BackgroundPediatricians in developing countries face different ethical dilemmas than do doctors working in settings with more resources. There are very few studies from developing countries analyzing pediatricians’ knowledge and attitudes regarding the ethical dilemmas that arise in such settings. To address this gap, we explored the clinical ethical knowledge, attitude and experience of physicians who are working in the Department of Pediatrics and Child Health of St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.Study populationAll (...) pediatric resident doctors and pediatric consultants who were working in the DPCH of SPHMMC in December, 2020.MethodA structured pretested self-administered questionnaire was distributed to all 79 of the residents and consultants in the department during the period December 15–27, 2020. The questionnaire assessed the knowledge, attitude and experiences of the study participants regarding a variety of bioethical issues. Data were analyzed using SPSS version 20.0 for windows. The mean, median, standard deviation, and interquartile range of respondents’ scores were determined and compared using Fisher’s exact test.ResultA total of 59/79 physicians completed the questionnaire. The mean age of the participants was 30.7 ± 4.1 years. Thirty six were female. At the time of data collection, more than half served < 5 years as a physician. The mean ethics knowledge score of the respondents was 12.3 ± 2.34 out of 23 knowledge questions. The lowest and highest knowledge scores were 8 and 19 respectively. Scores were highest on questions about confidentiality and lowest on questions about genetic testing and diagnosis. Only 13 physicians agreed with the practice of children should never be treated without consent of the parent. ConclusionTertiary care pediatricians at one hospital in Ethiopia lack knowledge about current standards in bioethics. There is a need for more ethics education in this setting. (shrink)

Starting from a pragmatist point of view the paper dismisses the argument that ethical conduct is always based on knowledge of justifying and applying rules. In a first section I show that Plato and Kant already claimed that the originality of the ethical can’t be represented as either propositional knowledge or a norm, but is instead given to us in a way that is never fully available for our rational grasp. In a second section, I will (...) address the ethical conclusions James and Dewey draw from the fact that ethical demands can’t be translated into forms of knowledge. In a third section, I conclude with an argument for the originality of the ethical based on the thoughts of Stanley Cavell, stating that it is always something more than a mere competence in the sense of a knowledge of rules. (shrink)

Knowledge about human wellbeing is a central part of ethical knowledge. But it is a neglected topic not only in ethics in general, but also in wellbeing theorizing, which has focused on enumerating the basic elements of wellbeing rather than on how to gauge, foster and maintain wellbeing in actual human lives. I consider the prospects for a procedural approach to wellbeing that sees it as depending on a process of continual adjustment between values, preferences, actions and (...) emotions. The value-fulfilment theory of Valerie Tiberius provides a model for such an approach, but needs to be corrected and supplemented in certain respects. I propose a version of the approach that is only partly, but still significantly procedural, and which does not privilege higher-order mental states. Considering the relevance of such an approach for ethics, I finally suggest that (certain forms of) moral agency may be best analyzed as an intersubjective process of adjustment and fulfilment of values and desires (etc.), and as a process of acquiring and exercising collective moral knowing how. (shrink)

The study of sport is characterised by its inter-disciplinarity, with researchers drawing on apparently incompatible research traditions and ethical benchmarks in the natural sciences and the social sciences, depending on their area of specialisation. In this groundbreaking study, Graham McFee argues that sound high-level research into sport requires a sound rationale for one’s methodological choices, and that such a rationale requires an understanding of the connection between the practicalities of researching sport and the philosophical assumptions which underpin them. By (...) examining touchstone principles in research methodology, such as the contested ‘gold standard’ of voluntary informed consent in the natural sciences and the postmodern denial of ‘truth’ in the social sciences, McFee demonstrates that epistemology and ethics are inextricably linked. Drawing on a wide range of examples, from the laboratory to the sports field, McFee explores the concepts of ‘knowledge’ and ‘truth’ in sports research and makes a powerful case for a philosophical deepening of our approach to method and methodology in sport. This book is important reading for all advanced students and researchers working in sport, exercise and related disciplines. (shrink)

How is ethical knowledge possible? One promising answer is Moral Empiricism: we can acquire ethical knowledge through emotional experiences. But Moral Empiricism faces a serious problem. Our emotions are unreliable guides to ethics, frequently failing to fit the ethical status of their objects, so the habit of basing ethical beliefs on one's emotions seems too unreliable to yield knowledge. I develop a new, virtue-epistemic solution to this problem, with practical implications for how we (...) approach ethical decision-making. By exploiting a frequently overlooked connection between reliability and defeaters, I argue that an agent can have a reliable belief-forming habit despite having unreliable emotions. The upshot is that emotion-based ethical knowledge is possible even for people whose emotions are unreliable, but only if we cultivate the skill of noticing and responding to signs that a given emotion is unfitting. (shrink)

This multidisciplinary book brings together a series of critical engagements regarding the notion of ethical practice. As a whole, the book explores the question of how the current neo-liberal socio-political moment, and its relationship to the historical legacies of colonialism, white settlement, and racism, informs and shapes our practices, pedagogies, and understanding of encounters in diverse settings. Drawing largely on the work of Sara Ahmed’s Strange Encounters: Embodied Others in Post-Coloniality, each chapter in this book takes up a particular (...) encounter and unravels the elements that created these meetings in specific times and spaces. Sites of encounters included in this volume range from the classroom to social work practice and from literary to media interactions, and take place both within Canada and internationally. Paramount to the discussions is a consideration of how relations of power and legacies of oppression shape self and others, and draw boundaries between bodies within an encounter. From a social justice perspective, Unravelling Encounters exposes the political conditions that configure our meetings with one another, and inquires into what it means to care, to respond, and to imagine oneself as an ethical subject. (shrink)

The author begins with an outline of Bernard William's moral philosophy, within which he locates William's notorious doctrine that reflection can destroy ethical knowledge. He then gives a partial defence of this doctrine, exploiting an analogy between ethical judgements and tensed judgements. The basic idea is that what the passage of time does for the latter, reflection can do for the former: namely, prevent the re-adoption of an abandoned point of view (an ethical point of view (...) in the one case, a temporal point of view in the other). In the final section the author says a little about how reflection might do this. Footnotes1 This essay is derived from a lecture entitled ‘Bernard Williams’, delivered at Oxford University in 2000, in the series ‘Oxford Philosophers on Oxford Philosophers’, organized by Peter Hacker and David Wiggins. I am grateful to those who attended the lecture, and to Bernard Williams, for helpful comments. (shrink)

Background Medical ethics deals with the ethical obligations of doctors to their patients, colleagues and society. The annual reports of Sri Lanka Medical Council indicate that the number of complaints against doctors has increased over the years. We aimed to assess the level of knowledge, attitude and practice regarding medical ethics among doctors in three teaching hospitals in Sri Lanka. Methods A hospital-based cross-sectional study was conducted among doctors using a pre-tested self-administered, anonymous questionnaire. Chi Squared test, and (...) ANOVA test were used to identify the significance of association between level of knowledge and selected factors. Results Most doctors had a poor level of knowledge on medical ethics, with postgraduate trainees showing significantly higher level of knowledge. The average knowledge on medical ethics among doctors was significantly different between the three hospitals. Over 95% had a favourable attitude towards gaining knowledge and advocated the need for training. The majority indicated awareness of unethical practices. 24.6% of respondents stated that they get a chaperone ‘sometimes’ during patient examination while 3.5% never do. The majority responded that they never accept gifts from pharmaceutical companies in recognition of their prescribing pattern. 12–41% of doctors participated in the study acknowledged that they ‘sometime’ engaged in unethical practices related to prescribing drugs, accepting gifts from pharmaceutical companies and when obtaining leave. Conclusion Most doctors had a poor level of knowledge of medical ethics. Postgraduate trainees had a higher level of knowledge than other doctors. The majority showed a favourable attitude towards gaining knowledge and the need of training. Regular in-service training on medical ethics for doctors would help to improve their knowledge on medical ethics, as well as attitudes and ethical conduct. (shrink)

ObjectiveTo evaluate the relationship between recently trained paediatricians' ethics knowledge and exposure to a formal ethics or professionalism curriculum during residency.MethodsWe conducted a cross-sectional survey of recently trained paediatricians which included a validated 23-item instrument called the Test of Residents' Ethics Knowledge for Pediatrics. The sample included paediatricians who completed medical school in 2006–2008, whose primary specialty was paediatrics or a paediatric subspecialty, and who completed paediatric residency training in 2010–2011. This sample was stratified based on residency programme (...) variables: presence of a formal curriculum in ethics or professionalism, programme size and American Board of Pediatrics certifying exam passage rate. Paediatricians were randomly selected from each stratum for survey participation.ResultsAmong the 370 responding paediatricians (55%), the mean knowledge score was 17.3 (SD 2.2) out of a possible 23. Presence of a formal curriculum in ethics and/or professionalism was not significantly associated with knowledge. Knowledge was lowest on items about parental requests for a child to undergo genetic testing (2 items, 44% and 85% incorrect), preserving patient confidentiality over email (55% incorrect), decision-making regarding life-sustaining technologies (61% incorrect), and decision-making principles such as assent and parental permission (2 items, 47% and 49% incorrect).ConclusionsThis study highlights several areas in which paediatricians' knowledge may be low and that are amenable to targeted educational interventions. These findings should prompt discussion and research among ethicists and educators about how ethics and professionalism curricula can more consistently influence paediatricians' knowledge. (shrink)

This volume is a comprehensive collection of critical essays on The Taming of the Shrew, and includes extensive discussions of the play's various printed versions and its theatrical productions. Aspinall has included only those essays that offer the most influential and controversial arguments surrounding the play. The issues discussed include gender, authority, female autonomy and unruliness, courtship and marriage, language and speech, and performance and theatricality.

This article analyses reflective practice by exploring ethical knowledge-in-use and the influence of context on professional nursing practice. Is ethical knowledge used in an appropriate context? The author identifies and discusses the theoretical underpinnings of reflective practice and offers an alternative paradigm to the generation and use of ethical knowledge in practice. The message to teachers and practitioners is decoded to facilitate teaching and learning.

An old question, still much discussed in moral philosophy, is whether there is any ethical knowledge. It is closely related, by simple etymology, to the question of cognitivism in ethics. Despite the fact that the terms ‘cognitivism’ and ‘objectivism’ seem sometimes to be used interchangeably, I take it that the question whether there can be ethical knowledge is not the same as the question whether ethical outlooks can be objective. A sufficient reason for this is (...) that an ethical outlook might be taken to consist of rules or principles, which do not admit of truth or falsehood and so cannot be objects of knowledge, but which can be seen as having an objective basis. (shrink)

Die Wissensvermittlung in Gesundheitsethik ermöglicht es Auszubildenden der Pflege, sich in ihrer zukünftigen Tätigkeit bei Entscheidungsprozessen des Behandlungsteams hinsichtlich pflegeethischer Fragestellungen einzubringen. Vor diesem Hintergrund wurde anhand der vorliegenden Studie die Entwicklung moralischer Positionen sowie pflegeethischer Kenntnisse von Pflegeauszubildenden sichtbar gemacht. An zwei Krankenpflegeschulen (Berlin und Fürth) wurden im Rahmen einer Panelstudie von August 2010 bis März 2011 Daten einer ersten Querschnittserhebung von Auszubildenden in der Pflege erhoben. Für die Studie wurde ein strukturierter Fragebogen verwendet. Die Studienteilnahme erfolgte freiwillig. Alle (...) Auszubildenden hatten vor der Befragung in unterschiedlichem Umfang Unterricht in Gesundheitsethik erhalten. An beiden Standorten zeigten die Teilnehmenden einen Zuwachs an pflegeethischen Kenntnissen. Auszubildende, die bislang keine praktische Erfahrung mit Sterbehilfe gemacht hatten, zeigten Schwierigkeiten in der theoretischen Handhabung dieser Maßnahmen. Für alle Auszubildenden zeigte sich ein allgemeiner Trend zu einer Befürwortung des partizipativen Interaktionsmodells und damit zu einer Förderung der Patientenselbstbestimmung. Zugleich schätzten die Studienteilnehmenden die Fähigkeiten von Patienten, medizinisch richtige Therapieentscheidungen zu treffen, als gering ein. Die Ausbildung in Gesundheitsethik besitzt ein großes Potential, Kenntnisse zu vermitteln und dadurch die ethische Kompetenzentwicklung zu befördern. Unsere Ergebnisse werfen die Frage auf, inwieweit es einer Integration praktischer Erfahrungen mit Fragestellungen der Gesundheitsethik bedarf, um eine praxisrelevante und wissenschaftlich fundierte Wissensvermittlung zu gewährleisten. (shrink)

This essay is concerned with Bernard Williams’ contention in Ethics and the Limits of Philosophy that, in ethics, reflection can destroy knowledge. I attempt to defend this contention from the charge of incoherence. I do this by taking seriously the idea that ethical knowledge is knowledge from an ethical point of view. There nevertheless remains an issue about whether the contention is consistent with ideas elsewhere in Williams’ own work, in particular with what he says (...) about knowledge in Descartes. In an earlier essay I argued that it is not. In a subsequent essay I indicated that I had changed my mind and gave a more sympathetic account of Williams’ contention. In this essay I set out the issues and say some more about my change of mind. (shrink)

Its preoccupation with ontology presents radical democracy with a thorny dilemma: how to combine commitment and affirmation with a distinctive emphasis on contingency and contestability. The article addresses this dilemma by engaging with three different perspectives. Ernesto Laclau’s work shows the intrinsic constraints of ontology and the inadequacy of a simple distinction between ontology and ethico-political decision. Simon Critchley opposes tying radical politics to ontological prefiguration and argues for a particular ethico-political orientation. But ethics and politics come entwined with ontological (...) assumptions, and the ethical direction of politics can be as restrictive as its ontological framing. William Connolly weds ontology and ethics to a sharp awareness of their contestability. But his approach does not reach deep enough. It is not alive to the contestability of the very recognition of contestability. To enhance openness and reflexivity, projects of radical democracy should combine a dimension of substantive, detailed accounts with a reflexive commitment to contestability, which disrupts, questions and renews the thicker descriptions in the name of democracy and truth. (shrink)

In the contemporary metaethical debate, expressivist (Blackburn, Gibbard) and constructivist (Korsgaard, Street) views can be viewed as inspired by irrealist ideas from Hume and Kant respectively. One realist response to these contemporary irrealist views is to argue that they are inconsistent with obvious surface-level appearances of ordinary ethical thought and discourse, especially the fact that we talk and act as if there is ethical knowledge . In this paper, I explore some constructivist and expressivist options for responding (...) to this objection. My conclusion is that, although both constructivists and expressivists can capture other surface-level features of ethical thought and discourse, the possibility of ethical knowledge causes special problems for these versions of irrealism. I end with some comments about where I think irrealists should begin to look for a response to these special problems, which points, somewhat surprisingly, towards an alternative inferentialist form of irrealism about epistemic and ethical thought and discourse, which is inspired by Sellars. (shrink)

Introduction The goal of this project was to develop and validate a new tool to evaluate learners' knowledge and skills related to research ethics. Methods A core set of 50 questions from existing computer-based online teaching modules were identified, refined and supplemented to create a set of 74 multiple-choice, true/false and short answer questions. The questions were pilot-tested and item discrimination was calculated for each question. Poorly performing items were eliminated or refined. Two comparable assessment tools were created. These (...) assessment tools were administered as a pre-test and post-test to a cohort of 58 Indian junior health research investigators before and after exposure to a new course on research ethics. Half of the investigators were exposed to the course online, the other half in person. Item discrimination was calculated for each question and Cronbach's α for each assessment tool. A final version of the assessment tool that incorporated the best questions from the pre-/post-test phase was used to assess retention of research ethics knowledge and skills 3 months after course delivery. Results The final version of the REKASA includes 41 items and had a Cronbach's α of 0.837. Conclusion The results illustrate, in one sample of learners, the successful, systematic development and use of a knowledge and skills assessment tool in research ethics capable of not only measuring basic knowledge in research ethics and oversight but also assessing learners' ability to apply ethics knowledge to the analytical task of reasoning through research ethics cases, without reliance on essay or discussion-based examination. These promising preliminary findings should be confirmed with additional groups of learners. (shrink)

Background: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is (...) reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. Research design: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. Participants and research context: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. Ethical considerations: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). Findings: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. Discussion: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. Conclusion: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions. (shrink)

This article reflects one scholar's attempt to locate herself within emerging ethical methodologies given a specific concern with cross-cultural women's moral praxis. The field of comparative ethics's debt to past debates over methodology is considered through a typology of three waves of methodological invention. The article goes on to describe a specific research focus on U.S. Catholic and Iranian Shii women that initiated a search for a distinct method. This method of comparative ethics, which focuses on the production of (...) ethical knowledge through the interaction of discursive logics of various moral agents, is described. The conclusion turns to how methodological invention can itself become a constructive project through the way it (1) locates the scholar in relation to her subject of study and (2) allows for isolation of tactics within specific moral discourses. (shrink)

The author draws on considerable research in this area to provide an overdue critical evaluation of the limits of the market, and future prospects for non-market socialism.

This book defends a form of ethical intuitionism, according to which (i) there are objective moral truths; (ii) we know some of these truths through a kind of immediate, intellectual awareness, or "intuition"; and (iii) our knowledge of moral truths gives us reasons for action independent of our desires. The author rebuts all the major objections to this theory and shows that the alternative theories about the nature of ethics all face grave difficulties.

Background: Healthcare organizations are now challenged to retain nurses’ generation and understand why they are leaving their nursing career prematurely. Acquiring knowledge about the effect of ethical work climate and level of perceived organizational support can help organizational leaders to deal effectively with dysfunctional behaviors and make a difference in enhancing nurses’ dedication, commitment, satisfaction, and loyalty to their organization. Purpose: This study aims to determine the relationship between ethical work climate, and perceived organizational support and nurses’ (...) organizational commitment, job satisfaction, and turnover intention. Methods: A descriptive correlational research design was conducted in all inpatient care units at three major hospitals affiliated to different health sectors at Alexandria governorate. All nurses working in these previous hospitals were included in the study (N = 500). Ethical Climate Questionnaire, Survey of Perceived Organizational Support, Organizational Commitment Questionnaire, Index of Job Satisfaction, and Intention to Turnover scale were used to measure study variables. Ethical considerations: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects’ informed consent to participate in the research before data collection. Findings: The result revealed positive significant correlations between nurses’ perception of overall ethical work climate and each of perceived organizational support, commitment, as well as their job satisfaction. However, negative significant correlations were found between nurses’ turnover intention and each of these variables. Also, approximately 33% of the explained variance of turnover intention is accounted by ethical work climate, organizational support, organizational commitment, and job satisfaction, and these variables independently contributed significantly in the prediction of turnover intention. Recommendation: Strategies to foster and enhance ethical and supportive work climates as well as job-related benefits are considered significant factors in increasing nurses’ commitment and satisfaction and decreasing their turnover intention. (shrink)

Targeted modifications of the human epigenome, epigenome editing (EE), are around the corner. For EE, techniques similar to genome editing (GE) techniques are used. While in GE the genetic information is changed by directly modifying DNA, intervening in the epigenome requires modifying the configuration of DNA, for example, how it is folded. This does not come with alterations in the base sequence (‘genetic code’). To date, there is almost no ethical debate about EE, whereas the discussions about GE are (...) voluminous. Our article introduces EE into bioethics by translating knowledge from science to ethics and by comparing the risks of EE with those of GE. We, first (I), make the case that a broader ethical debate on EE is due, provide scientific background on EE, compile potential use-cases and recap previous debates. We then (II) compare EE and GE and suggest that the severity of risks of novel gene technologies depends on three factors: (i) the choice of an ex vivo versus an in vivo editing approach, (ii) the time of intervention and intervention windows and (iii) the targeted diseases. Moreover, we show why germline EE is not effective and reject the position of strong epigenetic determinism. We conclude that EE is not always ethically preferable to GE in terms of risks, and end with suggestions for next steps in the current ethical debate on EE by briefly introducing ethical challenges of new areas of preventive applications of EE (III). (shrink)

Open peer commentary on the article “Ethics: A Radical-constructivist Approach” by Andreas Quale. Upshot: The first of my two main goals in this commentary is to establish thinking of ethics as concepts rather than as non-cognitive knowledge. The second is to argue that establishing models of individuals’ ethical concepts is a scientific enterprise that is quite similar to establishing models of individuals’ mathematical concepts. To accomplish these two primary goals, I draw from my experience of working scientifically with (...) von Glasersfeld for 25 years while he was developing radical constructivism as a coherent model of knowing, and appeal to several of his basic insights to establish constructing models of ethical concepts as a scientific enterprise. (shrink)

Background: Ascertaining the relationship between ethical ideology, moral judgment, and ethical decision among academic nurse educators at work appears to be a challenge particularly in situations when they are faced with a need to solve an ethical problem and make a moral decision. Purpose: This study aims to investigate the relationship between ethical ideology, moral judgment, and ethical decision as perceived by academic nurse educators. Methods: A descriptive correlational research design was conducted at Faculty of (...) Nursing, Alexandria University. All academic nurse educators were included in the study (N = 220). Ethical Position Questionnaire and Questionnaire of Moral Judgment and Ethical Decisions were proved reliable to measure study variables. Ethical considerations: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects’ informed consent. Findings: This study reveals a significant positive moderate correlation between idealism construct of ethical ideology and moral judgment in terms of recognition of the behavior as an ethical issue and the magnitude of emotional consequences of the ethical situation (p < 0.001; p = 0.031) respectively. Also, there is a positive significant moderate correlation between relativism construct of ethical ideology and overall moral judgment (p = 0.010). Approximately 3.5% of the explained variance of overall moral judgment is predicted by idealism together with relativism. Discussion: The findings suggest that variations in ethical position and ideology are associated with moral judgment and ethical decision. Conclusion: Organizations of academic nursing education should provide a supportive work environment to help their academic staff to develop their self-awareness and knowledge of their ethical position and promoting their ethical ideologies and, in turn, enhance their moral judgment as well as develop ethical reasoning and decision-making capability of nursing students. More emphasis in nursing curricula is needed on ethical concepts for developing nursing competencies. (shrink)

Der Unterricht in Medizinethik soll Medizinstudierenden die Grundlagen dafür vermitteln, in ihrer zukünftigen ärztlichen Tätigkeit gute Entscheidungen treffen zu können. Im Rahmen einer Panelstudie wird derzeit die Entwicklung moralischer Positionen, medizinethischer Kenntnisse und Motivationen von Medizinstudierenden der Ludwig-Maximilians-Universität München über den Verlauf des Studiums untersucht. Für die Datenerhebung wurde ein Fragebogen entwickelt, der medizinethische Positionen und Kenntnisse sowie Motivationen erfasst. Im Wintersemester 2009/10 wurde die erste Querschnittsuntersuchung mit Studierenden im 1., 3. und 8. Semester sowie im Praktischen Jahr durchgeführt. Die (...) Mehrzahl der Befragten verfügte über einen geringen Kenntnisstand in verschiedenen Themenbereichen des Unterrichtsfachs GTE. Rechtliche Grundlagen und praktische Umsetzung von Therapiebegrenzungsmaßnahmen waren bis ins PJ-Semester vielen Studierenden nicht bekannt. Im Verlauf des Studiums veränderten sich die Motivationen weg von der Motivation, Menschen helfen zu wollen, hin zu Wissenserwerb und dem Ergreifen eines sicheren Berufs. Obwohl viele Befragte ein hohes Interesse an medizinethischen Fragestellungen und Unterricht im Bereich GTE angaben, zeigte sich kein nachhaltiger Zuwachs an medizinethischen Kenntnissen im Laufe des Studiums. In der Zusammenschau werfen die Ergebnisse die Frage auf, inwieweit verschiedene Ausbildungskonzepte Einfluss auf die individuelle ethische Entwicklung Medizinstudierender nehmen können. Eine Untersuchung dieser Fragestellung bleibt Gegenstand weitergehender Forschung. (shrink)

This article explores the interrelationship among scientific knowledge, ethical debates and the question of responsibility through sustainability thinking. In a globalising world which appears to be establishing itself, sustainability should form the basis for achieving a new ethics, shared on both a local and global scale. The sustainability culture should become an integral part in this process, in which the rights of future generations, of non-human species and global shared resources are taken into account. Sustainable culture is, in (...) fact, an inevitable process that will involve changes in many of the established stances of society, science and ethics. (shrink)

Excerpt: 1. Introduction This chapter provides insight into the diverse ethical debates on genetics and epigenetics. Much controversy surrounds debates about intervening into the germline genome of human embryos, with catchwords such as genome editing, designer baby, and CRISPR/Cas. The idea that it is possible to design a child according to one’s personal preferences is, however, a quite distorted view of what is actually possible with new gene technologies and gene therapies. These are much more limited than the editing (...) and design metaphors suggest. Such metaphors are therefore highly problematic phrases in the context of new gene technologies, for two reasons. On one hand, to design a child of choice by modifying the genome would require modifying any gene of choice, which is more than can be done with current gene technologies, such as CRISPR/Cas. On the other hand, a modification of genes would need to be enough to create any characteristic of choice in the future child. The latter presupposes the assumption of genetic determinism. Moreover, the CRISPR/Cas technology can not only be used in a potentially therapeutic manner at the germline level. In addition, there is the (more likely) scenario of a future clinical therapeutic use of these new gene technologies for modifying the DNA sequence of other cells of the body (somatic genome editing). There is also the option of modifying the epigenome, that is, the spatial configuration of DNA (epigenome editing) (see table 1). Like genetics and genome editing, epigenetics has been at the center of recent popular scientific and ethical discourse as well as scientific debates. The concept of epigenetics has given rise to very different notions of inheritability and responsibility for health, which, however, are oftentimes based on scientifically controversial basic assumptions. That there continues to be covert genetic determinism in the form of epigenetic determinism (see table 2) in debates about epigenetics has been pointed out in ethical analyses of epigenetics. Neither genetic determinism nor epigenetic determinism has been confirmed scientifically. It is therefore important to recognize the concepts that are discussed (and sometimes harshly criticized) in debates about genome editing and epigenetics—for example, concepts about the causal role of DNA for our own life course. This importance is based on the fact that if we understand such controversial concepts, we will be able to remain critical when evaluating scientific knowledge and ethical arguments about genome editing and epigenetics. This chapter, therefore, explains some of these concepts. For an ethical analysis of epigenetics as well as of genome editing, it is necessary to understand and critically reflect upon the underlying concepts of genetic determinism and other, related -isms. The following section offers a detailed introduction to these -isms (section 2; see also table 2). Section 3 provides an ethical analysis of genome editing and epigenetics based on the explanations in section 2. Section 3 focuses on inheritability and responsibility, justice, safety, the problem of consent, and the effects of genome editing and epigenetics on embryos and future generations. This section does not discuss in detail further points that can be found in ethical debates about epigenetics as well as in ethical debates about genome editing. These points include (among others): • fear that the findings of epigenetics and that the methods of genome editing are misused—this also with respect to eugenics and enhancement; • naturalness—an issue we mention in passing a few times in the following analysis; • a possible connection between the genome/epigenome and the concept of human dignity, and the derived danger of instrumentalization and infringement of autonomy when intervening in the genome or epigenome. Since current discourse about ethical issues associated with genome editing focuses mainly on germline interventions, which are, for instance, interventions into a human embryo’s genome, we mainly focus on germline interventions when comparing the debates on genome editing and on epigenetics in section 3. (shrink)

Background With the huge number of patients who suffer from chronic and incurable diseases, medical scientists continue to search for new curative methods for patients in dire need of treatment. Interest in stem cells is growing, generating high expectations in terms of the possible benefits that could be derived from stem cell research and therapy. However, regardless of the hope of stem cells changing and improving lives, there are many ethical, religious, and political challenges and controversies that affect the (...) research, and mandated to establish ethical guidelines and regulations. In Saudi Arabia, key stakeholders play an active role in discussing the ethics of stem cell research and therapy. The focus of the study was to explore professionals’ perceptions related to the ethical challenges of using stem cells in research and treatment in Saudi Arabia. Results A qualitative research study was conducted to explore and describe the perceptions of 25 professionals employed at different tertiary hospitals in the various regions of Saudi. A thematic analysis was performed to search for and identify the most significant perceptions shared by the participants. Four themes were generated based on the ethical challenges of four areas related to stem cell use, including forbidden and permitted sources of stem cells, informed consent, beneficence, and ethical regulations and guidelines. Conclusion The study identified that there is a growing need to advance the knowledge, education, and awareness related to stem cell research and treatment in Saudi Arabia. (shrink)

Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according (...) to the Vancouver Protocol. Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress. (shrink)

The purpose of this article is to report what can be learned about nurses’ ethical conflicts by the systematic analysis of methodologically similar studies. Five studies were identified and analysed for: (1) the character of ethical conflicts experienced; (2) similarities and differences in how the conflicts were experienced and how they were resolved; and (3) ethical conflict themes underlying four specialty areas of nursing practice (diabetes education, paediatric nurse practitioner, rehabilitation and nephrology). The predominant character of the (...) ethical conflicts was disagreement with the quality of medical care given to patients. A significant number of ethical conflicts were experienced as ‘moral distress’, the resolution of which was variable, depending on the specialty area of practice. Ethical conflict themes underlying the specialty areas included: differences in the definition of adequacy of care among professionals, the institution and society; differences in the philosophical orientations of nurses, physicians and other health professionals involved in patient care; a lack of respect for the knowledge and expertise of nurses in specialty practice; and difficulty in carrying out the nurse’s advocacy role for patients. (shrink)

This paper builds on existing research investigating CSR and ethical consumption within luxury contexts, and makes several contributions to the literature. First, it addresses existing knowledge gaps by exploring the ways in which consumers perform ethical luxury purchases of fine jewellery through interpretive research. Second, the paper is the first to examine such issues of consumer ethics by extending the application of theories of practice to a luxury product context, and by building on Magaudda’s :15–36, 2011) circuit (...) of practice framework. This is significant in that, to date, consumer research using practice theories has focused mainly on routine and habitual practices. Our findings and discussion provide an analysis of intentional and less intentional ethical consumer performances within the interconnected nexus of activities of consumers’ fine jewellery consumption practice, where meanings, understandings and intelligibility of social phenomena are worked through the various activities that shape such a practice. Finally, the paper concludes with significant managerial and policy-related implications, as our extended circuit of practice analysis conveys that if ethics and sustainability dimensions are to be embedded in fine jewellery consumption practice, they must first be made an intrinsic part of the nexus of the social and material environment of trading and consumption places. (shrink)

The purpose of this study is to present a rigorous, focused review on how this field of ethical sourcing research has grown and evolved over the decades, providing implications for future research. We combine two research methodologies in this study: a systematic literature review and a citation network analysis. The former is used as a scientific tool to select the most relevant ethical sourcing articles, while the latter is then applied as a research technique to analyse these selected (...) articles. Such a combined approach allows for a rigorous investigation into this field of research in a more scientific and objective way. Based on this approach, we identify distinctive features of ethical sourcing studies such as growth trends and content issues; important articles that have played a significant role in developing this field; evolutionary paths that show how its knowledge has been created and transferred; emerging trends that have received growing attention in the recent literature; main research areas that underlie the entire ethical sourcing studies; and major implications that need to be pursued in future research. The results of this study provide not only the current status of the literature but also the patterns of evolution in this field of research, thus contributing to the existing literature. (shrink)

Research question and aim Clinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020, a CEC was established in an Oncology Research Hospital in the North of Italy. This paper describes the development process and the activities performed 20 months from the CEC’s implementation, to increase knowledge about CEC’s implementation strategy. Research design We collected quantitative data related to number and characteristics of CEC activities (...) carried out from October 2020 to June 2022 using the CEC internal database. Data were reported descriptively and compared with data from the literature to provide a complete overview of the CEC’s development and implementation process. Participants and research context The study has been conducted at the local health authority (LHA) of Reggio Emilia. It is a report of the activities provided by the CEC, where no HPs or patients were involved. Ethical Considerations The report is part of a larger study named EVAluating a Clinical Ethics Committee implementation process (EvaCEC), which has been approved by the Local Ethics Committee (AUSLRE Protocollo n° 2022/0026554 of 24/02/2022). EvaCEC is also the first author's PhD project. Findings In total, the CEC performed 7 ethics consultations (EC), published three policies related to particular ethical questions of clinical and organizational practice, provided one educational online course on ethics consultation targeting employed HPs, and promoted a specific dissemination process among the different departments of the LHA. According to our results, the CEC widely fulfilled the standard threefold set of clinical ethics support services tasks (namely, ethics consultation, ethics education, and policy development), but further investigations are needed to evaluate the CEC’s impact on clinical practice. Conclusion Our findings may increase knowledge regarding the composition, role, and tasks of a CEC in an Italian setting, informing future strategies and efforts to regulate these institutions officially. (shrink)

Artificial intelligence (AI) has sparked interest in various areas, including marketing. However, this exhilaration is being tempered by growing concerns about the moral and legal implications of using AI in marketing. Although previous research has revealed various ethical and legal issues, such as algorithmic discrimination and data privacy, there are no definitive answers. This paper aims to fill this gap by investigating AI’s ethical and legal concerns in marketing and suggesting feasible solutions.,The paper synthesises information from academic articles, (...) industry reports, case studies and legal documents through a thematic literature review. A qualitative analysis approach categorises and interprets ethical and legal challenges and proposes potential solutions.,The findings of this paper raise concerns about ethical and legal challenges related to AI in the marketing area. Ethical concerns related to discrimination, bias, manipulation, job displacement, absence of social interaction, cybersecurity, unintended consequences, environmental impact, privacy and legal issues such as consumer security, responsibility, liability, brand protection, competition law, agreements, data protection, consumer protection and intellectual property rights are discussed in the paper, and their potential solutions are discussed.,Notwithstanding the interesting insights gathered from this investigation of the ethical and legal consequences of AI in marketing, it is important to recognise the limits of this research. Initially, the focus of this study is confined to a review of the most important ethical and legal issues pertaining to AI in marketing. Additional possible repercussions, such as those associated with intellectual property, contracts and licencing, should be investigated more deeply in future studies. Despite the fact that this study gives various answers and best practices for tackling the stated ethical and legal concerns, the viability and efficacy of these solutions may differ depending on the context and industry. Thus, more research and case studies are required to evaluate the applicability and efficacy of these solutions in other circumstances. This research is mostly based on a literature review and may not represent the experiences or opinions of all stakeholders engaged in AI-powered marketing. Further study might involve interviews or surveys with marketing professionals, customers and other key stakeholders to offer a full knowledge of the practical difficulties and solutions. Because of the rapid speed of technical progress, AI’s ethical and regulatory ramifications in marketing are continually increasing. Consequently, this work should be a springboard for more research and continuing conversations on this subject.,This study’s findings have several practical implications for marketing professionals. Emphasising openness and explainability: Marketing professionals should prioritise transparency in their use of AI, ensuring that customers are fully informed about data collection and utilisation for targeted advertising. By promoting openness and explainability, marketers can foster customer trust and avoid the negative consequences of a lack of transparency. Establishing ethical guidelines: Marketing professionals need to develop ethical rules for the creation and implementation of AI-powered marketing strategies. Adhering to ethical principles ensures compliance with legal norms and aligns with the organisation’s values and ideals. Investing in bias detection tools and privacy-enhancing technology: To mitigate risks associated with AI in marketing, marketers should allocate resources to develop and implement bias detection tools and privacy-enhancing technology. These tools can identify and address biases in AI algorithms, safeguard consumer privacy and extract valuable insights from consumer data.,This study’s social implications emphasise the need for a comprehensive approach to address the ethical and legal challenges of AI in marketing. This includes adopting a responsible innovation framework, promoting ethical leadership, using ethical decision-making frameworks and conducting multidisciplinary research. By incorporating these approaches, marketers can navigate the complexities of AI in marketing responsibly, foster an ethical organisational culture, make informed ethical decisions and develop effective solutions. Such practices promote public trust, ensure equitable distribution of benefits and risk, and mitigate potential negative social consequences associated with AI in marketing.,To the best of the authors’ knowledge, this paper is among the first to explore potential solutions comprehensively. This paper provides a nuanced understanding of the challenges by using a multidisciplinary framework and synthesising various sources. It contributes valuable insights for academia and industry. (shrink)