings reveal that organizational members of NPOs take a _perspective_ on their hybrid nature which comprises four elements: motivational framing, actor engagement, resourcing attitude, and governance orientation. NPOs that combine multiple logics in productive and unproductive ways, respectively, are distinguished (...) by (1) a compelling or confused motivational framing for combining logics; (2) actors having active and shared, or passive and isolated, engagement with multiple logics; (3) attitudes toward resourcing multiple logics that are either coherent or competitive; and (4) a governance orientation toward multiple logics as opportunities to leverage or problems to resist. Our findings contribute to the literature by deepening understanding of the interplay between complex constellations of multiple logics in NPOs, including religious and professional logics. We also develop a model of organizational perspectives on hybridity and their implications for distinguishing NPOs that productively harness tensions between logics. (shrink)

This study provides comprehensive evidence on the link between boardroom diversity and reduction of carbon emissions. Analyzing data from a sample of 344 UK-listed non-financial and unregulated firms over the period from 2005 to 2021, our findings indicate that task-oriented (i.e., tenure) and structural (i.e., insider/outsider) board diversity are important for reducing corporate carbon emissions while relational diversity does not appear to be useful. Furthermore, the study explores the role of external carbon governance, such as the Paris Agreement, on firms (...) with weaker internal governance structures. The findings reveal that external governance plays a critical role in curbing emissions when internal governance is not effective. Overall, our research offers valuable insights for management and regulatory bodies on the interplay between various governance mechanisms internal and external to a firm. This knowledge could guide them in determining the right mix and degree of diversity in the boardroom to achieve environmental goals. (shrink)

This study investigates the influence of old directors on corporate social responsibility (CSR) using roughly 25,000 firm-year observations from 2001 to 2015 in the United States. We employ the widely used selection, optimization, and compensation (SOC) model from psychology to explain the CSR decisions of old directors. Our results indicate that firms with a higher percentage of old directors tend to have lower engagement in CSR activities. To address endogeneity, we adopt the difference-in-differences method and use the event of sudden (...) deaths and unexpected retirements of old directors and find that our results remain robust. Our analysis also reveals that the negative impact of old directors on CSR is more significant in firms where directors receive fewer reputational spillover benefits from CSR initiatives and/or firms exhibiting poor corporate governance. In addition, this adverse impact of old directors comes from two effects: a reduction in efforts to enhance CSR strengths and an increase in inaction to address CSR concerns. Overall, these findings suggest that the CSR decision-making process of old directors involves assessing the costs and benefits of CSR engagements, consistent with our hypothesis derived from the SOC model. (shrink)

This manuscript explores the argument for lower student-to-school counselor ratios in U.S. public education. Drawing upon a comprehensive historical review and existing research, we establish the integral role of school counselors and the notable benefits of reduced student-to-counselor ratios. Our analysis of national data exposes marked disparities across states and districts, with the most underfunded often serving higher percentages of low-income students and students of color. This situation raises significant ethical concerns, prompting a call for conscientious policy reform and targeted (...) investment. Informed by emerging best practices, we propose recommendations for enhancing counselor staffing and ultimately student outcomes. This ethical argument underscores the need for proactive actions and provides a basis for future research to further delineate the impact of school counselor ratios on educational equity and student success. (shrink)

Discussions of why corporations should cultivate a diverse workforce emphasize justice- and profit-based reasons. This paper defends a distinct third rationale of legitimacy-based reasons for diversity. I articulate and defend the _market power account_ of firm legitimacy, which holds that private firms, much like governmental institutions, have a moral obligation to justify the power they exercise over stakeholder groups when those groups lack meaningful rights of exit from their relationship with the firm. Firms can discharge this obligation by incorporating _moral (...) diversity_ into managerial teams that decide company policy. Moral diversity confers both epistemic and moral advantages onto teams tasked with solving complex problems that impact disparate stakeholder groups. These advantages confer proceduralist legitimacy onto implemented policies, giving impacted groups reason to accept those policies, even when those groups find those policies objectionable on other grounds. (shrink)

Background Clinical empathy is an essential part of healthcare, and patient-centered care models require clinical empathy to be established. Despite this, little is known about its measurement in the neonatal scenario. Research Aim To measure clinical empathy in health professionals who work with medium and high-risk neonates and build a construct of this empathy. Research Design Single-center survey study. Participants and Research Context The Jefferson Scale of Empathy for Health Professionals questionnaire was applied to health professionals who work in an (...) intensive care unit and a medium-risk unit, in Brazil. Analysis was done using descriptive statistics and a factor analysis model, to build the construct of empathy. Overall empathy was calculated, and the domains’ punctuations were analyzed and compared to the maximum punctuation possible. The study followed the STROBE checklist. Ethical Considerations This study was approved by the Research Ethics Committee of the institution. All participants signed the informed consent form. Participants’ confidentiality and anonymity were protected. Findings Median empathy was 117 (IQR 113–124). The domain of Walking in the Patient’s Shoes had lower scores and represented 77.6% of the maximum punctuation possible. The factor analysis included three factors named Understanding, Experiences, and Treatment, and Emotional Relationships, explaining 64.3% of the overall variance. The domain Walking in the Patient’s Shoes was not included in the model. Conclusions In this scenario, clinical empathy should improve. There is a need to improve the domain of Walking in the Patient’s Shoes, in this case, the neonate, and provide more empathic care to them. (shrink)

This study investigates how abnormally hot temperatures affect firms’ environmental behaviors in China. We find that firms exposed to abnormally hot temperatures participate in more environmental engagement. We also find that this improvement effect is driven mainly by environmental concerns, including public concerns, CEOs, and governments. Our results remain intact after an array of robustness tests. Further analysis shows that the effect of abnormally hot temperatures on corporate environmental engagement is more pronounced in SOEs, heavily polluting firms, and firms located (...) closer to local environmental protection agencies. Based on the political pressure channel, our results indicate that the improvement effect is more prominent in politically connected firms, cities where local officials can wield more influence, local governments have larger financial slack, and local governments disclose their environmental targets. Moreover, the positive impact of environmental engagement on firm value is stronger when firms are exposed to abnormally hot temperatures. Overall, this study sheds light on the potential stimulation of firms’ environmental actions by global warming, which is yet to be fully understood. (shrink)

The proposal to allow assisted dying for people who are not severely ill reignited the Dutch end‐of‐life debate when it was submitted in 2016. A key criticism of this proposal is that it is too radical a departure from the safe and well‐functioning system the Netherlands already has. The goal of this article is to respond to this criticism and question whether the Dutch system really can be described as safe and well functioning. I will reconsider the usefulness of the (...) suffering criterion, and I will ultimately argue this criterion should be rejected altogether. Instead, we should consider moving towards an autonomy‐only approach to assisted dying. This would resolve some significant issues occurring under the current system of assisted dying in the Netherlands and ultimately make the process safer and better functioning. I will then consider some possible objections to adopting an autonomy‐only approach and provide some preliminary responses to these also. I will finally highlight some potential areas where further research may be necessary, namely, how to mitigate the effect of external factors such as poverty or other life aspects that may have the potential to distort the individual's ability to make autonomous decisions. I will also consider some possible international lessons that can be taken from both current as well as the proposed practice in the Netherlands. (shrink)

Reporting peers’ counterproductive work behaviors (CWBs) is important for maintaining an ethical organization, but is a significant and potentially risky action. In Bandura’s Theory of Moral Thought and Action (Bandura, 1991) he states that such acts require significant moral agency, which is generated when an individual possesses adequate moral self-regulatory capacities to address the issue and is in a context that activates and reinforces those capacities. Guided by this theory, we assess moral potency (i.e., moral courage, moral efficacy, and moral (...) ownership) as key capacities predicting peer reporting intentions and assess three contextual factors influencing the generation and effects of moral potency: whether a potential informant (1) works for an ethical leader, (2) is embedded in a psychologically safe climate promoting interpersonal risk-taking, and (3) operates in a more normal or extreme context. We assess the proposed model across three field studies entailing both normal and extreme (i.e., firefighting units) contexts. Results show that ethical leaders raise employees’ moral potency, promoting greater willingness to report their peers’ CWBs. In normal work contexts, psychological safety positively moderated both the relationship between ethical leadership and moral potency and between moral potency and peer reporting intentions. However, psychological safety had the opposite effects in more extreme work contexts. Whereas psychological safety strengthens the positive association between moral potency and peer reporting intentions in normal work contexts, in contexts where individuals are more frequently exposed to extreme events, psychological safety weakens this relationship, thus highlighting the unforeseen downsides of psychological safety in extreme contexts. (shrink)

The proliferation of violations within industry sectors (e.g., banking, doping in sport, abuse in religious organizations) highlights how trust violations can thrive in particular sectors. However, scant research examines how macro institutional factors influence micro level trustworthy conduct. To shed light on how sectoral features may influence trust violations in organizations, we adopt a multilevel perspective to investigate the perceived causes of trust violations within the not-for-profit (NFP) sector, a sector that has witnessed a number of high-profile trust breaches. Drawing (...) on interviews with board members and senior executives of NFPs with cross-sectoral experience, we analyze the causes of trust violations to inductively develop a conceptual model of the multilevel factors contributing to trust violations in NFPs. Our model highlights how trust violations have their roots in sectoral-level factors, which trickle-down to influence the ethical infrastructure at the organizational-level, and in turn individual-level factors and violations. We identify how three NFP sectoral features influence trustworthy behavior: corporatization, resource scarcity, and assumed moral integrity. Our findings speak to the importance of looking beyond the organization to understand both the causes and prevention of trust violations and developing the concept of sector-level ethical infrastructure. (shrink)