Purpose Digital transformation leverages digital technologies to change current processes and introduce new processes in any organisation’s business model, customer/user experience and operational processes. Artificial intelligence plays a significant role in achieving DT. As DT is touching each sphere of humanity, AI led DT is raising many fundamental questions. These questions raise concerns for the systems deployed, how they should behave, what risks they carry, the monitoring and evaluation control we have in hand, etc. These issues call for the need (...) to integrate ethics in AI led DT. The purpose of this study is to develop an “AI led ethical digital transformation framework”. Design/methodology/approach Based on the literature survey, various existing business ethics decision-making models were synthesised. The authors mapped essential characteristics such as intensity and the individual, organisational and opportunity factors of ethics models with the proposed AI led ethical DT. The DT framework is evaluated using a thematic analysis of 23 expert interviews with relevant AI ethics personas from industry and society. The qualitative data of the interviews and opinion data has been analysed using MAXQDA software. Findings The authors have explored how AI can drive the ethical DT framework and have identified the core constituents of developing an AI led ethical DT framework. Backed by established ethical theories, the paper presents how DT pillars are related and sequenced to ethical factors. This research provides the potential to examine theoretically sequenced ethical factors with practical DT pillars. Originality/value The study establishes deduced and induced ethical value codes based on thematic analysis to develop guidelines for the pursuit of ethical DT. The authors identify four unique induced themes, namely, corporate social responsibility, perceived value, standard benchmarking and learning willingness. The comprehensive findings of this research, supported by a robust theoretical background, have substantial implications for academic research and corporate applicability. The proposed AI led ethical DT framework is unique and can be used for integrated social, technological and economic ethical research. (shrink)

Sarbanes–Oxley Section 406 requires a code of ethics for top financial and accounting officers in public companies. The objective of this research is to discover the impact of a financial code of ethics on firm behavior. We performed a longitudinal tracking of firm adoption of a financial code of ethics starting in 2005. We checked these companies’ codes again in 2011 to confirm their continued implementation. Financial restatements were used as a dependent variable to measure improved financial reporting after the (...) adoption of the financial codes. The results confirm that the adoption of a financial code of ethics improves the integrity of financial reporting. (shrink)

This book turns critical feminist scrutiny on national climate policies in India and examines what transition might really mean for marginalized groups in the country. -/- A vision of “just transitions” is increasingly being used by activists and groups to ensure that pathways towards sustainable futures are equitable and inclusive. Exploring this concept, this volume provides a feminist study of what it would take to ensure just transitions in India where gender, in relation to its interesting dimensions of power, is (...) at the centre of analysis. With case studies on climate mitigation and adaptation from different parts of India, the book brings together academics, practitioners and policymakers who provide commentary on sectors including agriculture, forestry and renewables. Overall, the book has relevance far beyond India’s borders, as India’s attempt to deal with its diverse population makes it a key litmus test for countries seeking to transition against a backdrop of inequality both in the Global North and South. -/- This volume will be of great interest to students and scholars of climate policy, gender studies, sustainable development and development studies more broadly. (shrink)

In this volume well-known scholars from India and Latin America - Enrique Dussel, Madhu Dubey, Walter D. Mignolo, and Sudipta Sen, to name a few - discuss the concepts of modernity and colonialism and describe how the two relate to each other. This second edition to the volume comes with a new introduction which extends and critically supplements the discussion in the earlier introduction to the volume. It explores the vital impact of the colonial pasts of India, Mexico, China, and (...) even the Unites States, on the processes through which these countries have become modern. The collection is unique, as it brings together a range of disciplines and perspectives. The topics discussed include the Zapatista movement in Southern Mexico, the image of the South in recent African-American literature, the theories of Andre Gunder Frank about the early modernization of Asian countries, and the contradictions of the colonial state in India. (shrink)

Existing research on the financial implications of corporate social responsibility (CSR) for firms has predominantly focused on positive aspects of CSR, overlooking that firms also undertake actions and initiatives that qualify as negative CSR. Moreover, studies in this area have not investigated how both positive and negative CSR affect the financial risk of firms. As such, in this research, the authors provide a framework linking both positive and negative CSR to idiosyncratic risk of firms. While investigating these relationships, the authors (...) also analyze the moderating role of financial leverage of firms. Overall, analysis of secondary information for firms from multiple industries over the years 2000–2009 shows that CSR has a significant effect on the idiosyncratic risk of firms, with positive CSR reducing risk and negative CSR increasing it. Results also show that the reduction in risk from positive CSR is not guaranteed, with firms having high levels of financial leverage witnessing lower idiosyncratic risk reduction. (shrink)

Although early-stage finance is critical to the growth of most ventures, it is even more important for social ventures as they face the challenges of balancing their social and commercial objectives. Drawing on institutional logics and signaling theory, this study uses a panel data set of 3,401 nascent social ventures to investigate the important role philanthropic grant funding plays in the organizational and financial development of social ventures. We find mixed results, with positive effects on employment and subsequent access to (...) debt finance, but no effects on revenues and access to equity. Our findings connect these theories by suggesting philanthropic grants provide social ventures with flexibility to invest in human capital without pushing them to pursue short-term financial objectives, and that receiving a philanthropic grant provides a signal that is interpreted differently by debt and equity financiers. These findings are especially relevant as funders increasingly use grants to support social entrepreneurship. (shrink)

The power of technology to transform religions, science, and political institutions has often been presented as nothing short of revolutionary. Does technology have a similarly transformative influence on societies’ morality? Scholars have not rigorously investigated the role of technology in moral revolutions, even though existing research on technomoral change suggests that this role may be considerable. In this paper, we explore what the role of technology in moral revolutions, understood as processes of radical group-level moral change, amounts to. We do (...) so by investigating four historical episodes of radical moral change in which technology plays a noteworthy role. Our case-studies illustrate the plurality of mechanisms involved in technomoral revolutions, but also suggest general patterns of technomoral change, such as technology’s capacity to stabilize and destabilize moral systems, and to make morally salient phenomena visible or invisible. We find several leads to expand and refine conceptual tools for analysing moral change, specifically by crystallizing the notions of ‘technomoral niche construction’ and ‘moral payoff mechanisms’. Coming to terms with the role of technology in radical moral change, we argue, enriches our understanding of moral revolutions, and alerts us to the depths of which technology can change our societies in wanted and unwanted ways. (shrink)

The complexity and fluidity of emotions in the epic of Mahābhārata present before us an interesting case for delving into the phenomenology of emotions. In the rationalist tradition of Kant, emotions are considered as an impediment to moral discernment. The rationalist account of emotions considers it as an animal instinct which needs to be controlled through the exercise of Reason. The paper problematizes the rationalist interpretation of emotions mainly on two counts. First, it ignores the evaluative content of the emotions (...) and considers it as a non-cognitive element. Second, it also overlooks the productive role of various emotions like guilt, shame, remorse in moral deliberation. The paper critically analyzes the episode of Yudhiṣṭhira’s grief in Śānti Parva and argues that the grief of Yudhiṣṭhira cannot be explained as personal loss. Rather, Yudhiṣṭhira’s grief should be understood as a case of moral conflict where a moral agent finds it difficult to justify his moral choices. Yudhiṣṭhira’s analysis of the futility of war and the condemnation of violence should be understood as the evaluative perspective offered by his emotions. The phenomenological analysis of Yudhiṣṭhira’s grief allows us to understand the significance of emotions in constituting the moral perspective on any conflicting situation. Hence, emotions cannot be relegated to the domain of irrationality rather they become the site where the truth unveils itself. (shrink)

What does it mean to study places in ‘crisis’ and how does that affect the research done on the ‘rural’? To be considered to be in crisis is not really new as any literature review of rural studies indicates. And yet, we live now in a new context, with new challenges for ‘rural’ research, in particular that of sustainability. Sustainability is the new policy focus and is increasingly reflected in research on rural Europe. Although scholars are beginning to theorize on (...) what is sustainable in and for rural areas, our intention is to take this further. We theorize on what the focus on crisis and, increasingly on sustainability, means for the research we do and the knowledge we produce on rural Europe. Our aim is to bring attention to the politics of past and present knowledge production on the rural to be able to imagine just and sustainable futures. In an analysis of literature primarily from Sweden and the UK, we argue that two construals, that of a rural crisis and that of rural–urban polarization, have set the tone for rural studies and may have overshadowed a more plural approach. We outline what might be needed from rural research to meet future challenges and what the notion of sustainability, with its emphasis on the entanglements of the social, economic and environmental, might mean for the future of rural research. (shrink)

Arguments for a just transition are integral to debates about climate change and the drive to create a carbon-neutral economy. There are currently two broad approaches rooted in ethics and justice for framing just energy transitions. The first can be described as internal to the transition and emphasizes the anticipation, assessment, and redressing of harms created by the transition itself and the inclusion in transition governance of groups or communities potentially harmed by its disruptions. In this article, we propose a (...) second approach to ethics and justice in an energy transition, which we describe as systemic or societal in scope. This approach complements attention to the proximate dynamics and impacts of the transition process with a focus on the distant societal and economic outcomes the transition brings into being and how they compare to conditions prior to the transition. It poses the question: do the transformative social, economic, and technological changes wrought by energy systems create more just societies and economies, or do they instead reinforce or recreate long-standing injustices and inequalities? We illustrate this approach with an assessment of one of the most significant existing forms of energy injustice: the energy-poverty nexus. We argue that the energy-poverty nexus reflects configurations of socio-energy systems that create complex, extractive feedbacks between energy insecurity and economic insecurity and, over time, reinforce or exacerbate poverty. We further argue that just energy transitions should work to disentangle these configurations and re-design them so as to create generative rather than extractive feedbacks, thus ending the energy-poverty nexus and creating long-term outcomes that are more just, equitable, and fair. (shrink)

Feminist decolonial scholars have called for disengaging from the current system built on a hierarchical logic of race and gender central to modern, colonial thinking. They have looked to worlds outside the modern system to lead us out of current unjust practices harming both humans and the environment. Although policymaking may be seen as the stronghold of the current political agenda and of the structures that have led to the climate crisis, we argue that climate policies too, are also crucial (...) for rethinking and transforming societies. Our examination of climate adaptation policies in Sweden and the literature from Europe shows how policy documents ignore and unknow the oppressive intersections of gender and power despite the knowledge that exists on these issues in the public domain. Drawing on the tools of agnotology, we examine how this is achieved by strategies of ‘denial, dismissal, diversion and displacement.’ Building on feminist post and decolonial scholarship, we make explicit the gendered and racial hierarchies and dichotomies underpinning these policy documents. At the same time, we bring attention to the nuances in the policy documents we study and look for the openings that might be used to bring about transformation by making these hierarchies explicit and calling them into question. We argue that a transformation is possible through a feminist post and decolonial intervention, even in policymaking otherwise ignorant of culture, values and the colonial histories that have produced contemporary society. (shrink)

This special issue contributes to a grounded understanding about 'sustainability' in a range of rural contexts and in so doing sheds light on accompanying tensions and implications for the future of rural areas in Europe. It also brings attention to how the rural might be changing as a result of this new focus on sustainability. The 17 contributions bring to light crucial dimensions of sustainability: (1) the imperative of wellbeing, belonging and care; (2) dimensions of power and identity; (3) the (...) apprehension of time and space - in other words, sustainability as a process and always in transition; (4) social and spatial justice; and (5) the question of knowledge production on the rural and on sustainability. (shrink)

The paper deals with the notion of synthesis and transcendental ego in Kant and Husserl. It will argue that the actual difference between Kant and Husserl’s notion of transcendental ego can be understood through their conception of time. Kant accepts transcendental ego as the kind of logical necessity for synthesizing the various temporal units which provides unity to the consciousness. However, Husserl discards the necessity of transcendental ego by giving the phenomenological interpretation of time as internal time consciousness. The interpretation (...) of time as the flow of protention and retention synthesizes the time without invoking the necessity of Kantian transcendental ego outside the flow. Husserl’s analysis of internal time consciousness will also help us in understanding the methodological differences between Kant’s transcendental philosophy and phenomenology. (shrink)

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; (...) whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward. (shrink)

We examine the role of alignment between organizational social consciousness and the informal and formal institutions of a country in increasing female representation on boards. Using fixed-effects and Hausman Taylor regression methodology for endogenous covariate with panel data for the years 2006–2020, we find that the greater the alignment between organizational social consciousness and certain formal and informal institutions, the more progress there is toward gender representation on corporate boards in Europe. We also find that more socially conscious firms make (...) the most progress, often going beyond the minimum regulatory targets. By showing the complementarity of these factors, we address the enduring question of how the interplay of formal and informal institutions directly affects corporate behavior, thus contributing to the institutional, public policy/regulatory, and corporate governance literatures. We note the need for policymakers to go beyond mere codification of rules via quotas and simultaneously work toward raising national and organizational social consciousness levels on issues of gender equality. (shrink)

Some scholars blame capitalism for the prevalence of modern slavery. However, data reveal that it is wrong to blame capitalism for a problem that long preceded it and would likely be much worse without it. We explain why this is the case.

Despite research establishing emojis as sites of critical racial discourse, there is a paucity of literature examining their importance in the increasingly popular context of mobile payments. This is particularly important as new forms of social payment platforms such as Venmo bridge the seamlessness of mobile payments with the vibrant communicative practices of social networks. As such, they provide a unique medium to examine how emojis are used within the context of digital consumption, and by extension, self-representation. This study analyzes (...) approximately 325 million public transactions on the U.S. payment platform Venmo to understand whether emoji usage in mobile payments is more hedonic or utilitarian. We then explore how race is represented across emoji usage on Venmo via tone-modified emojis, a subset of emojis whereby users can choose a skin tone. We found that while emojis in general are used for more hedonic purposes than utilitarian ones, darker tone-modified emojis indicate a proportionately higher use in hedonic consumption as compared to lighter tone-modified emojis, and also show a higher representation of utilitarian categories in transactions. Thematic analysis revealed that subsets with darker tone-modified emojis have a greater lexical variety and engage in more playful uses of emoji in mobile payments. (shrink)

This paper explores ethical concerns arising in healthcare integration. We argue that integration is necessary imperative for meeting contemporary and future healthcare challenges, a far stronger evidence base for the conditions of its effectiveness is required. In particular, given the increasing emphasis at the policy level for the entire healthcare infrastructure to become better integrated, our analysis of the ethical challenges that follow from the logic of integration itself is timely and important and has hitherto received insufficient attention. We evaluated (...) an educational intervention which aims to improve child health outcomes by making transitions between primary to secondary care more efficient, ensuring children and parents are better supported throughout. The programme provided skills for trainee paediatricians and general practitioners in co-designing integrated clinical services. The key ethical challenges of integrated care that arose from a clinical perspective are: professional identity and autonomy in an integrated working environment; the concomitant extent of professional responsibility in such an environment; and the urgent need for more evidence to be produced on which strategies for integrating at scale can be based. From our analysis we suggest a tentative way forward, viewed from a normative position broadly situated at the intersection of deontology and care ethics. We adopt this position because the primary clinical ethical issues in the context of integrated care concern: how to ensure that all duties of care to individual patients are met in a newly orientated working environment where clinical responsibility may be ambiguous; and the need to orientate care around the patient by foregrounding their autonomous preferences and ensuring good patient clinician relationships in clinical decision-making. (shrink)

This edited volume presents perspectives from computer science, information theory, neuroscience and brain imaging, aesthetics, social sciences, psychiatry, and philosophy to answer frontier questions related to artificial intelligence and human experience. Can a machine think, believe, aspire and be purposeful as a human? What is the place in the machine world for hope, meaning and transformative enlightenment that inspires human existence? How, or are, the minds of machines different from that of humans and other species? These questions are responded to (...) along with questions in the intersection of health, intelligence and the brain. It highlights the place of consciousness by attempting to respond to questions with the help of fundamental reflections on human existence, its life-purposes and machine intelligence. The volume is a must-read for interdisciplinary and multidisciplinary researchers in humanities and social sciences and philosophy of science who wish to understand the future of AI and society. (shrink)

Opponents of male circumcision have increasingly used human rights positions to articulate their viewpoint. We characterize the meaning of the term “human rights.” We discuss these human rights arguments with special attention to the claims of rights to an open future and to bodily integrity. We offer a three-part test under which a parental decision might be considered an unacceptable violation of a child's right. The test considers the impact of the practice on society, the impact of the practice on (...) the individual, and the likelihood of adverse impact. Infant circumcision is permissible under this test. We conclude that infant circumcision may be proscribed as violating local norms, even though it does not violate human rights. (shrink)

Working from home (WFH) is a new reality and norm in today’s work culture. COVID-induced lockdown introduced the concept of WFH for many people. Blurring home and workplace boundaries was a prominent cause of disorientation in people’s lives. Hence, WFH becomes a significant phenomenon to explore as it raises the fundamental question of body and space in shaping people’s experiences. To study this, the researchers designed a phenomenological inquiry and examined the lived phenomenon of WFH during the COVID lockdown. Borrowing (...) theoretical concepts from philosophers Martin Heidegger and Merleau-Ponty, they aimed to understand human experiences from an embodied perspective. They interviewed a few adults (age group 27–50) in three urban Indian cities during the first phase of the COVID-19 lockdown. The participants’ experiences were transcribed, and Interpretative Phenomenological Analysis (IPA) was conducted. The IPA themes highlighted their varied lived experiences and lifeworld, such as distractions in working from home, their changed routines, habits, and social interaction. The findings are discussed through phenomenological psychology concepts such as embodied cognition, body memory, extended self, shared empathy, intersubjectivity and pre-reflective bodily intelligence in coping. The study’s contribution is that it advances a methodological understanding by interpreting people’s experiences from a phenomenological view of being-in-the-world in which the individual is not an isolated entity but is in the world/placed in the world with other people and the environment. (shrink)

As AI technologies are rolled out into healthcare, academia, human resources, law, and a multitude of other domains, they become de-facto arbiters of truth. But truth is highly contested, with many different definitions and approaches. This article discusses the struggle for truth in AI systems and the general responses to date. It then investigates the production of truth in InstructGPT, a large language model, highlighting how data harvesting, model architectures, and social feedback mechanisms weave together disparate understandings of veracity. It (...) conceptualizes this performance as an operationalization of truth, where distinct, often-conflicting claims are smoothly synthesized and confidently presented into truth-statements. We argue that these same logics and inconsistencies play out in Instruct’s successor, ChatGPT, reiterating truth as a non-trivial problem. We suggest that enriching sociality and thickening “reality” are two promising vectors for enhancing the truth-evaluating capacities of future language models. We conclude, however, by stepping back to consider AI truth-telling as a social practice: what kind of “truth” do we as listeners desire? (shrink)

Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by (...) trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk–benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents’ unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents’ ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted. (shrink)

The fields of HIV care in pregnancy and reproductive genetics have always been ‘exceptional’ in that patients are highly concerned about the potential for stigma and the corresponding need for privacy and confidentiality. However, the two fields have diverged in how they have addressed these concerns. The systematic review analyzed 61 manuscripts for similarities and differences between the fields of HIV care in pregnancy and reproductive genetics in the United States, with respect to privacy, confidentiality, disclosure, and stigma. The systematic (...) review revealed that the field of HIV care in pregnancy has insufficiently addressed patient concerns about privacy, confidentiality, and stigma compared to the field of reproductive genetics. Failure to adequately protect confidentiality of HIV-positive patients, and failure to reduce stigma associated with HIV testing and treatment are deficiencies in the delivery of care to HIV-positive pregnant woman and barriers to reducing vertical transmission of HIV. Im.. (shrink)

We demonstrate that the key components of cognitive architectures (declarative and procedural memory) and their key capabilities (learning, memory retrieval, probability judgment, and utility estimation) can be implemented as algebraic operations on vectors and tensors in a high‐dimensional space using a distributional semantics model. High‐dimensional vector spaces underlie the success of modern machine learning techniques based on deep learning. However, while neural networks have an impressive ability to process data to find patterns, they do not typically model high‐level cognition, and (...) it is often unclear how they work. Symbolic cognitive architectures can capture the complexities of high‐level cognition and provide human‐readable, explainable models, but scale poorly to naturalistic, non‐symbolic, or big data. Vector‐symbolic architectures, where symbols are represented as vectors, bridge the gap between the two approaches. We posit that cognitive architectures, if implemented in a vector‐space model, represent a useful, explanatory model of the internal representations of otherwise opaque neural architectures. Our proposed model, Holographic Declarative Memory (HDM), is a vector‐space model based on distributional semantics. HDM accounts for primacy and recency effects in free recall, the fan effect in recognition, probability judgments, and human performance on an iterated decision task. HDM provides a flexible, scalable alternative to symbolic cognitive architectures at a level of description that bridges symbolic, quantum, and neural models of cognition. (shrink)

This essay addresses tensions within political philosophy between group rights, which allow historically marginalized communities some self-governance in determining its own rules and norms, and the rights of marginalized subgroups, such as women, within these communities. Community norms frequently uphold patriarchal structures that define women as inferior to men, assign them a subordinate status within the community, and cut them off from the individual rights enjoyed by women in other sections of society. As feminists point out, the capacity for voice (...) and exit cannot be taken for granted, for community norms may be organized in ways that deny women any voice in its decision-making forums as well as the resources they would need to survive outside the community. This essay draws on research among the Gond, an indigenous community in India, to explore this debate. Given the strength of the forces within the community militating against women’s capacity for voice or exit, the question motivating our research is: Can external organizations make a difference? We explore the impacts of two external development organizations that sought to work with women within these communities in order to answer this question. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Impatience to EmpathyStephanie Pierce and Kavita Shah AroraWe gave J.H. a label the first time we met her, as many often do—“Uncooperative.” She was a patient with autism and intellectual delay who had presented to the emergency department (ED) with vaginal bleeding. After receiving the gynecology consult request from the emergency medicine physicians, we were already mentally formulating our recommendations based on the information they told us over (...) the phone. “Does not cooperate with exam,” “no acute surgical intervention is currently warranted,” and “recommend outpatient follow–up.”When we arrived in her room, she was sitting in the hospital bed surrounded by a protective shield of caregivers from her group home. We introduced ourselves as the gynecology team but it was obvious that J.H. could not communicate verbally. Upon speaking with her caregivers we learned that she had Cowden syndrome, a genetic disease that confers significantly increased risks for several types of cancer including endometrial, thyroid, and breast cancers. J.H. had also been having heavy vaginal bleeding, which was difficult for her caregivers to manage, and this was the reason she was brought into the emergency department. After attempting to gain as much information as we could from the caregivers, we started to perform an abdominal exam, which made J.H. extremely agitated. We quickly stopped the exam and the caregivers helped to calm J.H. We remember our mixture of emotions—bewilderment at the agitation and commotion in the exam room full of people, frustration at not being able to complete our exam fully, and annoyance that this “difficult patient” was taking up our limited time between surgical cases. Thankfully, these knee–jerk reactions were quickly replaced by feelings of concern for the patient and the realization of how frightening an experience this must be for her—being in a strange place with white walls and unfamiliar people, unable to communicate her thoughts.J.H.’s mother, her surrogate decision–maker, was not at the hospital that day but the caregivers told us that she had expressed a strong desire for her daughter to have a prophylactic hysterectomy due to her lifetime risk for developing uterine cancer as well as a permanent solution to the bleeding concerns. What had initially started as a simple ED consult was now turning into a complex question. The ethical and legal dilemma was obvious—whether to perform a major surgery that would irreversibly sterilize a patient who could not consent on her own behalf in order to minimize the potential risk of cancer later in life. While medical management could improve the bleeding and potentially reduce the risk of cancer, frequent exams would be necessary [End Page 19] to ensure that the medication was working and that premalignant changes were not occurring in J.H.’s uterus. However, based on our experience in the emergency department, J.H. would need anesthesia for such exams and it was doubtful the medications would completely normalize her elevated risk of uterine malignancy. We knew that in order to address this question, we would need to see J.H. again along with her mother to have a frank discussion about the risks and benefits of such a decision, and so we made plans to see her in our outpatient clinic.Several days later, J.H., her mother, and the group home caregivers arrived in the office. Anticipating a complex discussion, we had requested a representative from the hospital ethics committee to join us at the visit. We didn’t know what to expect meeting J.H.’s mother for the first time but as we sat in the room talking, it was obvious that she was truly trying to act in her daughter’s best interest. Similarly, it was touching to watch the faces of the caregivers from the group home as they nodded in solidarity with J.H.’s mother, also clearly wanting what was best for her and supporting her mother in this difficult decision. J.H., meanwhile, seemed content to sit silently with us during the discussion, surrounded as she was by people who cared deeply for her well–being.After extensive partnership with the ethics consultants... (shrink)

Moving forward rapidly in the clinical research phase, uterus transplantation may be a future treatment option for women with uterine factor infertility, which accounts for three per cent of all infertility in women. This new method of treatment would allow women, who currently rely on gestational surrogacy or adoption, to gestate and birth their own genetic offspring. Since uterus transplantation carries significant risk when compared with surrogacy and adoption as well as when compared with other organ transplants, it requires greater (...) justification because its goals are quality of life, not life-saving, in their scope. It is important to address questions regarding the physical, psychosocial and ethical risks and benefits of uterus transplantation for all three parties involved—the patient, the donor and the potential child—as well as discuss the regulatory implications as research on uterus transplantations moves forward. (shrink)

The environment impacts human health in profound ways, yet few theories define the form of the relationship between human physiology and the environment. It is conjectured that such complex systems cannot interact directly, but rather their interaction requires the formation of an intermediary “interface.” This position contrasts with current epidemiological constructs of causation, which implicitly assume that two complex systems transfer information directly while remaining separate entities. Further, it is contended that dynamic, process‐based interfaces incorporate components from all the interacting (...) systems but exhibit operational independence. This property has many consequences, the foremost being that characteristics of the interface cannot be fully resolved by only studying the systems involved in the interaction. The interface itself must be the subject of inquiry. Without refocusing the attention on biodynamic interfaces, how the environment impacts health cannot be discerned. Also see the video abstract here https://youtu.be/XeyjeZeyo4o. (shrink)

The rising use of social media, for both clinical and nonclinical purposes, obviates the need for policy to more explicitly guide physicians, and their behaviors, in this new digital environment. The current report from the AMA Council on Ethical and Judicial Affairs (CEJA) addresses a number of these issues, specifically the nature of interaction and representation between physicians and patients. However, given the nature of the focus of this report—the nonclinical use of the internet and social media—there are a number (...) of issues that deserve attention, in particular encouraging education and addressing how to approach relationships among medical professionals of varying levels of training. (shrink)

Female genital alteration is any cutting, removal or destruction of any part of the external female genitalia. Various FGA practices are common throughout the world. While most frequent in Africa and Asia, transglobal migration has brought ritual FGA to Western nations. All forms of FGA are generally considered undesirable for medical and ethical reasons when performed on minors. One ritual FGA procedure is the vulvar nick. This is a small laceration to the vulva that does not cause morphological changes. Besides (...) being performed as a primary ritual procedure it has been proposed as a substitute for more extensive forms of FGA. Measures advocated or taken to reduce the burden of FGA can be punitive or non-punitive. Even if it is unethical to perform VN, we argue that it also is unethical to attempt to suppress it through punishment. First, punishment of VN is likely to cause more harm than good overall, even to those ostensibly being protected. Second, punishment is likely to exceed legitimate retributive ends. We do not argue in favor of performing VN. Rather, we argue that non-punitive strategies such as education and harm reduction should be employed. (shrink)

In the last few decades, several philosophers have written on the topic of moral revolutions, distinguishing them from other kinds of society-level moral change. This article surveys recent accounts of moral revolutions in moral philosophy. Different authors use quite different criteria to pick out moral revolutions. Features treated as relevant include radicality, depth or fundamentality, pervasiveness, novelty and particular causes. We also characterize the factors that have been proposed to cause moral revolutions, including anomalies in existing moral codes, changing honour (...) codes, art, economic conditions and individuals or groups. Finally, we discuss what accounts of moral revolutions have in common, how they differ and how moral revolutions are distinguished from other kinds of moral change, such as drift and reform. (shrink)

BackgroundResuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit, meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people regarding resource allocation decisions in the NICU.MethodsThe study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were (...) 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing.ResultsThe majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival, life expectancy, and cost of treatment. In the classic ‘lifeboat’ scenario, all but two respondents were utilitarian.ConclusionsThis survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment. (shrink)