The general area of business and professional ethics is full of vexing and confusing problems. For example, questions concerning the im portance of ethical standards, whether ethics is unnecessary given appropriate legal enforcement, whether it is imperative to teach ethical behavior in professional education, and similar questions are all controversial. The specific ethical problems to be found in the areas of accounting and finance are at least as difficult as those in other areas. However, there is one kind of ethical (...) problem which is unusually prominent in finance and accounting, which deserves to be recognized more widely in ethics as a significant kind of issue. This is the problem of conflicts of interest. (shrink)
Two groups of agents, G1 and G2, face a *moral conflict* if G1 has a moral obligation and G2 has a moral obligation, such that these obligations cannot both be fulfilled. We study moral conflicts using a multi-agent deontic logic devised to represent reasoning about sentences like "In the interest of group F of agents, group G of agents ought to see to it that phi". We provide a formal language and a consequentialist semantics. An illustration of our semantics (...) with an analysis of the Prisoner’s Dilemma follows. Next, necessary and sufficient conditions are given for (1) the possibility that a single group of agents faces a moral conflict, for (2) the possibility that two groups of agents face a moral conflict within a single moral code, and for (3) the possibility that two groups of agents face a moral conflict. (shrink)
Board composition, insider participation on compensation committees, and director compensation practices can potentially cause conflicts of interest between directors and shareholders. If these corporate governance structures result in situations where actions beneficial to directors do not also benefit shareholders, then shareholders may suffer.Corporate ethics programs usually address conflicts of interest that may arise in the firm''s activities. Some boards of directors take active roles in their firms'' ethics programs by actively overseeing the programs. This paper empirically examines the (...) relationship between ethics programs and potential conflicts of interest and the relationship between board involvement in a firm''s ethics program and potential conflicts of interest. (shrink)
This paper considers the relation between the sources of normativity, reasons, and normative conflicts. It argues that common views about how normative reasons relate to their sources have important consequences for how we can understand putative normative conflicts.
This paper examines one aspect of professional practice for bioethicists: managing conflicts of interest. Drawing from our qualitative study and descriptive analysis of the experiences of conflicts of interest and/or conflicting interests (COI) of 13 Canadian clinical bioethicists (Frolic and Chidwick 2010), this paper examines how bioethicists define their roles, the nature of COIs in their roles, how their COIs relate to conventional definitions of conflicts of interest, and how COIs can be most effectively managed.
Dependence in nanotechnology on external funding and academic-industry relationships has led to questions concerning its influence on research directions, as well as the potential for conflicts of interest to arise and impact scientific integrity and public trust. This study uses a survey of 193 nanotechnology industry and academic researchers to explore whether they share similar concerns. Although these concerns are not unique to nanotechnology, its emerging nature and the prominence of industry funding lend credence to understanding its researchers’ views, (...) as these researchers are shaping the norms and direction of the field. The results of the survey show general agreement that funding sources are influencing research directions in nanotechnology; many respondents saw this influence in their own work as well as other researchers’ work. Respondents also agreed that funding considerations were likely to influence whether researchers shared their results. Irrespective of their institutional affiliation or funding status, twice as many researchers as not considered financial conflicts of interest a cause for concern, and three times as many respondents as not disagreed financial conflicts of interest in nanotechnology were uncommon. Only a third was satisfied with the way that conflicts of interest are currently managed and believed current procedures would protect the integrity of nanotechnology research. The results also found differences in views depending on researchers’ institutional affiliation and funding status. (shrink)
Financial and nonfinancial conflicts of interest in medicine and surgery are troubling because they have the capacity to skew decision making in ways that might be detrimental to patient care and well-being. The recent case of the Articular Surface Replacement (ASR) hip provides a vivid illustration of the harmful effects of conflicts of interest in surgery.
Imperatives occur ubiquitously in natural languages. They produce forces which change the addressee’s cognitive state and regulate her actions accordingly. In real life we often receive conflicting orders, typically, issued by various authorities with different ranks. A new update semantics is proposed in this paper to formalize this idea. The general properties of this semantics, as well as its background ideas are discussed extensively. In addition, we compare our framework with other approaches of deontic logics in the context of normative (...)conflicts. (shrink)
In this paper we argue that surgeons face a particular kind of within-role conflict of interests, related to innovation. Within-role conflicts occur when the conflicting interests are both legitimate goals of professional activity. Innovation is an integral part of surgical practice but can create within-role conflicts of interest when innovation compromises patient care in various ways, such as by extending indications for innovative procedures or by failures of informed consent. The standard remedies for conflicts of interest are (...) transparency and recusal, which are unlikely to address this conflict, in part because of unconscious bias. Alternative systemic measures may be more effective, but these require changes in the culture of surgery and accurate identification of surgical innovation. (shrink)
This paper develops the thesis that personal identity is neither to be taken in terms of an unchanging self-sufficient ‘substance’ nor in terms of selfhood ‘without substance,’ i.e. as fluctuating processes of pure relationality and subject-less activity. Instead, identity is taken as self-transformation that is bound to particular embodied individuals and surpasses them as individuated entities. The paper is structured in three parts. Part I describes the experiential givenness of conflicts that support our sense of self-transformation. While the first (...) part develops an inter-subjective topography of emotional movements, the second part pays attention to their temporal dimension. We work with conflicts and get transformed by them also in the way we remember them. Part II focuses on the process of self-understanding that accompanies conflicts and their metamorphosis in memory. Part III compares and discusses different models of a ‘relational ontology’ of the person, which question the idea that we are defined only by how we define ourselves—just as they question the idea that one’s identity is independent of how one relates to one’s having changed. (shrink)
Social, political, and economic environments play an active role in nurturing professional virtue. Yet, these environments can also lead to the erosion of virtue. As such, professional virtue is fragile and vulnerable to environmental shifts. While physicians are often considered to be among the most virtuous of professional groups, concern has also always existed about the impact of commercial arrangements on physicians’ willingness and capacity to enact their professional virtues. This article examines the ways in which commercial arrangements have been (...) negotiated to secure medical virtue from real or perceived threats of erosion. In particular, we focus on the concern surrounding conflicts of interest arising from commercial arrangements that have developed as a result of neoliberal economic and social policies. The deregulation of medical markets and privatization of services have produced new commercial relationships that are often misunderstood by patients, publics, and physicians themselves. ‘Conflicts of interest’ policies have been introduced in an attempt to safeguard ethical conduct and medical practice. However, a number of virtue ethicists have critiqued these policies as inadequate for securing virtue. We examine the ways in which commercial arrangements have been seen to impact upon medical virtue, both historically and in the context of modern medicine. We then describe and critique current efforts to restore clinical virtue through both conflict of interest policies and through virtue ethics. Finally, we suggest some possible ways of addressing the corrosive effects of neoliberalism on medical virtue. (shrink)
Risk governance of GM plants and GMfood products is presently subject to heatedscientific and public controversies. Scientistsand representatives of the biotechnologyindustry have dominated debates concerningsafety issues. The public is suspicious withregard to the motives of scientists, companies,and political institutions involved. Thedilemmas posed are nested, embracing valuequestions, scientific uncertainty, andcontextual issues. The obvious lack of data andinsufficient information concerning ecologicaleffects call for application of thePrecautionary Principle (PP). There are,however, divergent opinions among scientistsabout the relevance of putative hazards,definition of potential ``adverse effects,'' (...) andwhether actions should be taken to preventharm. The reliance on the concept ofsubstantial equivalence in safety evaluation ofGM food is equally controversial. Consequently,value assumptions embedded in a scientificframework may be a barrier for employment ofthe PP. One of our major conclusions is thatprecautionary GMP usage requires riskassessment criteria yet undeveloped, as well asbroader and more long-term conceptions of risk,uncertainty, and ignorance. Conflicts ofinterest and public participation are otherissues that need to be taken intoconsideration. GMP governance regimes that arejustifiable from a precautionary and ethicalpoint of view must transcend traditionalscientific boundaries to include alternativescientific perspectives as well as publicinvolvement. (shrink)
The welfare and protection of human subjects is critical to the integrity of clinical investigation and research. Institutional review boards were thus set up to be impartial reviewers of research protocols in clinical research. Their main role is to stand between the investigator and her human subjects in order to ensure that the welfare of human subjects are protected. While there is much literature on the conflicts of interest faced by investigators and researchers in clinical investigations, an area that (...) is less explored is CIs that may affect members of IRBs during the institutional ethics review of clinical investigations. This article examines the notion of CIs in clinical research and attempts to develop a framework for a clearer and more balanced approach to identifying CIs that may influence members of IRBs and impede their independence. It will also apply the proposed framework to demonstrate how IRBs possess, or at least may appear to possess, forms of financial CIs and non-financial CIs. The proper identification and management of these CIs is critical to preserving the integrity of clinical investigations and achieving the primary aim of human subjects protection. (shrink)
In his recent book The Dimensions of Consequentialism, Martin Peterson defends, amongst other things, the claim that moral rightness and wrongness come in degrees and that, therefore, the standard view that an act’s being morally right or wrong is a one-off matter ought to be rejected. An ethical theory not built around a gradualist conception of moral rightness and wrongness is, according to Peterson, unable to account adequately for the phenomenon of moral conflicts. I argue in this paper that (...) Peterson’s defence of this claim is not convincing. Over and above this negative result, a careful assessment of Peterson’s case for degrees of rightness reveals that the theoretical corridor for accounting for moral conflicts without a gradualist conception of rightness and wrongness is relatively narrow. As I show, the only way of avoiding the conclusion of Peterson’s argument is to reject his conception of the ‘final analysis’ that an ethical theory provides, i.e. of what the theory ultimately has to say about individual acts and their normative properties. According to Peterson, such a final analysis should be seen as comprising the all-things-considered judgements yielded by the theory, and nothing else. As it turns out, the only alternative to this account that is compatible with the standard view about moral rightness and wrongness is to conceive of the final analysis as also containing judgements about morally relevant factors, or aspects, and the way in which they are normatively relevant. (shrink)
This paper argues that a putative conflict between negative rights and positive rights is not a genuine conflict. The thought that they might conflict presupposes, I argue, that the two rights are valid. This is the first assumption of my argument. The second is that general rights impose duties on everyone, not just the party who faces a conflict of correlative duties. These two assumptions yield the conclusion that positive rights impose enforceable duties on the holder of the negative right; (...) no right is thus infringed if this duty is enforced so no conflict occurs. If this is correct, it means that we can include welfare or socio-economic rights in a set of general rights without generating conflicts with negative rights to non-interference; this might clear some space for arguments that favour egalitarian redistribution although it does not show that general positive rights do exist. (shrink)
This article proposes a formal analysis of a fundamental aspect of legal reasoning: dealing with normative conflicts. Firstly, examples are illustrated concerning the dynamics of legal systems, the application of rules and exceptions, and the semantic indeterminacy of legal sources. Then two approaches to cope with conflicting information are presented: the preferred theories of Brewka, and the belief change functions of Alchourrón, Gärdenfors, and Makinson. The relations between those approaches are closely examined, and some aspects of a model of (...) reasoning with normative conflicts are outlined. Since this model takes into account an ordering of the involved regulations, criteria to order legal norms are finally specified. (shrink)
Merck suppressed data on harmful effects of its drug Vioxx, and Guidant suppressed data on electrical flaws in one of its heart-defibrillator models. Both cases reveal how financial conflicts of interest can skew biomedical research. Such conflicts also occur in electric-utility-related research. Attempting to show that increased atomic energy can help address climate change, some industry advocates claim nuclear power is an inexpensive way to generate low-carbon electricity. Surveying 30 recent nuclear analyses, this paper shows that industry-funded studies (...) appear to fall into conflicts of interest and to illegitimately trim cost data in several main ways. They exclude costs of full-liability insurance, underestimate interest rates and construction times by using overnight costs, and overestimate load factors and reactor lifetimes. If these trimmed costs are included, nuclear-generated electricity can be shown roughly 6 times more expensive than most studies claim. After answering four objections, the paper concludes that, although there may be reasons to use reactors to address climate change, economics does not appear to be one of them. (shrink)
Conflicts of interest affect recommendations in clinical guidelines and disclosure of such conflicts is important. However, not all conflicts of interest are disclosed. Using a public available disclosure list we determined the prevalence and underreporting of conflicts of interest among authors of clinical guidelines on drug treatments.
Upholding public trust in clinical research necessitates that human subjects be protected from avoidable harm and that the design, interpretation and reporting of research results be shielded from avoidable bias. On both counts, managing financial conflicts of interest is critically important, especially in the modern era when the opportunities for investigators to benefit personally from the commercialization of their intellectual property are overtly encouraged and rapidly expanding. Efforts are underway in the United States to provide more useful guidance to (...) universities and medical schools for purposes of strengthening the oversight and management of financial conflicts of interest in clinical research. (shrink)
The present paper aims at addressing a crucial legal conflict in the information society: i.e., the conflict between security and civil rights, which calls for a “fine and ethical balance”. Our purpose is to understand, from the legal theory viewpoint, how a fine ethical balance can be conceived and what the conditions for this balance to be possible are. This requires us to enter in a four-stage examination, by asking: (1) What types of conflict may be dealt with by means (...) of balancing? (2) What is meant by balancing? Is it a metaphor that hides and dissimulates discretionary powers and subjective decisions or a rational instrument that helps us cope with conflicts between fundamental values and interests? (3) What models of balancing are available to us? Are these models irreducible to each other? What can provide us with a common understanding of different models of balancing? (4) How can the crucial issues of rational controllability, predictability, and homogeneity of legal decisions be dealt with? Our paper will try to answer those questions by trying to reconstruct the act of balancing in terms of a rational legal reasoning, which relies upon information. In fact, every judicial decision contains some information that is delivered to the legal system: that information may serve as the basis for future evaluations, decisions, and actions, and thus influence the way we recognize and hence we protect our values, interests, and rights. In this perspective, our examination will attempt to understand those questions in informational terms. This informational treatment can provide us with a more universalistic understanding of those issues and offer us a novel way to conceptually deal with them. To this aim, we will avail yourself of Luciano Floridi’s philosophy of information: notably, we believe his constructionist conception of epistemology is crucial, based on the Maker’s Knowledge approach and his solution of the upgrading problem (i.e., from information to knowledge) in terms of a network theory of account. The informational approach will help us having a better understanding of the balance between competing interests. (shrink)
We present the inconsistency-adaptive deontic logic DP r , a nonmonotonic logic for dealing with conflicts between normative statements. On the one hand, this logic does not lead to explosion in view of normative conflicts such as O A ∧ O ∼A, O A ∧ P ∼A or even O A ∧ ∼O A. On the other hand, DP r still verifies all intuitively reliable inferences valid in Standard Deontic Logic (SDL). DP r interprets a given premise set (...) ‘as normally as possible’ with respect to SDL. Whereas some SDL-rules are verified unconditionally by DP r , others are verified conditionally. The latter are applicable unless they rely on formulas that turn out to behave inconsistently in view of the premises. This dynamic process is mirrored by the proof theory of DP r. (shrink)
This volume contains contributions on different aspects of practical conflicts by: Peter Baumann Monika Betzler Ruth Chang Jon Elster Barbara Guckes Christine M. Korsgaard Isaac Levi Alfred R. Mele Joseph Raz Henry S. Richardson Peter Schaber J. David Velleman Nicholas White.
The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of conflict of interest (...) that can arise in the practice of medicine are outlined. (shrink)
On the Importance of the Institution and Social Self in a Sociology of Conflicts of Interest Content Type Journal Article Category Case Studies Pages 1-2 DOI 10.1007/s11673-012-9355-1 Authors Christopher Mayes, Rock Ethics Institute, The Pennsylvania State University, 201 Willard Building, University Park, PA 16802-1601, USA Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529.
Academic-industry collaborations and the conflicts of interest (COI) arising out of them are not new. However, as industry funding for research in the life and health sciences has increased and scandals involving financial COI are brought to the public’s attention, demands for disclosure have grown. In a March 2008 American Council on Science and Health report by Ronald Bailey, he argues that the focus on COI—especially financial COI—is obsessive and likely to be more detrimental to scientific progress and public (...) health than COI themselves. In response, we argue that downplaying the potential negative impact of COI arising out of academic-industry relationships is no less harmful than overreacting to it. (shrink)
The increasing interconnectedness of academic research and external industry has left research vulnerable to conflicts of interest. These conflicts have the potential to undermine the integrity of scientific research as well as to threaten public trust in scientific findings. The present effort sought to identify themes in the perspectives of faculty researchers regarding conflicts of interest. Think-aloud interview responses were qualitatively analyzed in an effort to provide insights with regard to appropriate ways to address the threat of (...)conflicts of interest in research. Themes in participant responses included disclosure of conflicts of interest, self-removal from situations where conflict exists, accommodation of conflict, denial of the existence of conflict, and recognition of complexity of situations involving conflicts of interest. Moral disengagement operations are suggested to explain the appearance of each identified theme. In addition, suggestions for best practices regarding addressing conflicts of interest given these themes in faculty perspectives are provided. (shrink)
Recently adopted international texts have given a new focus on conflicts of interests and access to information resulting from biomedical research. They confirmed ethical review committees as a central point to guarantee individual rights and the effective application of ethical principles. Therefore specific attention should be paid in giving such committees all the facilities necessary to keep them independent and qualified.
The current proxy voting system in the United States has become the subject of considerable controversy. Because institutional investment managers have the authority to vote their clients’ proxies, they have a fiduciary obligation to those clients. Frequently, in an attempt to fulfill that obligation, these institutional investors employ proxy advisory services to manage the thousands of votes they must cast. However, many proxy advisory services have conflicts of interest that inhibit their utility to those seeking to discharge their fiduciary (...) duties. In this article, we describe the current proxy advisory network as an example of how current notions of conflicts of interest fall short when explaining the behavior of an interconnected set of market players whose remit is to act in the best interests of their investors. We discuss what participants in this system should do to bring transparency and accuracy to the proxy advice industry. (shrink)
Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the (...) United States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their “experience in the NICU.” Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects. (shrink)
This study examines the cultural roots of ethical conflicts in the global business environment. It begins with a brief look at worldviews on ethical behavior in general. Based on this, it is argued that an in-depth understanding of ethical conflicts has been hampered by an overreliance on Western models and viewpoints. Three common sources, or bases, of ethical conflicts are discussed as they relate to business practices, including conflicts over tastes and preferences, the relative importance of (...) moral imperatives compared to legal requirements, and people’s level of tolerance for different values among others. It is then argued that an understanding of ethical conflicts can be facilitated through different levels of understanding, including the meaning of universal values, the relationship between values and practices, and the existence of multiple levels of conflict within the same organizations or industries. These specific and interrelated ingredients in cross-cultural ethical conflicts form the basis for a broader discussion of the meaning of truth as it relates to such conflicts. The paper concludes with the need for more research that is cross-cultural and multidisciplinary in order to improve theory building and managerial practice. (shrink)
Practical conflicts pervade human life. Agents have many different desires, goals, and commitments, all of which can come into conflict with each other. How can practical reasoning help to resolve these practical conflicts? In this collection of essays a distinguished roster of philosophers analyse the diverse forms of practical conflict. Their aim is to establish an understanding of the sources of these conflicts, to investigate the challenge they pose to an adequate conception of practical reasoning, and to (...) assess the degree to which that challenge can be met. These essays will serve as a major resource for students of philosophy but will also interest students and professionals in related fields of the social sciences such as psychology, political science, sociology and economics. (shrink)
Pharmaceutical companies are major sponsors of biomedical research. Most scholars and policymakers focus their attention on government and academic oversight activities, however. In this article, I consider the role of pharmaceutical companies’ internal ethics statements in guiding decisions about corporate research and development (R&D). I review materials from drug company websites and contributions from the business and medical ethics literature that address ethical responsibilities of businesses in general and pharmaceutical companies in particular. I discuss positive and negative uses of pharmaceutical (...) companies’ ethics materials and describe shortcomings in the companies’ existing ethics programs. To guide employees and reassure outsiders, companies must add rigor, independence, and transparency to their R&D ethics programs. (shrink)
Practical conflicts include conflicts in agents who judge, from the perspective of their own values, desires, beliefs, and the like, that one prospective course of action is superior to another but are tempted by what they judge to be the inferior course of action. A man who wants a late-night snack, even though he judges it best, from the identified perspective, to abide by his recent New Year's resolution against eating such snacks until he has lost ten pounds, (...) is the locus of a practical conflict. So is a woman who judges it best (in the same way) to run a mile this morning but is tempted to spend the entire morning working in her office instead. The topic of this essay is practical outcomes of conflicts of this kind. My concern, more specifically, is with outcomes of two general kinds: akratic (from the classical Greek term akrasia: want of self-control) and enkratic (from enkrateia: self-control) actions. (shrink)
The author describes problems facing Armenia in reorganization of the structure of science in the post-socialist era with the aim of utilizing limited state resources more efficiently by reducing the number of separate scientific institutes, concentrating on essential core subjects required by the nation and encouraging all other projects to compete in the international arena for grant sponsorship.
How should liberal democratic states respond to cultural practices and arrangements that run afoul of liberal norms and laws? This article argues for a reframing of the challenges posed by traditional or nonliberal cultural minorities. The author suggests that viewed from up close, such dilemmas are revealed to be primarily intracultural rather than intercultural conflicts, and reflect the political and practical interests of factions of communities much more than deep moral differences. Using the example of the reform of customary (...) marriage laws in post-apartheid South Africa, this article makes the case for a more pragmatic, politically focused approach to resolving conflicts of culture that it is argued is both more democratic and effective than alternatives recently advanced by liberals and deliberative democracy theorists. (shrink)
Professional sports with high rates of concussion have become increasingly concerned about the long-term effects of multiple head injuries. In this context, return-to-play decisions about concussion generate considerable ethical tensions for sports physicians. Team doctors clearly have an obligation to the welfare of their patient (the injured athlete) but they also have an obligation to their employer (the team), whose primary interest is typically success through winning. At times, a team’s interest in winning may not accord with the welfare of (...) an injured player, particularly when it comes to decisions about returning to play after injury. Australia’s two most popular professional football codes—rugby league and Australian Rules football—have adopted guidelines that prohibit concussed players from continuing to play on the same day. I suggest that conflicts of interest between doctors, patients, and teams may present a substantial obstacle to the proper adherence of concussion guidelines. Concussion management guidelines implemented by a sport’s governing body do not necessarily remove or resolve conflicts of interest in the doctor–patient–team triad. The instigation of a concussion exclusion rule appears to add a fourth party to this triad (the National Rugby League or the Australian Football League). In some instances, when conflicts of interest among stakeholders are ignored or insufficiently managed, they may facilitate attempts at circumventing concussion management guidelines to the detriment of player welfare. (shrink)
Financial relationships in academic research can create institutional conflicts of interest because the financial interests of the institution or institutional officials may inappropriately influence decision-making. Strategies for dealing with institutional COIs include establishing institutional COI committees that involve the board of trustees in conflict review and management, developing policies that shield institutional decisions from inappropriate influences, and establishing private foundations that are independent of the institution to own stock and intellectual property and to provide capital to start-up companies.
Neuroscience research has improved our understanding of the long term consequences of sports-related concussion, but ethical issues related to the prevention and management of concussion are an underdeveloped area of inquiry. This article exposes several examples of conflicts of interest that have arisen and been tolerated in the management of concussion in sport (particularly professional football codes) regarding the use of computerized neuropsychological (NP) tests for diagnosing concussion. Part 1 outlines how the recommendations of a series of global protocols (...) for dealing with sports-related concussions (the 1st, 2nd and 3rd Consensus Statements on Concussion in Sport) have endorsed the use of NP testing. The development of these protocols has involved experts who have links with companies that sell computerised NP tests for concussion management. Part 2 describes how some professional football leagues—in particular the National Football League (NFL), the Australian Football League (AFL) and the National Rugby League (NRL)—have mandated specific NP testing products. They have done so on the basis of these international guidelines and by engaging experts who have conflicts of interest with NP testing companies. These decisions have also been taken despite evidence that casts doubt on the reliability and validity of NP tests when used in these ways. (shrink)
Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive (...) than generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)
Conflicts of interest can lead experts to give biased and corrupt advice. Although disclosure is often proposed as a potential solution to these problems, we show that it can have perverse effects. First, people generally do not discount advice from biased advisors as much as they should, even when advisors’ conflicts of interest are disclosed. Second, disclosure can increase the bias in advice because it leads advisors to feel morally licensed and strategically encouraged to exaggerate their advice even (...) further. As a result, disclosure may fail to solve the problems created by conflicts of interest and may sometimes even make matters worse. (shrink)
In this pilot qualitative study 13 clinical bioethicists from across Canada were interviewed about their experiences of conflicts of interest and/or conflicting interests in their professional roles. The interviews generated five composite cases. Participants reported being significantly impacted by these experiences both personally and professionally.
The heart of the matter -- The evolution of the French medicine -- Coping with physicians' conflicts of interest in France -- The rise of a protected medical market : the United States before 1950 -- The commercial transformation : the United States, 1950-1980 -- The logic of medical markets : the United States, 1980 to the present -- Coping with physicians' conflicts of interest in the United States -- The evolution of Japanese medicine -- Coping with physicians' (...)conflicts of interest in Japan -- Reforms -- Professionalism reconsidered. (shrink)
This paper presents the results of a national study of the beliefs and perceptions of small business professionals concerning ethics within their company and business in general. The study examined their views on the relationship between success and ethical conduct as well as the extent and nature of ethical conflicts experienced by the respondents. Some comparisons are made with similar studies that have been conducted in the past. Respondents have the most ethical conflicts with customers and employees, and (...) with regard to honesty in contracts/agreements. Most also believe that ethical standards are lower than they were 10 and 20 years ago, primarily because society's moral standards are lower. Additionally, they believe that the behavior of top management has the most influence on decisions in ethical situations. Finally, consistent with prior studies, they believe that they have the most responsibility to customers, ahead of employees and stockholders. (shrink)
Background: Financial conflict of interest in clinical research is an area of active debate. While data exist on the perspectives and roles of academic institutions, investigators, industry sponsors, and scientific journals, little is known about the perspectives of potential research participants.Methods: The authors surveyed potential research participants over the internet, using the Harris Interactive Chronic Illness Database. A potential research participant was defined by: self report of diagnosis by a health care professional and willingness to participate in clinical trials. Email (...) invitations were sent to 20 205 persons with coronary artery disease, breast cancer, or depression; a total of 6363 persons were screened; of these, 86% or 5478 met inclusion criteria and completed the survey. The outcome measures were respondents’ ratings on: importance of knowing conflict of interest information, whether its disclosure ought to be required, and its effect on willingness to participate—across seven widely discussed scenarios of financial conflicts of interest .Results: Majority responded that knowing conflict of interest information was “extremely” or “very” important; a larger majority felt financial conflicts of interest should be disclosed as part of informed consent . In all seven scenarios, a majority was still willing to participate but in some scenarios a sizable minority would be wary of participation. Respondents were more wary of individual than institutional conflicts of interest. Illness group and sociodemographic factors had modest effects and did not affect the main trends.Conclusions: The prevailing practice of non-disclosure of financial conflicts of interest in clinical research appears contrary to the values of potential research participants. (shrink)
"Guanxi" involves interpersonal obligations, which may conflict with other obligations people have that are based on general or abstract moral considerations. In the West, the latter have been widely accepted as the general source of obligations, which is perhaps tied to social changes associated with the rise of capitalism. Recently, Western ethicists have started to reconsider the extent to which personal relationships may form a distinct basis for obligation. In administration and management, salient bases for decision-Making include deontological, consequentialist and (...) personalist ethics. The first may be reflected in a bureaucratic approach, the second in a price system, and the third in arrangements like "guanxi". Each has positive and negative aspects, but problems arise when they lead to conflicting obligations, as may occur for an office holder who has some obligations based in deontological considerations and others based in personal relationships. This is a type of conflict of interest. Such conflicts have been considered in the West, and remedies proposed. Problems arise especially in cases where it is not clear how to prioritise different obligations, and this has been noted as a difficulty in the Chinese legal system. Questions that need to be answered include not only questions about how to deal with conflicting obligations, but also questions about what institutions to accept as giving rise to obligations. Institutions themselves may be problematic not only because of their consequences for economic productivity, but because they are internally incoherent, and this may be manifested in frequent conflicts faced by office holders. (shrink)