M. Laura Gemelli Marciano ist Titularprofessorin für Klassische Philologie an der Universität Zürich.

M. Laura Gemelli Marciano ist Titularprofessorin für Klassische Philologie an der Universität Zürich.

M. Laura Gemelli Marciano ist Titularprofessorin für Klassische Philologie an der Universität Zürich.

M. Laura Gemelli Marciano ist Titularprofessorin für Klassische Philologie an der Universität Zürich.

Questo volume, curato da Livio Rossetti e Massimo Pulpito, raccoglie le lezioni su Parmenide e Zenone di Elea tenute da M. Laura Gemelli Marciano (d’ora in poi GM) durante il convegno “Eleatica 2007” (Ascea Marina, 29 novembre - 2 dicembre 2007). Tali lezioni si presentano come la sintesi degli studi che GM ha condotto negli ultimi decenni sui Presocratici, in particolare dei suoi tentativi di emanciparli definitivamente dalla geschichtliche Entwicklung in cui Eduard Zeller li aveva inquadrat...

L’article prend en considération la façon dont différents auteurs rassemblés sous l’étiquette générale de « présocratiques » commençaient leurs discours. Dans le contexte d’une transmission essentiellement orale tel que celui de la culture de la Grèce archaïque, l’incipit prend une importance fondamentale, dans la mesure où il pose les bases de la communication, définit le type de message que l’auteur veut transmettre et indique dans quelle voie il s’engage. Il donne donc des indications non seulement sur le type de texte, (...) mais aussi sur le genre de public auquel ce texte était adressé. S’il s’agit d’un public restreint et choisi, l’incipit est généralement élitiste, obscur, et fait référence à un code auquel il est difficile d’accéder ou, comme dans le cas de l’écrit d’Alcméon, mise sur la difficulté d’une entreprise que les disciples doivent surmonter à l’aide de l’enseignement du maître. Si le texte est destiné à un public plus large d’amateurs cultivés, il mise sur des phrases ronflantes qui suscitent des visions grandioses et des émotions et placent l’orateur dans une position dominante vis-à-vis de l’auditoire. Ici on prend en considération en particulier les incipit de quatre auteurs assez différents les uns des autres, de la fin du vie au dernier tiers du ve siècle av. J.‑C. : Héraclite, Alcméon, Anaxagore et Diogène d’Apollonie. En recourant à l’analyse linguistique et en les confrontant avec d’autres textes de même époque, on cherche à définir la particularité de chaque texte en relation avec le message qu’il véhicule et avec ses destinataires. Les résultats de cette analyse invitent à reconsidérer la méthode à employer pour aborder les fragments des auteurs dits présocratiques et à se libérer du modèle herméneutique « anthologique » d’Aristote qui vise à rechercher un « système » philosophique et néglige le rythme prosodique, l’harmonie de la langue, le caractère persuasif des textes et leur contexte culturel. (shrink)

Classical models of decision making deal fairly well with uncertainty, where settings are well-structured in terms of goals, alternatives, and consequences. Conversely, the typical ill-structured nature of strategy choices remains a challenge for extant models. Such cases can hardly build on the past, and their novelty makes the prediction of consequences a very difficult and poorly robust task. The weakness of the classical expected utility model in representing such problems has not been adequately solved by recent extensions. In this paper (...) we offer an explanatory coherence model for decision making in ill-structured problems. We model alternatives as sets of concurrent causal explanations of reality that act as justifications for action. According to these premises, choice is based on an evaluation of the internal coherence and the consistency of competing explanations of the available evidence. This model is psychologically grounded on causal inference and builds on the connectionist tradition of explanatory coherence. To illustrate the model, we consider the decision of investing in a new technology and we discuss how changes in the structure of alternatives may impact on the solution. We show how the final choice depends on collecting the relevant evidence, making the suitable hypotheses, and drawing the consistent causal explanations linking the two. (shrink)

We discuss the concepts of Weyl and Riemann frames in the context of metric theories of gravity and state the fact that they are completely equivalent as far as geodesic motion is concerned. We apply this result to conformally flat spacetimes and show that a new picture arises when a Riemannian spacetime is taken by means of geometrical gauge transformations into a Minkowskian flat spacetime. We find out that in the Weyl frame gravity is described by a scalar field. We (...) give some examples of how conformally flat spacetime configurations look when viewed from the standpoint of a Weyl frame. We show that in the non-relativistic and weak field regime the Weyl scalar field may be identified with the Newtonian gravitational potential. We suggest an equation for the scalar field by varying the Einstein-Hilbert action restricted to the class of conformally-flat spacetimes. We revisit Einstein and Fokker’s interpretation of Nordström scalar gravity theory and draw an analogy between this approach and the Weyl gauge formalism. We briefly take a look at two-dimensional gravity as viewed in the Weyl frame and address the question of quantizing a conformally flat spacetime by going to the Weyl frame. (shrink)

Over the last decade, Corporate Social Responsibility (CSR) has been defined first as a concept whereby companies decide voluntarily to contribute to a better society and cleaner environment and, second, as a process by which companies manage their relationship␣with stakeholders (European Commission, 2001. Nowadays, CSR has become a priority issue on governments’ agendas. This has changed governments’ capacity to act and impact on social and environmental issues in their relationship with companies, but has also affected the framework in which CSR (...) public policies are designed: governments are incorporating multi-stakeholder strategies. This article analyzes the CSR public policies in European advanced democracies, and more specifically the EU-15 countries, and provides explanatory keys on how governments have understood, designed and implemented their CSR public policies. The analysis has entailed the classification of CSR public policies taking into consideration the actor to which the governments’ policies were addressed. This approach to the analysis of CSR public policies in the EU-15 countries leads us to observe coinciding lines of action among the different countries analyzed, which has enabled us to propose a ‹four ideal’ typology model for governmental action on CSR in Europe: Partnership, Business in the Community, Sustainability, and Citizenship, and Agora. The main contribution of this article is to propose an analytical framework to analyze CSR public policies, which provide a perspective on the relationships between governments, businesses, and civil society stakeholders, and enable us to incorporate the analysis of CSR public policies into a broader approach focused on social governance. (shrink)

The aim of this article is to contribute to understanding the changing role of government in promoting corporate social responsibility (CSR). Over the last decade, governments have joined other stakeholders in assuming a relevant role as drivers of CSR, working together with intergovernmental organizations and recognizing that public policies are key in encouraging a greater sense of CSR. This paper focuses on the analysis of the new strategies adopted by governments in order to promote, and encourage businesses to adopt, CSR (...) values and strategies. The research is based on the analysis of an explanatory framework, related to the development of a relational analytical framework, which tries to analyze the vision, values, strategies and roles adopted by governments, and the integration of new partnerships that governments establish in the CSR area with the private sector and social organizations. The research compares CSR initiatives and public policies in three European countries: Italy, Norway and the United Kingdom, and focuses on governmental drivers and responses. The preliminary results demonstrate that governments are incorporating a common statement and discourse on CSR, working in partnership with the private and social sectors. For governments, CSR implies the need to manage a complex set of relationships in order to develop a win–win situation between business and social organizations. However, the research also focuses on the differences between the three governments when applying CSR public policies. These divergences are based on the previous cultural and political framework, such as the welfare state typology, the organizational structures and the business and social and cultural background in each country. (shrink)

Instant messaging is a highly diffused form of communication among younger populations, yet little is known about the emotional experience during IM. The present study aimed to investigate the emotional experience during IM by drawing on the Circumplex Model of Affect and measuring heart rate and electrodermal activity as indicators of arousal in addition to self-reported perceived emotional valence. Using an experimental design, we manipulated message latency and message valence. Based on data collected from 65 young adults, we observed arousal (...) as participants’ electrodermal activity levels increased from the time a fictitious peer started typing a response to the receipt of that response, especially in the delayed condition. Electrodermal activity levels also increased in both the positive and the negative message conditions. No changes were observed for heart rate. Participants’ self-report perceived emotional valence revealed that positive messages were evaluated as more pleasant and the peer as more available, while no difference in the self-report was found for message latency. These findings shed light on the emotional experience during IM by adding valuable insights on the physiological processes underlying the anticipation of social reward, but only during delayed IM exchange that can be observed in Human–Computer-Interaction. (shrink)

Data documenting poor understanding among research participants and real-time efforts to assess comprehension in large-scale studies are focusing new attention on informed consent comprehension. Within the context of biobanking consent, we previously convened a multidisciplinary panel to reach consensus about what information must be understood for a prospective participant’s consent to be considered valid. Subsequently, we presented them with data from another study showing that many U.S. adults would fail to comprehend the information the panel had deemed essential. When asked (...) to evaluate the importance of the information again, panelists’ opinions shifted dramatically in the direction of requiring that less information be understood. Follow-up interviews indicated significant uncertainty about defining a threshold of understanding and what should happen when prospective participants are unable to grasp key information. These findings have important implications for urgently needed discussion of whether... (shrink)

The informed consent process for genetic testing does not commonly address preferences regarding disclosure of results in the event of the patient's death. Adults being tested for familial colorectal cancer were asked whether they want their exome sequencing results disclosed to another person in the event of their death prior to receiving the results. Of 78 participants, 92% designated an individual and 8% declined to. Further research will help refine practices for informed consent.

Book reviewed in this article: Feminist Ethics. Ed. Claudia Card.

The aim of this article is to contribute to understanding the changing role of government in promoting corporate social responsibility (CSR). Over the last decade, governments have joined other stakeholders in assuming a relevant role as drivers of CSR, working together with intergovernmental organizations and recognizing that public policies are key in encouraging a greater sense of CSR. This paper focuses on the analysis of the new strategies adopted by governments in order to promote, and encourage businesses to adopt, CSR (...) values and strategies. The research is based on the analysis of an explanatory framework, related to the development of a relational analytical framework, which tries to analyze the vision, values, strategies and roles adopted by governments, and the integration of new partnerships that governments establish in the CSR area with the private sector and social organizations. The research compares CSR initiatives and public policies in three European countries: Italy, Norway and the United Kingdom, and focuses on governmental drivers and responses. The preliminary results demonstrate that governments are incorporating a common statement and discourse on CSR, working in partnership with the private and social sectors. For governments, CSR implies the need to manage a complex set of relationships in order to develop a win–win situation between business and social organizations. However, the research also focuses on the differences between the three governments when applying CSR public policies. These divergences are based on the previous cultural and political framework, such as the welfare state typology, the organizational structures and the business and social and cultural background in each country. (shrink)

This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics—autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician–patient relationship is a deontological construct in which the physician’s primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. (...) During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic. (shrink)

Moral disengagement is the process by which individuals mitigate the consequences of their own violations of moral standards. Although MD is understood to be co-determined by culture norms, no study has yet explored the extent to which MD applied to safety at work fosters safety violations, nor the role of organizational culture as a predictor of JS-MD. The current study seeks to address this gap in the literature by examining individual- and organizational-level factors that explain why employees fail to report (...) workplace accidents. We tested a latent variable structural model positing organizational culture typologies as predictors of JS-MD, which in turn is expected to mediate the relationship with accident underreporting. Using data from 1033 employees in 28 Italian organizations, findings suggest that bureaucratic safety culture was related to lower levels of JS-MD, whereas technocratic safety culture was related to greater JS-MD. In turn, JS-MD positively predicted employee accident underreporting and fully mediated the relationship between culture and underreporting. Theoretical and practical implications are discussed in light of the increasing focus on underreporting as well as the adverse individual and organizational consequences of failing to report workplace accidents. (shrink)

Aristotle's Topics is a handbook for dialectic, which can be understood as a philosophical debate between a questioner and a respondent. In book 2, Aristotle mainly develops strategies for making deductions about 'accidents', which are properties that might or might not belong to a subject (for instance, Socrates has five fingers, but might have had six), and about properties that simply belong to a subject without further specification. In the present commentary, here translated into English for the first time, Alexander (...) develops a careful study of Aristotle's text. He preserves objections and replies from other philosophers whose work is now lost, such as the Stoics. He also offers an invaluable picture of the tradition of Aristotelian logic down to his time, including innovative attempts to unify Aristotle's guidance for dialectic with his general theory of deductive argument (the syllogism), found in the Analytics. The work will be of interest not only for its perspective on ancient logic, rhetoric, and debate, but also for its continuing influence on argument in the Middle Ages and later. (shrink)

We have previously found that attention to internal somatic sensations during a heart beat perception task increases the misperception of external touch on a somatic signal detection task , during which healthy participants erroneously report feeling near-threshold vibrations presented to their fingertip in the absence of a stimulus. However, it has been suggested that mindful interoceptive attention should result in more accurate somatic perception, due to its non-evaluative and controlled nature. To investigate this possibility, 62 participants completed the SSDT before (...) and after a period of brief body-scan mindfulness meditation training, or a control intervention . The meditation intervention reduced tactile misperception and increased sensitivity during the SSDT. This finding suggests that the perceptual effects of interoceptive attention depend on its particular nature, and raises the possibility that body-scan meditation could reduce the misperception of physical symptoms in individuals with medically unexplained symptoms. (shrink)

Feminist criticism of health care and ofbioethics has become increasingly rich andsophisticated in the last years of thetwentieth century. Nonetheless, this body ofwork remains quite marginalized. I believe thatthere are (at least) two reasons for this.First, many people are still confused aboutfeminism. Second, many people are unconvincedthat significant sexism still exists and aretherefore unreceptive to arguments that itshould be remedied if there is no largerbenefit. In this essay I argue for a thin,``core'' conception of feminism that is easy tounderstand and (...) difficult to reject. Corefeminism would render debate within feminismmore fruitful, clear the way for appropriaterecognition of differences among women andtheir circumstances, provide intellectuallycompelling reasons for current non-feminists toadopt a feminist outlook, and facilitatemutually beneficial cooperation betweenfeminism and other progressive socialmovements. This conception of feminism alsomakes it clear that feminism is part of alarger egalitarian moral and political agenda,and adopting it would help bioethics focus onthe most urgent moral priorities. In addition,integrating core feminism into bioethics wouldopen a gateway to the more speculative parts offeminist work where a wealth of creativethinking is occurring. Engaging with thisfeminist work would challenge and strengthenmainstream approaches; it should also motivatemainstream bioethicists to explore othercurrently marginalized parts of bioethics. (shrink)

In qualitative interviews with a diverse group of experts, the vast majority believed unregulated researchers should seek out independent oversight. Reasons included the need for objectivity, protecting app users from research risks, and consistency in standards for the ethical conduct of research. Concerns included burdening minimal risk research and limitations in current systems of oversight. Literature and analysis supports the use of IRBs even when not required by regulations, and the need for evidence-based improvements in IRB processes.

Messaging from U.S. authorities about COVID-19 has been widely divergent. This research aims to clarify popular perceptions of the COVID-19 threat and its effects on victims. In four studies with over 4,100 U.S. participants, we consistently found that people perceive the threat of COVID-19 to be substantially greater than that of several other causes of death to which it has recently been compared, including the seasonal flu and automobile accidents. Participants were less willing to help COVID-19 victims, who they considered (...) riskier to help, more contaminated, and more responsible for their condition. Additionally, politics and demographic factors predicted attitudes about victims of COVID-19 above and beyond moral values; whereas attitudes about the other kinds of victims were primarily predicted by moral values. The results indicate that people perceive COVID-19 as an exceptionally severe disease threat, and despite prosocial inclinations, do not feel safe offering assistance to COVID-19 sufferers. This research has urgent applied significance: the findings are relevant to public health efforts and related marketing campaigns working to address extended damage to society and the economy from the pandemic. In particular, efforts to educate the public about the health impacts of COVID-19, encourage compliance with testing protocols and contact tracing, and support safe, prosocial decision-making and risk assessment, will all benefit from awareness of these findings. The results also suggest approaches, such as engaging people's stable values rather than their politicized perspectives on COVID-19, that may reduce stigma and promote cooperation in response to pandemic threats. (shrink)

The woman at the heart of Pearl Jam’s “Better Man” (Vitalogy, 1994) is trapped. She has committed herself to a relationship that makes her miserable, but she sees no viable alternative to staying in it. She mourns a past self who might have been able to leave and dreams of a dierent way things might be, but remains unable to move on. It is tempting to view her with a mixture of pity and frustration (reecting some of the personal circumstances (...) -- Eddie Vedder’s mother’s second marriage -- informing its composition). As a moral being, she appears to be hopelessly compromised by her situation, even as she is also doing her best to survive under conditions designed to undermine her autonomy and keep her trapped (as abusive relationships do). The song is not so much critical of her choice to stay as it is confused by and resigned to it. -/- What keeps a person where she so clearly does not want to be? -/- The song itself was, at least early in its recorded life for Pearl Jam, similarly compromised. Vedder appears to have thought of it as too “accessible”, too much of a pop hit for the kind of musical vision he had in mind either for Vs. (for which it had originally been intended) or for Vitalogy; by this point in the band’s career, he was ever more actively resisting success, accessibility, and everything that went with the version of rock star life imposed collectively on the band and on him as an individual. The form that resistance took was an exercise of artistic and other forms of control, sometimes exercised in ways that were destructive or damaging (to the band and its internal relationships, its fame or success, its image, its artistic identity, etc.). -/- What keeps an artist or a band where they so clearly do not want to be? In this chapter, I oer a loose exploration of some possible philosophical approaches to answering the question of what keeps us where we are, like it or not, worked out in parallel through the lyrics of “Better Man” and the circumstances of the song’s eventual arrival Vitalogy. My main interest is in examining the ethical dimensions of the question itself -- what, if anything, are we morally required or expected to do under compromised or compromising conditions? My main suggestion is that answering the question might require of us a messier, more ambivalent, and perhaps more compassionate notion of moral agency, inspired by Simone Weil’s work on affliction. (shrink)

An audiovisual correspondence (AVC) refers to an observer’s seemingly arbitrary yet consistent matching of sensory features across the two modalities; for example, between an auditory pitch and visual size. Research on AVCs has frequently used a speeded classification procedure in which participants are asked to rapidly classify an image when it is either accompanied by a congruent or an incongruent sound (or vice versa). When, as is typically the case, classification is faster in the presence of a congruent stimulus, researchers (...) have inferred that the AVC is automatic and bottom-up. Such an inference is incomplete because the procedure does not show that the AVC is not subject to top-down influences. To remedy this problem, we devised a procedure that allows us to assess the degree of “bottom-up-ness” and “top-down-ness” in the processing of an AVC. We did this in studies of AVCs between pitch and five visual features: size, height, spatial frequency, brightness, and angularity. We find that all the AVCs we studied involve both bottom-up and top-down processing, thus undermining the prevalent generalization that AVCs are automatic. (shrink)

This paper examines faculty perceptions regarding ethical behavior among colleagues and students, and faculty practices with regard to teaching ethics in three institutions over a 4-year period. Faculty reported an uneven pattern of unethical behavior among colleagues over the period. A majority of business courses included ethics, however as both a specific topic on the syllabus and within course discussions. The percentage of courses with ethics discussions increased in 2006, however, the time allocated to these discussions decreased. These results suggest (...) that faculty are approaching ethics instruction less formally, raising concerns over the success of curriculum integration. (shrink)

Health policymakers employ utility measures to inform resource allocation decisions. They often rely on a conceptual tool called the quality-adjusted life year that discounts the value of years lived in a state of disability relative to years lived in full health. A representative sample of the general public is asked to place values on hypothetical health states as part of a standard gamble or time trade-off task. Policymakers use the resulting values to calculate the number of QALYs gained through particular (...) interventions. Utilitarian reasoning mandates that policymakers maximize QALYs gained per unit cost.Although many scholars have explored the problems of distributive justice that arise from this system... (shrink)

Recruiting research participants based on genetic information generated about them in a prior study is a potentially powerful way to study the functional significance of human genetic variation, but it also presents ethical challenges. To inform policy development on this issue, we conducted a survey of U.S. institutional review board chairs concerning the acceptability of recontacting genetic research participants about additional research and their views on the disclosure of individual genetic results as part of recruitment. Our findings suggest there is (...) unlikely to be a “one-size-fits-all” solution, but rather several ethically acceptable approaches to genotype-driven recruitment, depending on context. Disclosures made during the consent process for the original study and the clinical validity of the results are key considerations. Researchers must be prepared to communicate and answer questions in clear lay language about what is known and not known regarding the role of genetics in their proposed area of research. (shrink)

As library collections and services have increasingly moved from print to digital, much of the work that used to be done by libraries themselves with regard to creating, maintaining, and managing the systems that hold collections and facilitate user access to them is now done primarily by vendors. This change to the information services landscape for academic libraries is the occasion not only of technical and procedural challenges, but also some internal conflicts concerning the ethical demands of the library profession. (...) This essay examines the ways in which these conflicts become acute and obvious when attention is paid to the way in which attempts to promote equity, diversity, and inclusion (EDI) are undermined by the handover of library services to vendors, even when—or perhaps especially when—those vendors use their control of content and platforms to commodify diverse content instead of making the necessary systemic changes required by truly effective EDI efforts. (shrink)

Ecological restoration and native landscaping are increasing, particularly in the American Midwest, where they form part of the area's history and culture of conservation. But practitioners rarely pause to ask philosophical questions related to categories of native and invasive or human control and harmony with nature. This article brings philosophy into conversation with practice, using members of Wild Ones Native Landscaping, a non-profit headquartered in Neenah, WI, as a case study. Philosophers and ethicists who are studying Ecological Restoration and Native (...) Landscaping can learn valuable lessons - in practicality, aesthetics and flexibility - from practitioners such as the Wild Ones. (shrink)

Climate engineering is subject to the “playing God” critique, which charges that humans should not undertake to control nature in ways that seem to overstep the proper scope of human agency. This argument is easily discredited, and in fact the opposite—that we should “play God”—may be equally valid in some circumstances. To revive the playing God critique, I argue that it functions not on a logical but on a symbolic and emotional level to highlight nostalgia for functional dualisms in the (...) face of the bewildering problem of climate change. It also raises significant questions about the virtue of those who might engineer the climate. These two concerns point to questions about the proper role of human agency. I use the scholarship of Aldo Leopold and H. Richard Niebuhr to argue for a model of human agency based on contextual awareness and responsive, communal responsibility. I conclude with some implications of this view for decision-makers engaging the topic of climate engineering. (shrink)

: This paper reviews current and suggested policies designed to increase organ donation in the United States and indicates the problems inherent to these approaches for increasing organ donation by African Americans. Data from a population-based study assessing attitudes and beliefs about organ donation among white and African-American respondents are presented and discussed. We pose the question of whether it is reasonable to maintain the existing system or whether we should institute a system that uses policies based on the attitudes (...) and beliefs of a minority group that is in greater need than the majority. In light of the discussion, we suggest that the current policies guiding the organ procurement system are not adequate to address existing concerns within the African-American community and that a different set of assumptions may be needed to drive organ procurement policy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation to (...) its patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the... (shrink)