Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, Switzerland. A (...) Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives. (shrink)

The Kimberley Process Certification Scheme is an innovation in global governance that combines a voluntary industry-led certification system with an inter-state import/export control regime. States, industry, and activists speedily negotiated it in large part due to the concentrated structure of the industry, and the complementary nature of emerging norms regarding both corporate behavior and international intervention in civil conflicts. The potential strength of the Kimberley Process lies in its state-led border controls, but these are being undermined by weak national governments. (...) This effort may not provide an effective model for regulating other "conflict commodities" because of the unique character of the diamond market. (shrink)

Goldberg notes that the relationship is a component of Conflicts of Interests. Networks of relationships and the simultaneous presence of several interests are not negative per se but become so when they generate a conflict that undermines impartiality. The solution to the problem of COIs, therefore, cannot be to abolish relationships and the interests that they necessarily express but rather to verify whether those relationships are such as to unduly affect an individual’s judgement. The evolution of an Italian legislation (...) about COIs is eloquent in this regard. (shrink)

Dixon et al. overlook the fact that contact predicts not only favorable out-group attitudes/evaluations, but also cognitions, affect, and behavior. The weight of evidence supporting the benefits of intergroup contact cautions against throwing the (contact) baby out with the bathwater. The goal to “ignite struggles” in pursuit of social equality, we argue, incautiously risks hurling us down the proverbial rabbit hole.

At least since the time of Hippocrates, the physician-patient relationship has been the paradigmatic ethical arrangement for the provision of medical care. Yet, a physician-patient relationship does not exist in every professional interaction involving physicians and individuals they examine or treat. There are several “third-party” relationships, mostly arising where the individual is not a patient and is merely being examined rather than treated, the individual does not select or pay the physician, and the physician's services are provided for the benefit (...) of another party. Physicians who treat NFL players have a physician-patient relationship, but physicians who merely examine players to determine their health status have a third-party relationship. As described by Glenn Cohen et al., the problem is that typical NFL team doctors perform both functions, which leads to entrenched conflicts of interest. Although there are often disputes about treatment, the main point of contention between players and team physicians is the evaluation of injuries and the reporting of players’ health status to coaches and other team personnel. Cohen et al. present several thoughtful recommendations that deserve serious consideration. Rather than focusing on their specific recommendations, however, I would like to explain the rationale for two essential reform principles: the need to sever the responsibilities of treatment and evaluation by team physicians and the need to limit the amount of player medical information disclosed to teams. (shrink)

While ethical conflicts in the provision of healthcare are common, the current third-party mediator model is limited by a lack of expert ethical mediators, who are often not on site when conflict escalates. In order to improve clinical outcomes in situations such as conflicts at the end of life, we suggest that clinicians—physicians, nurses and social workers—be trained to prevent and deescalate emerging conflicts. This can be achieved using a mediation model framed by a communication-training approach. A case example (...) is presented and the model is discussed. The implication of this preventative/early intervention model for improving clinical outcomes, in particular end-of life conflict, is considered. (shrink)

National revival is a process of forming a national consciousness that appears as the unity of the national psyche and national ideology. An important element of national consciousness is the national idea. This broad concept is revealed in the historical, political, legal, cultural, moral and philosophical plans.

Volume 31, Issue 1, December 2020, Page 47-66.

From an ethical point of view, there is an important distinction between two types of prenatal screening. The first of these targets maternal or foetal conditions (e.g., infectious diseases, blood group sensitization) where early detection allows for interventions that improve the chances of a healthy pregnancy outcome. The second screens for foetal conditions such as Down syndrome, where a timely diagnosis in most cases only allows for a choice between preparation for a child with special needs or termination of the (...) pregnancy. Whereas the former makes an easy fit with the prevention aim of most other population screening programmes, the latter does not. In order to steer clear from a possible eugenic reading of its aim, a wide international consensus has emerged for the view that prenatal screening of this type should have the atypical aim of helping women (couples) to make autonomous reproductive choices, rather than reducing the birth prevalence of the relevant disorders. However, keeping these types of prenatal screening apart may become increasingly difficult given the development of tests, such as the Non‐Invasive Prenatal Test, which cannot only be used for both types of screening but may also lead to interconnected findings on both sides of the divide. This makes it an urgent question: What the aim or aims of this new hybrid screening should be? As neither ‘prevention’ nor ‘autonomy’ will do, we argue for a normative framework that gives both aims their due, while recognizing the tensions between them. (shrink)

Background: Ethical conflict is a barrier to decision-making process and is a problem derived from ethical responsibilities that nurses assume with care. Intensive care unit nurses are potentially exposed to this phenomenon. A deep study of the phenomenon can help prevent and treat it. Objectives: This study was aimed at determining the frequency, degree, level of exposure, and type of ethical conflict among nurses working in the intensive care units. Research design: This was a descriptive cross-sectional research. Participants (...) and research context: In total, 382 nurses working in the intensive care units in Iranian hospitals were selected using the random sampling method. Data were collected using the Ethical Conflict in Nursing Questionnaire-Critical Care Version (Persian version). Ethical considerations: This study was approved by the Medical Research Ethics Committee. Ethical considerations such as completing the informed consent form, ensuring confidentiality of information, and voluntary participation were observed. Findings: The results showed that the average level of exposure to ethical conflict was 164.39 ± 79.06. The most frequent conflict was related to “using resources despite believing in its futility,” with the frequency of at least once a week or a month (68.6%, n = 262). The most conflictive situation was violation of privacy (76.9%, n = 294). However, the level of exposure to ethical conflict according to the theoretical model followed was the situation of “working with incompetent staff.” The most frequently observed type of conflict was moral dilemma. Conclusion: The moderate level of exposure to ethical conflict was consistent with the results of previous studies. However, the frequency, degree, and type of ethical conflict were different compared to the results of other studies. Recognizing ethical conflict among intensive care unit nurses can be useful as it allows to consolidate those measures that favor low levels of ethical conflict, design appropriate strategies to prevent ethical conflicts, and improve the nursing work environment. (shrink)

Violence suffered by children is a violation of human rights and a global health problem. Children with disabilities are especially vulnerable to violence in the school environment, which has a negative impact on their well-being and health. Students with disabilities educated in special schools have, in addition, more reduced experiences of interaction that may reduce both their opportunities for learning and for building protective social networks of support. This study analyses the transference of evidence-based actions to prevent violence in schools (...) – the dialogic model of prevention and resolution of conflicts (DMPRC) – in the context of a special school, and its impact on the reduction of violence, the creation of egalitarian relationships, and the prevention of bullying. A case study with a communicative approach was conducted including in-depth interviews and communicative focus groups with the diverse participants to analyze the process of transformation carried out in the school and the main actions that give students a voice in the management and creation of egalitarian non-violent relationships. The results show that the inclusion of the students’ voices in the resolution and prevention of conflicts reduces violence, empowers special education students, strengthens friendship relationships, caring behavior, and active positioning among the community. The positive impact of the transference of the DMPRC to special schools contributes to students’ well-being and healthy development by offering safe and protective educational spaces and quality emotional education, also contributing to the achievement of the Sustainable Development Goals related to the elimination of all forms of violence in childhood. (shrink)

Preventing War and Promoting Peace: A Guide for Health Professionals is an interdisciplinary study of how pervasive militarism creates a propensity for war through the influence of academia, economic policy, the defense industry, and the news media. Comprising contributions by academics and practitioners from the fields of public health, medicine, nursing, law, sociology, psychology, political science, and peace and conflict studies, as well as representatives from organizations active in war prevention, the book emphasizes the underlying preventable causes of (...) war, particularly militarism, and focuses on the methods health professionals can use to prevent war. Preventing War and Promoting Peace provides hard-hitting facts about the devastating health effects of war and a broad perspective on war and health, presenting a new paradigm for the proactive engagement of health professions in the prevention of war and the promotion of peace. (shrink)

A prevailing issue in clinical research is the duty clinicians have to treat or prevent the progression of disease during a study that they are conducting. While all clinical researchers have a duty of care for the patients who participate in clinical research, intervening at the onset or progression of disease may skew results and have a negative impact on the scientific validity of a study. Extreme examples of failures to intervene can be found in the Tuskegee syphilis study and (...) in an attempt to determine if cervical smears were an accurate predictor of cancer, which was uncovered by the Cartwright Inquiry. However, the issue arises in all research where delay in intervention can cause harm. A current study in Singapore is investigating the significance of an ‘ultra-high risk’ state that may constitute the prodromal phase of psychosis. This project called ‘The Longitudinal Youth at Risk Study’ is potentially contentious because it is recruiting young people who are identified as being ‘at risk’ of developing psychosis. In this paper, the decision to offer treatment to all participants as well as a fast track for those who are assessed to have developed serious mental illness into treatment is discussed. It is argued that this approach is ethically justified because of the duty of care that is owed to research participants, and suggests that the principle of equipoise may be used to guide intervention decisions in other clinical research protocols. (shrink)

The growing commercialization of science has raised concerns about financial conflicts of interest (COIs). Evidence suggests that such conflicts threaten the integrity of research and the well-being of research participants. Trying to minimize these negative effects, federal agencies, academic institutions, and publishers have developed conflict-of-interest policies. Among such policies, recommendations or requirements to disclose financial COIs to potential research participants and patients have become commonplace. Here, I argue that disclosing conflicts of interest to potential research participants fails to achieve (...) the weighty moral goals that presumably ground such policies. This is so either because disclosure is simply a wrong means for achieving some of the goals in question or because, although disclosure could be an appropriate means for some of those goals, the way in which it is implemented prevents fulfillment of the desirable moral aim. (shrink)

It is well known that prisoners’ human rights are often violated. In this chapter we examine whether guidelines can be effective in preventing such violations and in helping physicians resolve the significant conflicts of interest that they often face in trying to protect prisoners’ rights. We begin by explaining the role of clinical and ethical guidelines outside prisons, in the context of healthcare for non-incarcerated prisoners, and then the specific role of such guidelines within prisons, where the main concerns are (...) ensuring respect for the principle of equivalence of care, and for a prisoner patient’s autonomy in health care decisions. After reviewing and analysing various national and international guidelines, we review the literature and assess whether the good practices set out in these guidelines actually translate into changes in professional behaviour and consequent benefits for prisoners. It emerges that physicians both outside and within prisons tend to be insufficiently familiar with the relevant guidelines, and that they too infrequently use the guidance to make decisions, preferring instead to use personal codes of conduct. Guidelines designed specifically for the prison context are important to ensure equivalence of care and should be better known by health care personnel and other professional groups working in prison. Further guidelines should be developed that describe challenging situations and provide concrete guidance as to how to deal with them. (shrink)

Neuroscience research has improved our understanding of the long term consequences of sports-related concussion, but ethical issues related to the prevention and management of concussion are an underdeveloped area of inquiry. This article exposes several examples of conflicts of interest that have arisen and been tolerated in the management of concussion in sport (particularly professional football codes) regarding the use of computerized neuropsychological (NP) tests for diagnosing concussion. Part 1 outlines how the recommendations of a series of global protocols (...) for dealing with sports-related concussions (the 1st, 2nd and 3rd Consensus Statements on Concussion in Sport) have endorsed the use of NP testing. The development of these protocols has involved experts who have links with companies that sell computerised NP tests for concussion management. Part 2 describes how some professional football leagues—in particular the National Football League (NFL), the Australian Football League (AFL) and the National Rugby League (NRL)—have mandated specific NP testing products. They have done so on the basis of these international guidelines and by engaging experts who have conflicts of interest with NP testing companies. These decisions have also been taken despite evidence that casts doubt on the reliability and validity of NP tests when used in these ways. (shrink)

Taking advantage of economic opportunities has led to numerous conflicts between society and business in various geographies of the world. Companies have developed social responsibility programs to prevent and manage these types of problems. However, some authors comment that these programs lack a strategic vision. Starting with the Working with People model, created for the field of rural development planning, this paper proposes a methodology to prevent the generation of social conflicts from business strategy: the territorial dimension. The proposal emphasizes (...) that local development support prevents the generation of social conflicts. Finally, an experience in Peru, a country that has been characterized in recent years by high economic growth and also by the presence of social conflicts that have stopped entrepreneurship is analyzed. (shrink)

Background: Nurses and surgeons may experience intra-team conflict during decision making about the use of postoperative life-sustaining treatment in the intensive care unit due to their perceptions of professional roles and responsibilities. Nurses have a sense of advocacy—a responsibility to support the patient’s best interest; surgeons have a sense of agency—a responsibility to keep the patient alive. Objectives: The objectives were to (1) describe the discourse surrounding the responsibilities of nurses and surgeons, as “advocates” and “agents,” and (2) apply (...) these findings to determine how differences in role responsibilities could foster conflict during decision making about postoperative life-sustaining treatment in the intensive care unit. Research design: Articles, books, and professional documents were explored to obtain descriptions of nurses’ and surgeons’ responsibilities to their patients. Using discourse analysis, responsibilities were grouped into themes and then compared for potential for conflict. Ethical considerations: No data were collected from human participants and ethical review was not required. The texts were analyzed by a surgeon and a nurse to minimize profession-centric biases. Findings: Four themes in nursing discourse were identified: responsibility to support patient autonomy regarding treatment decisions, responsibility to protect the patient from the physician, responsibility to act as an intermediary between the physician and the patient, and the responsibility to support the well-being of the patient. Three themes in surgery discourse were identified personal responsibility for the patient’s outcome, commitment to patient survival, and the responsibility to prevent harm to the patient from surgery. Discussion: These responsibilities may contribute to conflict because each profession is working toward different goals and each believes they know what is best for the patient. It is not clear from the existing literature that either profession understands each other’s responsibilities. Conclusion: Interventions that improve understanding of each profession’s responsibilities may be helpful to reduce intra-team conflict in the intensive care unit. (shrink)

This article is about the novel role of the Unión de Naciones Suramericanas (South American Nations Union) - UNASUR as a peacekeeper in the SouthAmerican region. It begins with an overview of UNASUR, its history, legal framework, and its mandate related to peacekeeping activities. Then, the efforts for regional integration and peacekeeping are addressed, with an explanation of the different frameworks backing those intents and the new peacemaking body known as UNASUR. Examples of political conflict are outlined, namely those (...) in Bolivia and Venezuela, and the ways in which the novel intervention of UNASUR deescalated the violence. After providing a brief description of South American history, its recent conflicts, and a review of some applicable conflict causation theories, the article concludes with a theoretical explanation of the role of UNASUR and its intervention for building peace in the region. This leads to questions and suggestions about how the work of UNASUR can be protected and enhanced to benefit the creation and maintenance of harmonious relationships within South American states. (shrink)

BackgroundBesides balancing burdens and benefits of intensive care, ethical conflicts in the process of decision-making should also be recognised. This calls for an ethical analysis relevant to clinicians. The aim was to analyse ethically difficult situations in the process of deciding whether a patient is admitted to intensive care unit.MethodsAnalysis using the ‘Dilemma method’ and ‘wide reflective equilibrium’, on ethnographic data of 45 patient cases and 96 stakeholder interviews in six UK hospitals.Ethical analysisFour moral questions and associated value conflicts were (...) identified. Who should have the right to decide whether a patient needs to be reviewed? Conflicting perspectives on safety/security. Does the benefit to the patient of getting the decision right justify the cost to the patient of a delay in making the decision? Preventing longer-term suffering and understanding patient’s values conflicted with preventing short-term suffering and provision of security. To what extent should the intensivist gain others’ input? Professional independence versus a holistic approach to decision-making. Should the intensivist have an ongoing duty of care to patients not admitted to ICU? Short-term versus longer-term duty to protect patient safety. Safety and security were key values at stake in the ethical conflicts identified. The life-threatening nature of the situation meant that the principle of autonomy was overshadowed by the duty to protect patients from harm. The need to fairly balance obligations to the referred patient and to other patients was also recognised.ConclusionProactive decision-making including advance care planning and escalation of treatment decisions may support the inclusion of patient autonomy. However, our analysis invites binary choices, which may not sufficiently reflect reality. This calls for a complementary relational ethics analysis. (shrink)

Background: Clinical ethics committees have been broadly implemented in university hospitals, general hospitals and nursing homes. To ensure the quality of ethics consultations, evaluation should be mandatory. Research question/aim: The aim of this article is to evaluate the perspectives of all people involved and the process of implementation on the wards. Research design and participants: The data were collected in two steps: by means of non-participating observation of four ethics case consultations and by open-guided interviews with 28 participants. Data analysis (...) was performed according to grounded theory. Ethical considerations: The study received approval from the local Ethics Commission (registration no.: 32/11/10). Findings: ‘Communication problems’ and ‘hierarchical team conflicts’ proved to be the main aspects that led to ethics consultation, involving two factors: unresolvable differences arise in the context of team conflicts on the ward and unresolvable differences prevent a solution being found. Hierarchical asymmetries, which are common in the medical field, support this vicious circle. Based on this, minor or major disagreements regarding clinical decisions might be seen as ethical conflicts. The expectation on the clinical ethics committee is to solve this (communication) problem, but the participants experienced that hierarchy is maintained by the clinical ethics committee members. Discussion: The asymmetrical structures of the clinical ethics committee reflect the institutional hierarchical nature. They endure, despite the fact that the clinical ethics committee should be able to detect and overcome them. Disagreements among care givers are described as one of the most difficult ethically relevant situations and should be recognised by the clinical ethics committee. On the contrary, discussion of team conflicts and clinical ethical issues should not be combined, since the first is a mandate for team supervision. Conclusion: To avoid dominance by physicians and an excessively factual character of the presentation, the case or conflict could be presented by both physicians and nurses, a strategy that strengthens the interpersonal and emotional aspects and also integrates both professional perspectives. (shrink)

An unresolved issue in the occupational health literature that is of both theoretical and practical importance is whether interpersonal conflicts, aggression and bullying at work are distinct or overlapping phenomena for exposed workers. In this study, we addressed this question empirically by employing a Latent Class (LC) analysis using cross-industry data from 6,175 Belgian workers. We found that a two-factor solution with a conflict-aggression factor and a bullying factor had the best fit. Employees with low exposure to workplace conflicts-aggression (...) and bullying perceived the phenomena as mostly overlapping. Reversely, employees who were exposed more frequently to the phenomena perceived them as more distinct - especially so for workplace bullying. Conflicts-aggression and bullying seem to be perceived as separate phenomena given their distinctive relationships with criterion variables in the domain of well-being and strain. These findings entail that a simple unifying approach or a single label for the three phenomena is not appropriate, at least from a measurement point of view and from the different perspectives of those exposed. Our results have important implications for the theoretical understanding of the concepts of interpersonal conflicts, aggression and bullying, and for practitioners who have to assist those involved with how to handle these problems and who have to develop legal as well as internal policies for the prevention and management of these issues at the workplace. (shrink)

Executive control of attention refers to processes that detect and resolve conflict among competing thoughts and actions. Despite the high-level nature of this faculty, the role of awareness in executive control of attention is not well understood. In this study, we used interocular suppression to mask the flankers in an arrow flanker task, in which the flankers and the target arrow were presented simultaneously in order to elicit executive control of attention. Participants were unable to detect the flanker arrows (...) or to reliably identify their direction when masked. There was a typical conflict effect (prolonged reaction time and increased error rate under flanker-target incongruent condition compared to congruent condition) when the flanker arrows were unmasked, while the conflict effect was absent when the flanker arrows were masked with interocular suppression. These results suggest that blocking awareness of competing stimuli with interocular suppression prevents the involvement of executive control of attention. (shrink)

This research study investigates the implementation of the Conflict Management Socialization and Mapping of Conflict Prone Areas program by the National Unity and Political Affairs Agency (Bakesbangpol) in Kuningan Regency, Indonesia. Using qualitative methods, including interviews and a literature review, the study examines how Bakesbangpol Kuningan detects and manages potential conflicts to maintain regional stability. Findings reveal that the program effectively utilizes early detection initiatives and community engagement forums such as Focus Group Discussions (FGDs) and collaborates with various (...) stakeholders, including local authorities and community organizations. Creating a conflict-prone area map in 2017 is a vital tool for proactive conflict prevention and policy formulation. However, the study identifies areas for enhancement, including further staff training, robust administrative support systems development, and more decisive leadership in program execution. This research highlights the significance of systematic program implementation and collaborative efforts in managing social conflicts and ensuring sustained regional harmony. It contributes to the field by providing insights into effective conflict management strategies at the local level in Indonesia, particularly in diverse and potentially conflict-prone regions like Kuningan. (shrink)

Some have argued that no analysis of counterfactual conditionals can succeed without appealing to causal notions. Such authors claim that, in determining what would transpire had some events gone differently, we hold fixed everything that is causally independent from those events. Call this view Causal Independence. Some have argued that we need Causal Independence to accommodate intuitive judgments about certain kinds of counterfactuals in indeterministic worlds. The aim of this paper is to show that, contra these authors, Causal Independence systematically (...) delivers counterintuitive results for a certain subset of such counterfactuals-namely, those involving causation by double prevention. I conclude that intuitions about such counterfactuals do not motivate Causal Independence, at least in any form in which it has thus far been articulated. However, I suggest that a refined Causal Independence thesis that presupposes a kind of causal pluralism might be able to accommodate these intuitions, though such a refined version of Causal Independence may not conflict with reductive analyses of causal notions that appeal to counterfactuals after all. (shrink)

Les ONG constituent une pièce maîtresse pour résoudre les conflits apparus dans le Caucase du Sud à la suite de l'effondrement de l'empire soviétique. Il est malheureusement à déplorer que les processus de résolution et de prévention des conflits de la région sont essentiellement mis en oeuvre par les États, tandis que se trouve minimisé le rôle des ONG. Il faut promouvoir leurs actions, en développant des programmes s'étendant à des sphères d'activités de plus en plus larges, que ce soit (...) dans le domaine économique ou culturel.NGOs are a centerpiece to resolve conflicts emerged in the South Caucasus after the collapse of the Soviet empire. Unfortunately, it is unfortunate that the resolution process and conflict prevention in the region are mainly implemented by the states, is minimized while the role of NGOs. Must promote their actions in developing programs extending spheres of activity increasingly large, whether in the economic or cultural. (shrink)

Although companies recognize the importance of social responsibility and community engagement, conflicts between companies and communities have been noticeably increasing. To better understand the role of institutional environments in company–community conflicts, we analyze two mining conflicts—Minera Yanacocha's Minas Conga extension project in Peru and Minera Los Pelambres' El Mauro Tailings Dam in Chile. Our findings imply that, to prevent negative consequences and alleviate company–community conflicts, mining companies should address underlying structural causes and pursue informal approaches in order to obtain and (...) maintain their social license. We find that better formal institutional environments not only alleviate conflict intensity but also facilitate informal approaches through which companies and communities can cooperate to resolve conflicts. The best practice would be to start and continue dialogs between communities and companies, mediated by impartial governments, to understand the concerns of the counterparty and find means by which to address the causes. (shrink)

Background: The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves. Objectives: This study describes operating theatre nurses’ experiences of ethical value conflicts in perioperative practice. Research design: Qualitative design, narratives from 15 operating theatre nurses and hermeneutic text interpretation. (...) Ethical consideration: The study followed ethical principles in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee. Findings: The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient’s care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient’s best. This occurred when operating theatre nurses’ competence was not taken seriously and was ignored in patient care. Conclusion: Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations. (shrink)

Economists and legal scholars routinely posit an implicit contract between Japanese firms and their principal lender. Under this arrangement, the bank implicitly agrees to rescue the firm when times turn bad. Out of court, it rescues the firm from insolvency. Not only does it save the investments specific to the troubled firm, it lowers the use of costly bankruptcy proceedings and cuts the costs of those bankruptcy procedures firms do occasionally invoke. Given the creditor-shareholder conflicts of interest that arise as (...) firms approach insolvency, such arrangements would seem unstable. Yet according to a long sociological tradition, conflicts of interest matter less in Japan than in the West. According to the emerging economic and legal tradition, Japanese economic actors do face those conflicts, but keep them in check through reputational concerns, close-knit ties, and government supervision. Using two datasets of troubled firms from the 1970s and 1980s, we ask whether Japanese main banks in fact rescue distressed borrowers. We find no evidence that they do: large Japanese firms fail; when large firms approach insolvency, main banks do not increase the share of the firm’s debt they bear; stronger ties between distressed firms and their main bank do not facilitate loans; and troubled firms do not try to preserve their main bank relationship. All told, the claim that Japanese banks ever implicitly agreed to rescue firms is sheer myth. That Japanese banks let troubled firms fail is no recent development; it has been thus for decades. Conflicts of interest do indeed matter in Japan and long have. They matter enough to prevent precisely the incentive-incompatible rescue deals that scholars in the field so routinely posit. (shrink)

While we agree with Fiester and Yuan (2023) that ethicists should not execute behavioral agreements in their role as clinical consultants along with many of the authors’ criticisms of such contract...

Many of us think human extinction would be a very bad thing, and that we have moral reasons to prevent it. But there is disagreement over what would make extinction so bad, and thus over what grounds these moral reasons. Recently, several theorists have argued that our reasons to prevent extinction stem not just from the value of the welfare of future lives, but also from certain additional values relating to the existence of humanity itself (for example, humanity’s “final” value, (...) or the value of humanity in itself). In this paper, I argue against these “additional value” views. Despite their initial appeal, these views will inevitably face conflicts between the additional values to which they appeal, and the value of the welfare of future lives. And, I argue, the views cannot plausibly resolve these conflicts. In contrast, these conflicts do not arise for a rival view, on which our reasons to prevent extinction stem just from the value of the welfare of future lives. I conclude that this gives us reason to prefer the latter view, despite the greater initial plausibility of additional value views. (shrink)

Analysing conflict from a logical perspective involves the exploration of concepts such as dualism and dialectics. In exploring the ontological determinants- identity and negation - it becomes evident that identity is a process and its essential component is negation. Dualism and the law of contradiction providethe framework that perceives reality as consisting of two irreducible elements or modes. It divides an entity into its extremities by denying its unity and creates aninsurmountable gap preventing the disparate components, principles or thoughts (...) f r om being harmonized. In other words reality is determined by polarization, i.e. good-evil, true-false, right-wrong. I am suggesting that using the logic of dualism as a method to approach conflict will necessarily be one-sided. It seems to be the case that a dialectical understanding of reality provides the means for dealing with negation in a non-existential manner, that is to say it opens the sphere of dialogue. A principle that recognizes reality as contradictory establishes an identity that holds in itself negation and affirmation as distinguished entities that claim successfully their existence as components of a unity. Hence within contradiction the perspective of both being and non-being is explored thereby providing the ideal starting point for conflict resolution. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Conflict, Culture, Change: Engaged Buddhism in a Globalizing WorldMarwood Larson-HarrisConflict, Culture, Change: Engaged Buddhism in a Globalizing World. By Sulak Sivaraksa. Boston: Wisdom Publications, 2005. 145 pp.Sulak Sivaraksa's Conflict, Culture, Change is a useful if uneven collection of essays that touch on many of the basic aspects of Engaged Buddhism. The book does not make an original contribution to the field, yet it serves as a (...) good introduction to the tenets and practice of socially responsible Buddhism.Though not as prolific as Thich Nhat Hanh or the Dalai Lama, Sulak Sivaraksa's contributions as a grassroots organizer and spokesperson are widely recognized, and he was nominated for the Nobel Peace Prize for his resistance to Thailand's military dictatorship. His few books bear witness to the ways that he and similar peacemakers have found innovative methods to prevent globalization from destroying traditional ways of life.It does not seem entirely relevant to criticize a book that is so well intentioned and written by such an exemplary human being. Nonetheless, Conflict, Culture, Change is an odd collection of essays. Most have been published elsewhere, and taken together they tend to be repetitive. They are loosely grouped into three sections; the first two—"Peace, Nonviolence, and Social Justice" and "Simplicity, Compassion, and Education"—lay out a range of ways that classic Theravada Buddhist values could bring sanity to a world out of balance, discussing global conflict, nonviolence, reconciliation, consumerism, and environmentalism. What ties them together is the use of Buddhist ideas to analyze and respond to current problems, but the ensuing discussion does not progress beyond an introductory level. While it is certainly true that the onslaught of capitalism is traceable to the three poisons (greed, hatred, and ignorance) and that sincere humility on the part of world leaders would help facilitate global diplomacy, [End Page 166] this kind of analysis will probably not convince anyone who is not already a fellow traveler.Indeed, some scholars have waited for the leaders of Engaged Buddhism to articulate a more consistent philosophical basis for their praxis. In some ways, this criticism is ironic. After all, the energies of Engaged Buddhism are appropriately directed toward action and not theory, and Sivaraksa and others rightly criticize the single-minded pursuit of meditation unless it is balanced by an active response to social problems. Sivaraksa is careful to balance these dimensions, arguing that either one without the other is unable to bring about real change. He also combines classical Buddhist concepts with modern approaches—liberation theology, for example. What is needed, in this regard, is a more sustained exploration of where precisely traditional Buddhism can be supplemented by modern critical discourse without losing its nature as a dharma-based soteriology. On the other hand, if Sivaraksa's book were more focused on practical steps and concrete agendas, it could have served as a blueprint for organizers. That it does neither philosophy nor pragmatics limits its shelf life.A third section, "Culture and Change," is the book's most coherent, focusing on Thailand and the rise and fall of its dictatorships and the decline of Thai Buddhism. Sivaraksa's many stories attest to an all-too-common dynamic in South Asian Theravada countries: monks becoming politically powerful and their spiritual discipline waning. Sivaraksa also finds reason for hope: some Buddhists have remained true to the values of simplicity and humility, and new movements have arisen to help the old culture resist the new. At times his descriptions seem, at least to the Western reader, to border on a romantic nostalgia for an agrarian, temple-centered past, when monks were the revered authorities in their villages and families sent their sons to be ordained early. Now, he points out, many monks have VCRs and air conditioning and sleep on "soft, fluffy mattresses." Sivaraksa's book vividly conveys the cultural memory of rural Thailand to the West, and one would want all CEOs of multinational companies to read these stories before they set about modernizing the Thai countryside. Yet modernity cannot be uninvented; there can be no return to the simplicity of yesterday. After an extended chapter describing how the Thai elites' fascination... (shrink)

In October 2000, the UN Security Council unanimously adopted Resolution 1325 on "Women, Peace and Security", calling for women's full and equal participation in all aspects of conflict prevention, resolution and peacebuilding. The world is at last recognizing that gender issues and peace are inextricably connected, and that women's involvement in peace efforts is essential for the prevention of renewed conflict. Given the need for women's involvement in peace and security issues, we must address the reasons (...) why women's influence is limited, why they still do not have access to power or leadership roles, while their level of participation in the armed forces is minimal to non-existent. Meanwhile, wars rage. This paper argues that to think through the deeper connections between gender issues and peace is to engage in an unsettling, necessarily philosophical inquiry about the nature of modern ethical life— as a dysfunctional system of separate and competing ethical imperatives: family and state, public and private, individual and state, masculine and feminine. My inquiry is conducted from the standpoint of Hegel's philosophy. In the Phenomenology of Mind. Hegel draws upon the tragedian Sophocles for his insight that once upon a time in the ancient world, universal ethical substance divided itself into distinct ethical spheres of human and divine law. Human relationships to these ethical worlds were shaped by gender. The division of ethical substance precipitated conflicts that eventually caused the ancient world to collapse. For Hegel, the project of modernity is all about the recovery, in self-conscious form, of a harmonious ethical life, through reconciliation of conflicting ethical worlds. Hegel's philosophy of modern life has its shortfalls, but is a powerful resource for the argument that gender justice is a condition for long-lasting peace. (shrink)

Conflicts of interest in the university context are receiving growing attention, but the focus has been largely on problematic financial COI arising from university-industry relations, which clearly need to be avoided. The result, unfortunately, is a pejorative perception of COI as being equivalent to fraud and thus an issue of academic misconduct. In this paper, the aim is to show that while some financial and non-financial COI are particularly problematic and so should be avoided, many are pervasive and actually the (...) norm in academia even if they are still largely ignored and misunderstood. Through a reflection on my own experiences as a university professor, I describe a diversity of common financial, non-financial and institutional COI of varying degrees of risk, that arise in the day-to-day activities of a professor, in order to then consider how these COI can and should be managed in practice. It is essential to attend to the full range of COI and to think about appropriate policies, procedures, or guidelines to prohibit some COI and mitigate the risks of others; but these “hard” mechanisms are only part of the solution. This paper will focus on elucidating the various “soft” mechanisms – such as education, self-awareness, humility, and dialogue – that can empower professors to manage those COI that cannot be prevented or avoided. (shrink)

Minerals originated from eastern Democratic Republic of Congo (DRC) are blamed for financing violent conflict in the area over the past decade and have been called conflict minerals. They vividly demonstrate a key human rights issue facing responsible supply chain management. The conflict minerals issue has led to a significant shift in responsible supply chain management in two ways: extending producer responsibility to respect human rights in the total supply chain through establishing traceability and transparency; and developing (...) legally binding supply chain responsibility.This article examines an emerging effort to source conflict‐free minerals using closed‐pipe supply chain in the DRC as a new strategy to respond to the above paradigm shift. By exploring whether this new strategy can contribute to conflict prevention in the DRC, this article argues that the closed‐pipe supply chain allows building long‐term relationship with various stakeholders and has the potential to transform socio‐economic structures in the producing communities, thereby leading to peacebuilding in the long run. (shrink)

Background Respect for patient autonomy, the principle that patients are capable to make informed decisions about medical interventions, is fundamental in present-day medicine. However, if a patient’s request is medically not indicated, the practitioner faces an ethical dilemma represented by the conflict of the principles of patient autonomy, beneficence, and maleficence. Adjacent to topics such as medical assistance in dying and healthy limb amputation, this ethical dilemma also manifests in the care of the maxillofacial region (the oral cavity and (...) its surroundings), an area crucial to esthetic appearance, but also to everyday functions including mastication, speech, and facial expression, all of which are related to well-being. Our aim was to explore the manifestations and resolutions of the conflict between oral health and patient autonomy in relevant literature in order to contribute to the discourse of ethical challenges concerning patient autonomy, beneficence, and nonmaleficence. Methods We screened all journal articles discussing the researched ethical dilemma obtained from three databases. Two researchers developed a hierarchical coding scheme, where the parent and grandparent codes were designated deductively as: Case (situations involving the researched ethical dilemma), Judgement (decisions made in the ethical dilemma), and Principle (ideas, rules, propositions explaining the judgements); child codes were developed inductively. After coding the sources, we utilized thematic analysis to construct code constellations. Results Most themes identified in our sources advocated for the practitioner to choose the alternative that benefits the patient from a medical perspective, although no theme excluded the consideration of patient autonomy. Instances where respect for patient autonomy was encouraged concerned oral preventive care or when the requested intervention was expected to have an insignificant impact on oral health. Conclusions Ethical conflicts concerning patient autonomy, beneficence, and nonmaleficence have a marked presence in oral care. These conflicts arise through the issue of body modification, evident in cosmetic dentistry and requests for tooth extraction. Our sources generally support the argumentation for beneficence, despite the rise of cosmetic procedures in dentistry. (shrink)

In philosophy, a debate can live forever. Nowhere is this more evident than in ethics, a field that is fueled by apparently intractable dilemmas. To promote the wellbeing of many, may we sacrifice the rights of a few? If our actions are predetermined, can we be held responsible for them? Should people be judged on their intentions alone, or also by the consequences of their behavior? Is failing to prevent someone’s death as blameworthy as actively causing it? For generations, questions (...) like these have provoked passionate arguments and counterarguments, but few clear answers. Here, we offer a psychological account of why philosophical dilemmas arise, why they resist resolution, and why scientists should pay attention to them. Building on a family of recent proposals (Cushman & Young, 2009; Greene, 2008; Sinnott- Armstrong, 2008), we argue that dilemmas result from conflict between dissociable psychological processes. When two such processes yield different answers to the same question, that question becomes a “dilemma”. No matter which answer you choose, part of you walks away dissatisfied. This explanation of philosophical dilemmas has an important payoff for psychological research, and we discuss two specific cases in which it has yielded promising results. In each case, social neuroscience has played an important role in distinguishing the psychological processes responsible for producing a dilemma. This, we suggest, is no accident; cognitive neuroscientific methods are particularly well-suited to dissociating independent psychological processes (Henson, 2006). Consequently, philosophers’ dilemmas provide a reliable guide toward productive cognitive neuroscience by identifying the contours of distinct psychological process. The research we review below focuses particularly on moral dilemmas, which is our own area of expertise. The psychological processes that contribute to moral judgment are of interest in their own right, and play a central role in social cognition.. (shrink)

Virginia Woolf famously wrote 'as a woman I have no country', suggesting that women had little stake in defending countries where they are considered second-class citizens, and should instead be forces for peace. Yet women have been perpetrators as well as victims of violence in nationalist conflicts. This unique book generates insights into the role of gender in nationalist violence by examining feature films from a range of conflict zones. In The Battle of Algiers, female bombers destroy civilians while (...) men dress in women's clothes to prevent the French army from capturing and torturing them. Prisoner of the Mountains shows a Chechen girl falling in love with her Russian captive as his mother tries to rescue him. Providing historical and political context to these and other films, Matthew Evangelista identifies the key role that economic decline plays in threatening masculine identity and provoking the misogynistic violence that often accompanies nationalist wars. (shrink)

Rwanda witnessed devastating conflicts leading to genocidal attacks in 1994 with active participation of the police in the pogrom. Various reports implicated the police in high-handedness, torture, extra judicial killings, intimidation, rape, and other heinous crimes during the conflicts. The police force was reformed for optimal performance. This paper examines the impact of the post-conflict reconstruction of the police on internal security management in Rwanda. Findings from the study, which relied on secondary data, are that reform impacted positively on (...) the performance of the police, sharpening its skills in crime detection and prevention and leading to improved security for lives and property in Rwanda. Over-reliance on dwindling external sources and dysfunctional equipment still undermines maximum performance by the police. There should be adequate provision of advanced security devices and better funding of the police for the optimal discharge of their constitutional mandates of securing lives and property in Rwanda. (shrink)

Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

As recently stakeholders complain about the use of conflict minerals in consumer products that are often invisible to them in final products, firms across industries implement conflict mineral management practices. Conflict minerals are those, whose systemic exploitation and trade contribute to human right violations in the country of extraction and surrounding areas. Particularly, supply chain managers in the Western world are challenged taking reasonable steps to identify and prevent risks associated with these resources due to the globally (...) dispersed nature of supply chains and the opacity of the origin of commodities. Supply chain due diligence represents a holistic concept to proactively manage supply chains reducing the likelihood of the use of conflict minerals effectively. Based on an exploratory study with 27 semi-structured interviews within five European industries, we provide insights into patterns of implementation, key motivational factors, barriers and enablers, and impacts of SCDD in mineral supply chains. Our results contribute to both theory and practice as we provide first insights to SCDD practices and make recommendations for an industry-wide implementation of SCDD. Altogether, this study provides the basis for future theory testing research in the context of SCDD and conflict mineral management. (shrink)

A number of articles and empirical studies over the past decade, most by Paul Robinson and co-authors, have suggested a relationship between the extent of the criminal law's reputation for being just in its distribution of criminal liability and punishment in the eyes of the community – its "moral credibility" – and its ability to gain that community's deference and compliance through a variety of mechanisms that enhance its crime-control effectiveness. This has led to proposals to have criminal liability and (...) punishment rules reflect lay intuitions of justice – "empirical desert" – as a means of enhancing the system's moral credibility. In a recent article, Christopher Slobogin and Lauren Brinkley-Rubinstein (SBR) report seven sets of studies that they argue undermine these claims of empirical desert and moral credibility and instead support SBR's proposed distributive principle of "individual prevention," a view that focuses on an offender's future dangerousness rather than on his perceived desert. -/- The idea that there is a relationship between the criminal law's reputation for justness and its crime-control effectiveness did not originate with Robinson and his co-authors. Rather, it has been a common theme among a wide range of punishment theory scholars for many decades. A particularly important conclusion of recent Robinson studies, however, is their confirmation that this relationship is a continuous one: even small nudges in moral credibility can produce corresponding changes in the community's deference to the criminal law. This is important because it shows that even piecemeal changes or changes at the margin – as in reforming even one unjust doctrine or procedure – can have real implications for crime-control. SBR's studies, rather than contradicting the crime-control power of empirical desert, in fact confirm it. Further, SBR's studies do not provide support for their proposed "individual prevention" distributive principle, contrary to what they claim. -/- While SBR try to associate their principle with the popular "limiting retributivism" adopted by the American Law Institute in its 2007 amendment of the Model Penal Code, in fact it is, in many respects, just the reverse of that principle. With limiting retributivism, the Model Code's new provision sets desert as dominant, never allowing punishment to conflict with it. SBR would have "punishment" essentially always set according to future dangerousness; it is to be constrained by desert only when the extent of the resulting injustices or failures of justice is so egregious as to significantly delegitimize the government and its law. This ignores the fact that even minor departures from justice may have an important cumulative effect on the system as a whole. What SBR propose – essentially substituting preventive detention for criminal justice – promotes the worst of the failed policies of the 1960s, where detention decisions were made at the back-end by "experts," and conflicts with the trend of the past several decades of encouraging more community involvement in criminal punishment, not less. (shrink)

Patient visits are an important opportunity for general practitioners to discuss the risks of smoking and cessation strategies. In Australia, the guidelines on cessation published by the Royal Australian College of General Practitioners represent a key resource for GPs in this regard. The predominant message of the Guidelines is that pharmacotherapy should be recommended as first-line therapy for smokers expressing an interest in quitting. This, however, ignores established evidence about the success of unassisted quitting. Our analysis of the Guidelines identifies (...) a number of potential conflicts of interest which may have affected the advice provided. These include extensive funding by the pharmaceutical industry of sources cited to support the recommendations, and relations between members of the Guidelines Content Advisory Group and the pharmaceutical industry. Recommendations issued by professional bodies have enormous potential impact upon public health and there is a need for the highest levels of scrutiny and transparency in their development. Information about research cited in guidelines should include funding sources, and developers should be free of obvious conflicts of interest. Smoking remains the leading preventable cause of global mortality. Concerns related to pharmaceutical industry funding of research, scientific integrity and recommendations on smoking cessation by medical advisory groups clearly have implications beyond Australia. (shrink)

Caring for a child in a pediatric intensive care unit is emotionally and physically challenging and often leads to conflict. Skilled mediators may not always be available to aid in conflict resolution. Careproviders at all levels of training are responsible for managing difficult conversations with families and can often prevent escalation of conflict. Bioethics mediators have acknowledged the important contribution of mediation training in improving clinicians’ skills in conflict management. Familiarizing careproviders with basic mediation techniques is (...) an important step towards preventing escalation of conflict. While training in effective communication is crucial, a sense of fairness and justice that may only come with the introduction of a skilled, neutral third party is equally important. For intense conflict, we advocate for early recognition, comfort, and preparedness through training of clinicians in de-escalation and optimal communication, along with the use of more formally trained third-party mediators, as required. (shrink)