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)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

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 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.

Despite their diversity, human languages share consistent properties and regularities. Wherefrom does this consistency arise? And does it tell us something about the problem that all languages need to solve? The authors provide an intriguing analyses which focuses on the “communicative function of ambiguity” whose resolution entailed an equally intriguing “speaker–listener cross‐entropy objective for measuring the efficiency of linguistic systems from first principles of efficient language use.”.

Emmanuel Levinas gave an account of radical, asymmetrical responsibility for the Other that is phenomenologically sensible in the proximity of face-to-face relation. This original arrangement, however, is not interminable. The approach of the third party equalizes and creates distance between self and Other by introducing ontology and epistemology. It is a necessary process of totalization that moves from a primordial ethics to justice and institutional fairness. However, Levinas was aware that the third party's presence brought with it a possible forgetting (...) of the Other and a covering over of radical ethics. In this presentation, we propose that the psychotherapeutic process represents a context that bears the proximal dimension described by Levinas while also representing an institution that is, in definition and purpose, totalizing. Furthermore, using a play on words that represents a significant issue in contemporary psychotherapeutic practice, we explore the common presence and impact of third-party payers on the therapeutic relationship, and how third-party payers are disingenuously a-proximal and constantly approximating; faceless and consequently effacing the patient's august dignity, causing a forgetfulness of the justice to which Levinas called institutions. Lastly, we suggest some strategies by which therapists may recover the never-absolved proximity to the Other in a profession susceptible to the a-proximal effects of third-party economics. 2012 APA, all rights reserved). (shrink)

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.

In lieu of an abstract, here is a brief excerpt of the content:Citizenship and Culture in Early Modern EuropePeter N. MillerCharlotte Wells, Law and Citizenship in Early Modern France (Baltimore: The Johns Hopkins University Press, 1995), xviii, 198p.Paula Findlen, Possessing Nature: Museums, Collecting, and Scientific Culture in Early Modern Italy (Berkeley, Los Angeles, and London: University of California Press, 1994), xviii, 449p.Steven Shapin, The Social History of Truth: Civility and Science in Seventeenth-Century England (Chicago and London: University of Chicago (...) Press, 1994), xxiv, 483p.Anne Goldgar, Impolite Learning: Conduct and Community in the Republic of Letters 1680–1775 (New Haven and London: Yale University Press, 1995), xv, 395p.Lawrence Klein, Shaftesbury and the Culture of Politeness: Moral Discourse and Cultural Politics in Early Eighteenth-Century England (Cambridge, U.K., 1994), xiii, 217p.Daniel Gordon, Citizens Without Sovereignty: Equality and Sociability in French Thought, 1670–1789 (Princeton: Princeton University Press, 1994), viii, 270p.Dena Goodman, The Republic of Letters: A Cultural History of the French Enlightenment (Ithaca and London: Cornell University Press, 1994), xiii, 338p.E. J. Hundert, The Enlightenment’s “Fable”: Bernard Mandeville and the Discovery of Society (Cambridge: Cambridge University Press, 1994), xii, 284p.The pre-modern political world was broken and remade in the two centuries that separate Montaigne from Jefferson. The long agony of the mixed constitution that began in the civil wars which raged in Iberia, France, the Low Countries, and England and seemed settled by the widespread adoption of the maxims of reason of state, revived at the end of the period, with revolution in Poland, Denmark, Sweden, Geneva, and, more famously, [End Page 725] British North America and France. The problem, classically, turned on the location of sovereignty, or supreme authority, in political systems designed to balance and diffuse rather than concentrate power. When budget deficits and fratricidal culture wars raised the cry of “necessity”—with the knowledge, of course, that necessity knew no law—estates and kings across Europe found themselves at daggers drawn. The claim that the ruler, who naturally was wholly committed to the common good, had therefore the ability to take emergency action was used both by those accustomed to rule and those newly attained to it by force. The pursuit of an “interest” that was identified with the nation’s effectively marginalized discussions of right and law while still serving an essentially constitutional, justificatory role in political debate. But if unchecked authority was necessary in order to meet the challenge of a world characterized by change and chance and thus had to reside somewhere, was there anything that made its exercise by one body more appropriate than another? This was the question that lay behind the late eighteenth-century repudiation of the reason of state “solution” to the problem of the mixed constitution. The answer, which clearly underpinned the establishment in fact of what had first been theorized already a century earlier, was that only consent could legitimate the exercise of sovereignty in time of necessity.1Representation, in one form or another, was the acknowledged solution to the problem formulated by Hobbes: “the name of Tyranny, signifieth nothing more, nor less, than the name of Sovereignty, be it in one, or many men, saving that they that use the former word are understood to be angry with them they call Tyrants.” But representation also acknowledged the reality behind the charged category of “citizenship”: most people in most places could not be said to live the life of the active citizen celebrated in Roman republican literature. Hence Hobbes’s attack on recourse to classical exempla in general, and the Libertas of Lucca in particular. The idea of civis as law-abiding subject was as radical a redrawing of the terms of debate as the identification of human nature with unsociability. Insofar as politics, classically, justified itself as the means for individual self-perfection, the practice of the ancient citizen could be conceived of as the practice of that best life speculated upon by philosophers. For the represented citizen, however, politics necessarily occupied a more subsidiary position. What, then, defined the best life to which he could aspire?There is no simple answer to this question, and the early modern ambivalence has persisted into our own time... (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 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)

“Public health legal preparedness” is a term born in the ferment, beginning in the late 1990s, that has led to unprecedented recognition of the essential role law plays in public health and, even more recently, in protecting the public from terrorism and other potentially catastrophic health threats.The initial articulation of public health has not kept pace with rapid evolution in the concept and in practical development of public health preparedness itself. This poses the risk that legal preparedness may fall behind (...) construction of general readiness in the public health system—and may, in fact, undercut achievement of comprehensive public health preparedness for massive threats to health in both the United States and world-wide. Inadvertent results might include both negative health impacts and infringement on individual rights. (shrink)

“Public health legal preparedness” is a term born in the ferment, beginning in the late 1990s, that has led to unprecedented recognition of the essential role law plays in public health and, even more recently, in protecting the public from terrorism and other potentially catastrophic health threats.The initial articulation of public health has not kept pace with rapid evolution in the concept and in practical development of public health preparedness itself. This poses the risk that legal preparedness may fall behind (...) construction of general readiness in the public health system—and may, in fact, undercut achievement of comprehensive public health preparedness for massive threats to health in both the United States and world-wide. Inadvertent results might include both negative health impacts and infringement on individual rights. (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".

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)

Mammalian neural cells contain at least two forms of brain spectrin: brain spectrin (240/235) which is located primarily in the axons and presynaptic terminals of neurons, and brain spectrin (240/235E) which is found in the cell bodies, dendrites and postsynaptic terminals of neurones. Brain spectrin (240/235E) is also found in certain glial cell types. Antibodies against red blood cell spectrin detect only brain spectrin (240/235E), while antibodies against brain spectrin isolated from axonal and synaptic membranes detect brain spectrin (240/235). Previous (...) apparent discrepancies in the literature concerning brain spectrin localization at the light microscope level were undoubtedly due to different laboratories detecting distinct brain spectrin subtypes, based on the particular antibody being utilized for immunohistochemistry. In this review we (1) discuss the data supporting the presence of at least two distinct subtypes of mammalian brain spectrin, (2) explain how these results reconcile previous discrepancies concerning the localization of spectrin within neural cells, and (3) suggest the future implications of these findings. (shrink)