Papers presented at the Kierkegaard: Resources and Results Conference, held at McGill University, June 6-8, 1980.

forthcoming in Philosophy & Public Affairs [2008].

Introduction to cluster of papers on feminist standpoint theory.

The COVID-19 pandemic is putting the NHS under unprecedented pressure, requiring clinicians to make uncomfortable decisions they would not ordinarily face. These decisions revolve primarily around intensive care and whether a patient should undergo invasive ventilation. Certain vulnerable populations have featured in the media as falling victim to an increasingly utilitarian response to the pandemic—primarily those of advanced years or with serious existing health conditions. Another vulnerable population potentially at risk is those who lack the capacity to make their own (...) care decisions. Owing to the pandemic, there are increased practical and normative challenges to following the requirements of the Mental Capacity Act 2005. Both capacity assessments and best interests decisions may prove more difficult in the current situation. This may create a more paternalistic situation in decisions about the care of the cognitively impaired which is at risk of taking on a utilitarian focus. We look to these issues and consider whether there is a risk of patients who lack capacity to make their own care decisions being short-changed. (shrink)

Despite mounting evidence that abusive supervision triggers interpersonal aggression, much remains unknown regarding the underlying causal mechanisms within this relationship. We explore the role of turnover intentions as a mediator in the relationship between abusive supervision and subsequent supervisor-rated interpersonal aggression. We use a sample of 324 supervisor–subordinate dyads from nine organizations and find support for this mediation effect. Furthermore, we find that power-distance orientation and perceived human resource support climate, as important boundary conditions, independently interact with abusive supervision (...) to weaken this positive impact on turnover intentions, thereby reducing interpersonal aggression. We also find via turnover intentions that abusive supervision intensifies interpersonal aggression among high power-distance-oriented individuals when the HR support climate is perceived to be low. Theoretical and practical implications are discussed. (shrink)

The process of obtaining informed consent continues to be a contentious issue in clinical and public health research carried out in resource-limited settings. We sought to evaluate this process among human research participants in randomly selected active research studies approved by the School of Medicine Research and Ethics Committee at the College of Health Sciences, Makerere University.

We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. (...) We demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose. (shrink)

On March, 24, 2020, 818 cases of COVID-19 had been reported in New South Wales, Australia, and new cases were increasing at an exponential rate. In anticipation of resource constraints arising in clinical settings as a result of the COVID-19 pandemic, a working party of ten ethicists was convened at the University of Sydney to draft an ethics framework to support resource allocation decisions. The framework guides decision-makers using a question-and-answer format, in language that avoids philosophical and medical (...) technicality. The working party met five times over the following week and then submitted a draft Framework for consideration by two groups of intensivists and one group of academic ethicists. It was also presented to a panel on a national current affairs programme. The Framework was then revised on the basis of feedback from these sources and made publicly available online on April 3, ten days after the initial meeting. The framework is published here in full to stimulate ongoing discussion about rapid development of user-friendly clinical ethics resources in ongoing and future pandemics. (shrink)

Even though management scholars have offered several views on the process of corporate sustainability, these efforts have focused mainly on the technical aspects of sustainability while omitting the fundamental role played by individual moral competences. Therefore, previous work offers an incomplete and somewhat reductionist view of corporate sustainability. In this article, we develop a holistic framework of corporate sustainability in which both the moral and technical aspects of sustainability are considered. We do so by integrating the ethical, normative perspective of (...) the Catholic social teaching with the competitive view of the natural resource-based view. This framework highlights the importance of CST principles and ideas in developing executive moral competences such as moral sensitivity and awareness, and moral cognition and motivation. Moral competences, in turn, influence the organizational selection of environmental strategies, giving leaders the intrinsic motivation to promote both a longer-term stance on corporate sustainability efforts and a relentless search for greener business models. Such strategies move the firm closer towards achieving environmental sustainability. Hence, by bridging the individual, normative-ethical with the organizational, implementational levels of corporate sustainability, our framework provides a more realistic, coherent, and complete perspective on the complex process of achieving corporate sustainability. (shrink)

The study examines the relationship between the strength of an organizationÕs ethical climate and ethical problems involving human resource management. Data were collected through a survey of 1078 human resource managers. The results indicate a statistically significant negative relationship between the strength of an organization'ss ethical climate and the seriousness of ethical violations and a statistically significant positive relationship between an organization'ss ethical climate and success in responding to ethical issues. Thus, interventions that strengthen an organization'ss ethical climate (...) may help manage ethical behavior within organizations. (shrink)

The study examines the relationship between the strength of an organizationÕs ethical climate and ethical problems involving human resource management. Data were collected through a survey of 1078 human resource managers. The results indicate a statistically significant negative relationship between the strength of an organization'ss ethical climate and the seriousness of ethical violations and a statistically significant positive relationship between an organization'ss ethical climate and success in responding to ethical issues. Thus, interventions that strengthen an organization'ss ethical climate (...) may help manage ethical behavior within organizations. (shrink)

In this paper I attempt a moral justification of protecting wild species, ecosystems, and landscapes, a justification not directly grounded in appeals to human benefit. I begin with a description of anthropocentric and ecosystemic approaches to the valuing of nature and offer some empirical arguments in support of the ecosystemic view. I suggest that human beings have a genetic need for natural environments, and that the direct experience of wild nature is an intrinsic good. Theoretical coherence and scope is another (...) advantage of the ecological perspective over the anthropocentric view. Turning to moral psychology, I argue that human beings have a fundamental need to care for things outside themselves and that this need is suitably met, and human life enriched, by a transcending concern for the well-being of natural species, habitats, and ecosystems . These considerations are joined with the ecological point of view to yield the conclusion that a self-transcending concern for the welfare of wild species and their habitats enriches the quality of moral life. Persons with genuine reverence and respect for wild creatures and their habitats will enjoy greater fulfilment in their own lives and be better neighbors toeach other. (shrink)

This chapter examines whether an individual’s being worse off than others should be a relevant consideration in the allocation of limited medical resources. It reviews arguments pressed by proponents of different theories of justice about whether being worse off than others makes special demands on health care resource prioritization. Even if there is good reason to restrict the concern for the worse off to those with worse health in the prioritization and allocation of health care resources, additional issues remain. (...) One is how to determine who has worse health, and whether the worse off are those with the worse overall health or those with the most serious medical condition now in need of treatment. Another issue is whether only individuals’ present health, or instead their lifetime health, including past and expected future health, is relevant. (shrink)

Balancing environmental, social, and economic performance is today considered a key responsibility that firms have toward society. As a result, academics, practitioners, and political decision makers are increasingly paying attention to environmental management systems improving a full spectrum of environmental performance. In that regard, even if recent literature suggests that environmental management should be deployed through a cross-functional approach, extant literature mostly focuses on independent functional systems. This paper addresses this gap investigating how the deployment of environmental management in the (...) human resource function—adopting green human resource management practices—and the supply chain function—adopting green supply chain management practices—impact on environmental and financial performance. We draw from a multiple-respondent survey of human resource and supply chain managers in multiple industries in Italy. The study suggests that GHRM and GSCM impact on both environmental and financial performance and shows that GHRM and GSCM exert those impacts in a joint fashion. Indeed, our results show that GSCM plays a mediating role in the relationship between GHRM and performance. Overall, our results provide researchers and managers with relevant insights into the cross-functional deployment of the environmental values and principles across functions. (shrink)

As the USA contends with another surge in COVID-19 cases, hospitals may soon need to answer the unresolved question of who lives and dies when ventilator demand exceeds supply. Although most triage policies in the USA have seemingly converged on the use of clinical need and benefit as primary criteria for prioritisation, significant differences exist between institutions in how to assign priority to patients with identical medical prognoses: the so-called ‘tie-breaker’ situations. In particular, one’s status as a frontline healthcare worker (...) has been a proposed criterion for prioritisation in the event of a tie. This article outlines two major grounds for reconsidering HCW prioritisation. The first recognises trust as an indispensable element of clinical care and mistrust as a hindrance to any public health strategy against the virus, thus raising concerns about the outward appearance of favouritism. The second considers the ways in which proponents of HCW prioritisation deviate from the very ‘ethics frameworks’ that often preface triage policies and serve to guide resource allocation—a rhetorical strategy that may undermine the very ethical foundations on which triage policies stand. By appealing to trust and consistency, we re-examine existing arguments in favour of HCW prioritisation and provide a more tenable justification for adjudicating on tie-breaker events during crisis standards of care. (shrink)

The paper presents a new logic for reasoning about the formation of beliefs through perception or through inference in non-omniscient resource-bounded agents. The logic distinguishes the concept of explicit belief from the concept of background knowledge. This distinction is reflected in its formal semantics and axiomatics: we use a non-standard semantics putting together a neighborhood semantics for explicit beliefs and relational semantics for background knowledge, and we have specific axioms in the logic highlighting the relationship between the two concepts. (...) Mental operations of perceptive type and inferential type, having effects on epistemic states of agents, are primitives in the object language of the logic. At the semantic level, they are modelled as special kinds of model-update operations, in the style of dynamic epistemic logic. Results about axiomatization, decidability and complexity for the logic are given in the paper. (shrink)

BackgroundAn ethics reflection group is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark.MethodsThis is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis (...) of significance.ResultsA recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG.ConclusionThis study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives. (shrink)

Human resource management risks are due to the failure of employer organization to use relevant human resources reasonably and can result in tangible or intangible waste of human resources and even risks; therefore, constructing a practical early warning model of human resource management risk is extremely important for early risk prediction. The back propagation neural network is an information analysis and processing system formed by using the error back propagation algorithm to simulate the neural function and structure of (...) the human brain, which can handle complex and changeable things that do not have an obvious linear relationship between output results and input factors, so as to find the objective connection between the two. Based on the summary and analysis of previous research works, this article expounded the research status and significance of early warning for human resource management risks, elaborated the development background, current status, and future challenges of the BP neural network, introduced the method and principle of the BP neural network’s connection weight calculation and learning training, performed the risk inducement analysis, index system establishment, and network node selection of human resource management, constructed an early warning model of human resource management risk based on the BP neural network, conducted the risk warning model training and detection based on the BP neural network, and finally carried out a simulation and its result analysis. The study results show that the early warning model of human resource management risk based on the BP network is effective, and this trained and tested BP network risk warning model can be used to conduct early warning empirical research on human resource risks to prevent human resource risks, ensure enterprise’s benign operation, and at the same time play a role in supervision and promotion of market order rectification. (shrink)

This research focuses on the employee loyalty aspect of private hospitals in Pakistan during the COVID-19 pandemic, seriously impacted by strict work demand and work-family conflict. To manage this issue, social rewards and psychological rewards played a role as a mediator. The study uses a causal research design with a correlational study design in a non-contrived environment. Minimal researcher interference has been assured. AMOS 24 has been used to deal with the mediation in study design with bootstrap methodology. The study (...) was conducted on 250 nurses of different private hospitals across Punjab province using a proportionate stratified sampling technique. A finding of this study suggests that nurses remain loyal to their organizations despite having uncompromising work demands and facing work-family conflict when they are provided with social and psychological rewards on their job by their organizations. (shrink)

The reductive, as opposed to deductive, view of logic is the form of logic that is, perhaps, most widely employed in practical reasoning. In particular, it is the basis of logic programming. Here, building on the idea of uniform proof in reductive logic, we give a treatment of logic programming for BI, the logic of bunched implications, giving both operational and denotational semantics, together with soundness and completeness theorems, all couched in terms of the resource interpretation of BI’s semantics. (...) We use this set-up as a basis for exploring how coalgebraic semantics can, in contrast to the basic denotational semantics, be used to describe the concrete operational choices that are an essential part of proof-search. The overall aim, toward which this paper can be seen as an initial step, is to develop a uniform, generic, mathematical framework for understanding the relationship between the deductive structure of logics and the control structures of the corresponding reductive paradigm. (shrink)

The 21st century is characterized by an unpredictable and challenging work environment, and the Intrapreneurial Self-Capital (ISC) career and life construct can be seen as a core of individual intrapreneurial resources that enables people to cope with ongoing challenges, changes, and transitions founding innovative solutions when confronted with the constraints imposed by such an environment. The ISC is a challenging construct since it can enhance behavior and attitudes through specific training, unlike personality traits, which are considered substantially stable in the (...) literature. Against this background, the present study examined the relationship between ISC and well-being (hedonic well-being and eudaimonic well-being) controlling for the effects of personality traits. The Big Five Questionnaire (BFQ), the Intrapreneurial Self-Capital Scale (ISCS), the Satisfaction With Life Scale (SWLS), and the Flourishing Scale (FS) were administered to 258 Italian workers. Hierarchical regression analyses showed that ISC explained a percentage of incremental variance beyond that explained by personality traits in relation to both life satisfaction and flourishing. These results indicate that ISC is a key resource for hedonic well-being and eudaimonic well-being and that it offers new research and intervention opportunities. (shrink)

This article discusses the function, development and maintenance of meaning and the importance of meaning-making from different perspectives, as it is based on a collaboration between professionals from health science and psychology. The aim is to discuss how meaning-making processes can be employed in the health context to enhance individuals’ well-being. Starting point is a description of the common basis of the understanding of meaning-making. Afterwards brief examples from the different professional areas will show how meaning-making can improve health care (...) practice. We will focus on the processual nature of meaning-making, its existential layers, as well as the ways in which meaning-making is at play in everyday activities and limit situations, such as illness or suicidality. (shrink)

Artificial intelligence is increasingly inputting into various human resource management functions, such as sourcing job applicants and selecting staff, allocating work, and offering personalized career coaching. While the use of AI for such tasks can offer many benefits, evidence suggests that without careful and deliberate implementation its use also has the potential to generate significant harms. This raises several ethical concerns regarding the appropriateness of AI deployment to domains such as HRM, which directly deal with managing sometimes sensitive aspects (...) of individuals’ employment lifecycles. However, research at the intersection of HRM and technology continues to largely center on examining what AI can be used for, rather than focusing on the salient factors relevant to its ethical use and examining how to effectively engage human workers in its use. Conversely, the ethical AI literature offers excellent guiding principles for AI implementation broadly, but there remains much scope to explore how these principles can be enacted in specific contexts-of-use. By drawing on ethical AI and task-technology fit literature, this paper constructs a decision-making framework to support the ethical deployment of AI for HRM and guide determinations of the optimal mix of human and machine involvement for different HRM tasks. Doing so supports the deployment of AI for the betterment of work and workers and generates both scholarly and practical outcomes. (shrink)

Accountability for Reasonableness has gained international acceptance as a framework to assist with resource allocation within healthcare. Despite this, one of the four conditions, the relevance condition, has not been widely adopted. In this paper I will start by examining the relevance condition, and the constraints placed on it by Daniels and Sabin. Following this, I review the theoretical limitations of the condition identified to date, by prominent critics such as Rid, Friedman, Lauridsen and Lippert—Rasmussen. Finally, I respond to (...) Daniels and Sabin’s enthusiasm for testing the accountability for reasonableness framework in different contexts, by evaluating the challenges of implementing the relevance condition within the NHS. I use the funding of treatments for patients on the basis of their exceptional circumstances as a case study to examine whether the relevance condition could be applied in practice. (shrink)

BackgroundRespecting patients’ confidentiality is an ethical and legal responsibility for health professionals and the cornerstone of care excellence. This study aims to assess health professionals’ knowledge, attitudes, and associated factors towards patients’ confidentiality in a resource-limited setting.MethodsInstitutional based cross-sectional study was conducted among 423 health professionals. Stratified sampling methods were used to select the participants, and a structured self-administer questionnaire was used for data collection. The data was entered using Epi-data version 4.6 and analyzed using SPSS, version 25. Bi-variable (...) and multivariable binary logistic regression analyses were used to measure the association between the dependent and independent variables. Odds ratio with 95% confidence intervals and P value was calculated to determine the strength of association and to evaluate statistical significance.ResultOut of 410 participants, about 59.8% with [95% CI (54.8–68.8%)] and 49.5% with [95% CI (44.5–54.5%)] had good knowledge and favorable attitude towards patents confidentiality respectively. Being male (AOR = 1.63, 95% CI [1.03–2.59]), taking training on medical ethics (AOR = 1.73, 95% CI = [1.11–2.70]), facing ethical dilemmas (AOR = 3.07, 95% CI [1.07–8.79]) were significantly associated factors for health professional knowledge towards patients’ confidentiality. Likewise, taking training on medical ethics (AOR = 2.30, 95% CI [1.42–3.72]), having direct contact with the patients (AOR = 3.06, 95% CI [1.12–8.34]), visiting more patient (AOR = 4.38, 95% CI [2.46–7.80]), and facing ethical dilemma (AOR = 3.56, 95% CI [1.23–10.26]) were significant factors associated with attitude of health professionals towards patient confidentiality.ConclusionThe findings of this study revealed that health professionals have a limited attitude towards patient confidentiality but have relatively good knowledge. Providing a continuing medical ethics training package for health workers before joining the hospital and in between the working time could be recommended to enhance health professionals’ knowledge and attitude towards patient confidentiality. (shrink)

BackgroundPromoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been intense debate within (...) academic bioethics literature seeking to define the benefits, the beneficiaries, and the scope of obligations for providing these benefits. Although this debate may be indicative of willingness at the international level to engage with the responsibilities of researchers involved in global health research, it remains unclear which forms of benefits or beneficiaries should be considered. International and local research ethics guidelines are reviewed here to delineate the guidance they provide.MethodsWe reviewed documents selected from the international compilation of research ethics guidelines by the Office for Human Research Protections under the US Department of Health and Human Services.ResultsAccess to interventions being researched, the provision of unavailable health care, capacity building for individuals and institutions, support to health care systems and access to medical and public health interventions proven effective, are the commonly recommended forms of benefits. The beneficiaries are volunteers, disease or illness affected communities and the population in general. Interestingly however, there is a divide between "global opinion" and the views of particular countries within resource poor settings as made explicit by differences in emphasis regarding the potential benefits and the beneficiaries.ConclusionAlthough in theory benefit sharing is widely accepted as one of the means for promoting the social value of international collaborative health research, there is less agreement amongst major guidelines on the specific responsibilities of researchers over what is ethical in promoting the social value of research. Lack of consensus might have practical implications for efforts aimed at enhancing the social value of global health research undertaken in resource poor settings. Further developments in global research ethics require more reflection, paying attention to the practical realities of implementing the ethical principles in real world context. (shrink)

Background Increase in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of research has been closely associated with providing fair benefits to various (...) stakeholders involved in research. The debate over what constitutes fair benefits; whether those that addresses micro level issues of justice or those focusing on the key determinants of health at the macro level has continued. This debate has however not benefited from empirical work on what stakeholders consider fair benefits. This study explores practical experiences of stakeholders involved in global health research in Kenya, over what benefits are fair within a developing world context. Methods and results We conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups. The range of benefits articulated by stakeholders addresses both micro and macro level concerns for justice by for instance, seeking to engage with interests of those facilitating research, and the broader systemic issues that make resource poor settings vulnerable to exploitation. We interpret these views to suggest a need for global health research to engage with current crises that face people in these settings as well as the broader systemic issues that produce them. Conclusion Global health research should provide benefits that address both the micro and macro level issues of justice in order to forestall exploitation. Embracing the two is however challenging in terms of how the various competing interests/needs should be balanced ethically, especially in the absence of structures to guide the process. This challenge should point to the need for greater dialogue to facilitate value clarification among stakeholders. (shrink)

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...) 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

Rural, remote, and northern Indigenous communities in Canada frequently face limited access to healthcare services with ongoing physician and staff shortages, inadequate infrastructure, and resource challenges. These healthcare gaps have produced significantly poorer health outcomes for people living in remote communities than those living in southern and urban regions who have timely access to care. Telehealth has played a critical role in bridging long-standing gaps in accessing healthcare services by connecting patients and providers across distance. While the adoption of (...) telehealth in Northern Saskatchewan is growing, its initial implementation faced several barriers related to limited and stretched human and financial resources, infrastructure challenges such as unreliable broadband, and a lack of community involvement and engaged decision-making. Emerging ethical issues during the initial implementation of telehealth in community contexts have been wide ranging including concerns around privacy that have also shaped patients’ experiences and particularly the need to consider place and space within rural contexts. Drawing from a qualitative study with four Northern Saskatchewan communities, this paper offers critical perspectives on the resource challenges and place-based considerations that are shaping telehealth in the Saskatchewan context and provides recommendations and lessons learned that could inform other Canadian regions and countries. This work responds to the ethics of tele-healthcare in rural communities in Canada and contributes perspectives of community-based service providers, advisors, and researchers. (shrink)

ArgumentSince the 1970s, Danish population registries were increasingly used for research purposes, in particular in the health sciences. Linked with a large number of disease registries, these data infrastructures became laboratories for the development of both information technology and epidemiological studies. Denmark's system of population registries had been centralized in 1924 and was further automated in the 1960s, with individual identification numbers (CPR-numbers) introduced in 1968. The ubiquitous presence of CPR-numbers in administrative routines and everyday lives created a continually growing (...) data archive of the entire population. The resulting national-level database made possible unprecedented record linkage, a feature epidemiologists and biomedical scientists used as a resource for population health research. The specific assemblages that emerged with their practices of data mining were constitutive of registry-based epidemiology as a style of thought and of a distinct relationship between science, citizens, and the state that emerged as “Scandinavian.”. (shrink)

This paper expands on “An Ethics Framework for Making Resource Allocation Decisions within Clinical Care: Responding to COVID-19,” which is also published in this special issue of the Journal of Bioethical Inquiry. I first describe and explain the steps we took to develop this framework, drawing on previous experience and literature to explain what frameworks can and cannot do. I distinguish frameworks from other kinds of guidance and justify why our framework takes the form it does. Our key aim (...) was to help answer practical questions faced by frontline clinicians. I then explain some of the normative issues that shape the content of the framework itself. Here, I engage critically with the resource allocation literature and justify the particular positions that we take in the framework. Although we undertook this work to address resource allocation decisions anticipated during the unfolding COVID-19 pandemic, it will also serve as an example for others who wish to design practical ethics frameworks for other bioethical issues that will emerge in the future. (shrink)

Past research reveals a tension between children's preferences for egalitarianism and ingroup favoritism when distributing resources to others. Here we investigate how children's evaluations and expectations of others' behaviors compare. Four- to 10-year-old children viewed events where individuals from two different groups distributed resources to their own group, to the other group, or equally across groups. Groups were described within a context of intergroup competition over scarce resources. In the Evaluation condition, children were asked to evaluate which resource distribution (...) actions were nicer. In the Expectation condition, children were asked to predict which events were more likely to occur. With age, children's evaluations and expectations of others' actions diverged: Children evaluated egalitarian actions as nicer yet expected others to behave in ways that benefit their own group. Thus, children's evaluations about the way human social actors should behave do not mirror their expectations concerning those individuals' actions. (shrink)

In this article I attempt to reconcile two seemingly conflicting theorisations of love, the one elaborated by Roy Bhaskar as part of his philosophy of meta-Reality and Anna G. Jónasdóttir’s historical materialist-radical feminist theory of love power. While Bhaskar emphasises the essentially non-dual character of love, envisioning it as a ‘no-lose situation’, Jónasdóttir stresses the antagonistic features structuring love relations by conceptualising love as a productive power that men tend to exploit women of. Rather than seeing these accounts as mutually (...) exclusive I show that they can be reconciled by aid of the general ontology elaborated by Bhaskar in his philosophy of meta-Reality. (shrink)

The rule of rescue describes the moral impulse to save identifiable lives in immediate danger at any expense. Think of the extremes taken to rescue a small child who has fallen down a well, a woman pinned beneath the rubble of an earthquake, or a submarine crew trapped on the ocean floor. No effort is deemed too great. Yet should this same moral instinct to rescue, regardless of cost, be applied in the emergency room, the hospital, or the community clinic? (...) -/- In health care, the desire to save lives at any cost must be reconciled with the reality of resource scarcity. As one example, the estimated cost for prophylactic Factor VIII to treat one patient with hemophilia for one year is $300,000. Costs of this magnitude have been accepted by public and private insurers in the developed world, even though, in principle, these sums could provide greater overall health benefit if allocated to pay for the unmet health care needs of many other patients. Looking forward, however, broad application of the rule of rescue will be increasingly untenable. But the moral instinct will remain: the desire to help those weakest among us, especially when their small numbers allow us to see them as unique individuals. What, then, is the ethical framework that can guide coverage and reimbursement decisions for orphan drugs into the future? (shrink)

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...) 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

This article addresses two longstanding challenges for human resource (HR) managers; how far they can and should represent the interests of both management and workers and how they can gain the power to do so. Adopting a Kantian perspective, it is argued that to pursue an ethical human resource management (HRM), HR managers need to go some way to resolving both. Three possible avenues are considered. Contemporary approaches to organisation of the HR role associated with the work of (...) Ulrich are explored as a means of enhancing power, but rejected on the basis of research evidence as unlikely to succeed. Promotion of worker outcomes in the context of developing the link between HRM and performance offers the potential for a more ethical HRM but has not been seized by most HR managers. Finally, implementation of legislative and moral requirements to promote quality of working life is explored through the case of bullying at work. This highlights the boundaries of the HR role in a context of limited power and leads to the conclusion that it is unrealistic to look to HR managers, or at least HR managers alone, to achieve an ethical HRM. (shrink)

This paper addresses the sliding mode control problem for a class of networked control systems with long time delay and consecutive packet dropout. A new modeling method is proposed, through which time delay and packet dropout are modeled in a unified model described by one Markov chain. To avoid the chattering problem of classic reaching law, a new chattering-free reaching law is proposed. Then with a focus on the problem that controller-actuator channel network condition cannot be foreseen by the controller, (...) a new compensation strategy is proposed, which can effectively compensate for the effect of time delay and packet dropout in controller-actuator channel. Finally, a simulation example is presented to demonstrate the effectiveness of the proposed approach. (shrink)

On the basis of the Conservation of Resource theory and using the Job Demands-Resources model, this study examines the relationships among job demands and job resources of online teaching, perceived instructional efficacy of OT, mindfulness in teaching, and emotional exhaustion to understand the psychological stress experienced by teachers engaged in OT and how mindfulness has moderating effects on relieving anxiety and preventing burnout. A total of 476 teachers with OT experience completed online a self-report survey with items adapted from (...) related scales. The hypotheses were validated using structural equation modeling. Causal relationships were assessed using path analysis, and multi-group analysis was performed to examine the moderating effect of MiT. JD-OT has significant and negative impact on PIE-OT, JR-OT has significant and positive impact on PIE-OT, and PIE-OT has significant and negative impact on EE. Moreover, PIE-OT mediates the positive relationship of JD-OT with EE and the negative relationship of JR-OT with EE. The moderating role of MiT in the relationship of JD-OT and JR-OT with PIE-OT was also validated. In OT work environments, teachers have great need and desire for JR, which can have a positive impact on PIE. Mindfulness training contributes to improving OT efficacy and reducing EE. Enhancing teachers’ MiT enables them to deal with demands from work and their superiors and motivates them to respond with ease to the stressful external environment. (shrink)

This paper explores the character of emotion and its value in understanding ethical dilemmas in work organisations. Specifically, we examine the emotional labour of human resource professionals. Through in-depth interviews and diary study, we uncover the emotional and ethical struggles of HRPs as they search for the ‘right thing to do’ in situated interaction. Through the lens of emotion, we chart the process of how the very framing of what is deemed ‘right’ can move from the social to the (...) moral order and vice versa. Based on our findings, we contribute to understanding the linkages between emotional and ethical dilemmas, and how expectations of multiple ‘others’ at the individual, interpersonal and organisational level shape and constrain ethical choices. (shrink)

The COVID-19 pandemic has strained healthcare resources the world over, requiring healthcare providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped-down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave, we sought to make (...) such ramp down decisions more prudently and ethically. We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that a diverse range of stakeholder perspectives were represented in this development process. This team, called the clinical activity recovery team, established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria by using a variation on the well-known accountability for reasonableness ethical framework. The result of this is a stepwise, semiquantitative, ethical decision tool that can be applied to resource allocation challenges in order to reach fair and ethically defensible decisions. This ethical decision tool can be applied in various contexts and may prove useful at both the institutional and the departmental level; indeed this is how it is applied at our centre. As the second wave of COVID-19 strains healthcare resources, this tool can help clinical leaders to make fair decisions. There are no data in this work. (shrink)

Multi-stakeholder initiatives claim to make production of commodities more socially and environmentally sustainable by regulating their members and through systems of certification. These claims, however, are highly contested. In this article, I examine how actors use MSI regulation with regard to land conflicts with a focus on the Roundtable on Sustainable Palm Oil. MSIs are a resource that actors in land conflicts can use to generate evidence that gives them leverage in their negotiations. To do so, actors employ the (...) interrelations between two kinds of land conflict: localized land conflicts between local land users, and disputes between more distant actors over aggregated land-use related to the sustainability of palm oil production. To demonstrate this, I use the notion of assemblage in two case studies from Sumatra, Indonesia. Thinking in terms of assemblage allows the contradictory but interrelated practices that shape MSIs to be understood. In distinct locally embedded processes, actors enact MSIs in contexts of unequal power relations, from which MSI governance emerges. The way in which access to an MSI is distributed among contending actors shapes MSI enactments and thus its governance. The unequal distribution of access to the RSPO results in a governance that favors companies over communities. (shrink)

In order to understand the system wherein human resource management practices are determined by the interactions of a complex system of actors, it is necessary to have a conceptual framework of analysis. In this respect, the works of scholars concerning stakeholder theory opened new perspectives in management theory. An organisation is understood as being part of a politico-economic system of stakeholders who interact and influence management practices. Each stakeholder tries to optimise and protect his interests, 61-75). The framework of (...) stakeholder analysis enables escape from a purely instrumental approach to HRM, and avoids reducing our understanding of conflicts within companies to mere antagonism between employees and their employers. It enables us to point out the existence of other stakeholders in the relationship. Notably, it allows for the incorporation into management theory of actors from the sphere of politics as well as their dependent administrations. All these actors are considered to be stakeholders who define the legal framework of firm management and guarantee the application of these laws. (shrink)