This volume explores the ethical principles that guide institutions such as corporations, government agencies, and non-profit organizations. The author argues that institutional ethics must go beyond the traditional focus on individual morality, and instead address broader questions of social responsibility and accountability. This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work is in the "public domain in the United States of America, (...) and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Some health-care institutions have ethics committees. The experience of the Ethical Issues Committee at the Royal College of Physicians is described. Ethics committees in institutions may be reactive or creative, must determine an agenda and must deal with dissent.

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, (...) effective ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

This text provides a comprehensive and timely examination of the most pertinent factors affecting institutional ethics committees, for ethicists, trustees, administrators, physicians, clergy, nurses, social workers, attorneys and others with an interest in ethics committees.

My title may generate some perplexity. It is certainly not a familiar one. So I should make it plain at the outset that I shall not be talking about the ethics of organizations or associations or groups. I want to direct attention to the ethical and valuational questions associated with social institutions, and I distinguish institutions from associations and organizations. One question I am aiming at is whether the principles and standards applicable to moral judgments of actions and of (...) persons—call them individual principles—are also applicable, or applicable with only minor changes, to the judgment and critique and evaluation of institutions and practices. This is not the sole question of institutional ethics, but it is a main one. (shrink)

Clinical Study Agreements can have profound effects both on the protection of human subjects and on the independence of investigators to conduct research with scientific integrity. Sponsors, institutions, and even investigators may fail to give adequate attention to these issues in the negotiation of CSAs. Despite the key role of CSAs in structuring ethically important aspects of research, they remain largely unregulated and unreviewed for adherence to ethical norms. Academic institutions routinely enter into research contracts that fail to meet adequate (...) ethical standards. This is a failing that can have serious consequences.Accordingly, it is necessary that some independent body have the authority both to review research contracts for compliance with norms of subject protection and ethical integrity, and to reject studies that fail to meet ethical standards. Such review should take place prior to the start of research, not later. Because of its expertise and authority, the institutional ethics review board is the appropriate body to undertake such review. Much recent commentary has focused on contractual restrictions on the investigator’s freedom to publish research findings. The Olivieri experience, and that of other investigators, has brought freedom of publication issues into sharp focus. Clinical study agreements also raise a number of other ethical issues relating to human subjects and research integrity, however, including disclosures relating to patient safety, data analysis and reporting, budget, confidentiality, and premature termination of the study. This paper describes the ethical issues at stake in structuring such agreements and suggests ethical standards to guide institutional ethics review. (shrink)

This article presents standards for setting up and educating institutional ethics committees (IECs). These standards are based on experiences in the Netherlands, where IECs have been established in a large number of health care institutions. Though the IEC has become a generally accepted institution within Dutch health care, there are concerns over its effectiveness regarding the improving of the moral quality of clinical decision making. Health care practitioners and members of IECs too, experience a gap between the IEC (...) and the reality of the clinical environment. At this moment, there is interest in developing programmes which educate practitioners in moral issues and how to deal with them, using the method of a structured debate on the ward. The IEC will not be made obsolete by this development, but can play a guiding role in the implementation of such programmes. Current concerns are the lack of patient representation in the Dutch IEC, and the loss of contact with the local community of health care practitioners because of the merger of hospitals into bodies similar to UK National Health Service (NHS) trusts. (shrink)

While the story of Stanislav Petrov – the Soviet Lieutenant Colonel who likely saved the world from nuclear holocaust in 1983 – is often trotted out to advocate for the view that human beings ought to be kept “in the loop” of automated weapons’ responses, I argue that the episode in fact belies this reading. By attending more closely to the features of this event – to Petrov’s professional background, to his familiarity with the warning system, and to his decisions (...) to defy his protocol – it becomes clear that Petrov was not seamlessly working “in his loop,” but reassessing it entirely. I claim that this exhibits a paradox intrinsic to all automated loops: namely, that their optimum function in fact rests on unforeseen human interventions that cannot be reliably codified ex ante, that is, that good judgment cannot simply be “programmed into” their protocols. This dependence, moreover, reveals automation’s ineluctable need for virtue ethics – not in the usual sense (whereby ethics deliberates about, say, possible damages and loss of life), but in the sense that ethical judgment, rightly understood, entails the reassessment of all of the conditions surrounding a decision, including whether a protocol should be followed at all. (shrink)

Cook and Hoas (2008) have identified and illustrated serious shortcomings in rural bioethics and healthcare decision-making. Some of the problems that the authors discuss are unique to the rural co...

Care ethics has a curious relationship to justice. Care theorists alternately portray justice as separate from yet at times intersecting with, parallel and distinct from, or falling within yet secondary to care. Theories of justice tend to imagine an ideal world, and reason about justice from an imagined universal position. Care ethics, on the other hand, respond to a philosophical history in which abstract universal reasoning occludes the particular needs and contributions of marginalized or oppressed groups. I argue (...) that care ethics is a kind of nonideal theory. I further argue that understanding care ethics as nonideal theory does two things. One, it draws care and justice into conversation with each other such that neither one is prior: both can be produced through practices of justice enacted through care, and care that responds to justice. Moreover, health care models the way in which care and justice must work in tandem. Two, care theory as nonideal theory invites an institutional ethic of care. An institutional ethic of care is modeled by, and at the same time can strengthen, existing health care practices. Such an ethic builds on the feminist scholarship deconstructing dichotomous binaries, including gendered dichotomies between justice and care. In conclusion, I raise the possibility that an institutional ethic of care might reveal a porous boundary between an ideal/nonideal theory binary. (shrink)

As euthanasia has become a widely debated issue in many Western countries, hospitals and nursing homes especially are increasingly being confronted with this ethically sensitive societal issue. The focus of this paper is how healthcare institutions can deal with euthanasia requests on an organizational level by means of a written institutional ethics policy. The general aim is to make a critical analysis whether these policies can be considered as organizational-ethical instruments that support healthcare institutions to take their (...) class='Hi'>institutional responsibility for dealing with euthanasia requests. By means of an interpretative analysis, we conducted a process of reinterpretation of results of former Belgian empirical studies on written institutional ethics policies on euthanasia in dialogue with the existing international literature. The study findings revealed that legal regulations, ethical and care-oriented aspects strongly affected the development, the content, and the impact of written institutional ethics policies on euthanasia. Hence, these three cornerstones—law, care and ethics—constituted the basis for the empirical-based organizational-ethical framework for written institutional ethics policies on euthanasia that is presented in this paper. However, having a euthanasia policy does not automatically lead to more legal transparency, or to a more professional and ethical care practice. The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process. Administrators and ethics committees must take responsibility to actively create an ethical climate supporting care providers who have to deal with ethical dilemmas in their practice. (shrink)

The existential, experiential, ethical, pathic and pre-pathic dimensions of education are essential for the creative composition of subjectivities in institutional spaces, yet educational research and policy tend increasingly to privilege technical discourses and prescriptive approaches both when evaluating ‘what is effective in education’ and when determining educational policy. This essay explores those aspects of the educational experience and educational institutions that are often felt and sensed pre-cognitively by students, parents and teachers, but are seldom given further elaboration or articulation (...) in educational research. We will reflect on what is meant by the experience of education and experience in education, including the struggles to make sense of or understand something, the surprises that strike pre-reflectively, and the ways in which such moments are noticed, pursued, and explored rather than reflexively ‘evaluated’. We then explore the idea of experimentation in institutions, in particular in relation to the range of concepts that Jean Oury introduces in order to move our attention and awareness to questions of experience, existence, atmosphere, and the pathic—the way in which we undergo, sense and participate in the world prior to cognition and the desire for mastery and control of our encounters. Finally, we address the question of the ethics of institutions. (shrink)

This paper addresses what should be an important question for many institutional ethics committees: How might they justifiably trust external peer review of the scientific merit of research proposals under their consideration, since these committees are typically not constituted to review the science themselves?

: Originally presented during Ethic Rounds at the Dana-Farber Cancer Institute, this commentary on the case of a patient treated for life-threatening cancer explores the responsibilities of health care providers when addressing the patient's desire to adopt a child.

This article presents standards for setting up and educating institutional ethics committees (IECs). These standards are based on experiences in the Netherlands, where IECs have been established in a large number of health care institutions. Though the IEC has become a generally accepted institution within Dutch health care, there are concerns over its effectiveness regarding the improving of the moral quality of clinical decision making. Health care practitioners and members of IECs too, experience a gap between the IEC (...) and the reality of the clinical environment. At this moment, there is interest in developing programmes which educate practitioners in moral issues and how to deal with them, using the method of a structured debate on the ward. The IEC will not be made obsolete by this development, but can play a guiding role in the implementation of such programmes. Current concerns are the lack of patient representation in the Dutch IEC, and the loss of contact with the local community of health care practitioners because of the merger of hospitals into bodies similar to UK National Health Service (NHS) trusts. (shrink)

abstract Individuals tend to change their behaviour as a response to insurance. Such behavioural responses to insurance are commonly seen as ethically and morally problematic. This is especially true of effects on behaviour from social insurance. These effects have been seen as an ethical problem, associated with irresponsibility, fraud and an immoral character. This article discusses the relevance of four different types of reasons for claims that behavioural responses to social insurance are immoral. These reasons are independent reasons con‐tract related (...) reasons reasons related to fraud and reasons related to justice. I argue that reasons related to justice are most relevant, but that this type of reason does not render the individual morally blameworthy. Hence, insofar as behavioural responses to social insurance are an ethical problem it is a problem that concerns the institution, i.e. what incentives social insurance exhibits, rather than the individual, i.e. the morality of the individual responding to it. Insofar as behavioural responses to social insurance are an ethical problem it is a problem for political philosophy rather than individual ethics. (shrink)

This paper discusses a number of ethical issues that arise in the context of ethnographic research with people with severe intellectual disabilities and mental health problems living in closed institutions. These very vulnerable people have tended to live emotionally and physically deprived lives in segregated and bleak environments, and because they cannot communicate through speech, and often have seriously challenging behaviour, they have tended to become socially and physically isolated from society. Most research with people who do not communicate verbally (...) has been quantitative, or conducted through informal and formal carers. Ethnographic research, on the other hand, involves spending long periods of participant observation with people in their ‘natural’ settings, providing intensely qualitative material, in order to present data as far as possible from each individual's perspective. Such research provides rich and emotionally powerful material which is often distressing and even shocking. This raises a number of ethical issues in relation to the conduct of such research, including questions regarding consent – who can give consent for someone who does not have the capacity to give consent themselves? The ethics of publication of such research are also discussed. This paper outlines the reasons why such research, and its publication, is vital for the futures of institutionalized men and women with severe intellectual disabilities. (shrink)

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. This paper attempts to fill the gap. Healthcare professionals are on the front lines in the defense against medical error, but the changes that are needed to reduce medical errors and enhance patient safety are cultural and systemic in nature. As noted in the Hastings Centers recent report, Promoting Patient Safety, the occurrence of medical error involves a complex web of multiple factors. Human (...) misstep is certainly one such factor, but not the only one. In this paper, I build on the Hasting Centers report on patient safety in arguing that institutional ethics committees ought to play an integral role in the transformation of a culture of blame to a culture of safety in healthcare delivery. (shrink)

The Civil Economy approach, as developed by Italian economists Luigino Bruni and Stefano Zamagni, aims at introducing reciprocity into the economy as a humanizing factor. Despite being presented as an innovative perspective, the CE approach shares many characteristics with the German model of Social Market Economy. The present paper compares both approaches, showing that they in fact share a normative basis and similar aims but address them from diverse points of view; namely, CE addresses them from a virtue ethics (...) perspective and SME from an institutional ethics one. This leads them to stress different aspects and to focus on diverse problems. Therefore, CE would not constitute an alternative to SME but a complement. Thus, a combination of both approaches should allow each to take advantage of their respective strengths and lead to a better result in terms of the common good. (shrink)

It is well established within the ethics and institutional theory literatures that institutions can have conflicting logics with ethical dimensions and that there are solutions to the conflicts. Within institutional, ethics, and change leadership theory, quantitative, mixture solutions such as distributive solutions have been frequently considered. The ethics, institutional, and change leadership theory literatures have recognized that there are qualitative transformational solutions that are different than quantitative mixture solutions. However and for the most part, (...) with the notable exception of the Thornton et al. :801–843, 2012) typology of solutions, the institutional, change leadership, and ethics literatures have not considered typologies of transformational solutions. And more specifically with respect to this article, the institutional, change leadership, and ethics literatures have not considered different types of transformational solutions to institutional logic conflicts with ethical dimensions. This article: develops a typology of transformational solutions; applies the typology with historical examples of conflicting institutional ethics logics within factory, cultural, and institutional social change leadership cases; and, considers practical and theoretical implications for institutional ethics change leadership for achieving and/or resisting different types of transformational solutions. (shrink)

Institutional ethics committees in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed lECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and Nel (...) Noddings, is an unacknowledged basis for /EC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for lECs. (shrink)

ABSTRACT There is growing concern about the reuse and exportation of biological materials (human tissues) for use in research worldwide. Most discussions about samples have taken place in developed countries, where genetic manipulation techniques have greatly advanced in recent years. There is very little discussion in developing countries, although collaborative research with institutions from developed countries is on the increase. The study sought to identify and describe ethical issues arising in the storage, reuse and exportation of samples in a developing (...) country. Research protocols presented to two Ethics Review Committees in Kenya during a period of two years were reviewed. A record was made of the protocol title, sample collected, request for storage, reuse or exportation and whether or not subject consent was sought. The findings indicated that about 25% out of the 388 protocols sought permission for reuse and only half of those actually informed subjects of the contemplated re‐use. Less than 20% requested storage and again, about half of them sought consent from subjects. There is an indication that investigators do not see the need to seek consent for storage, reuse and exportation of samples. It is proposed that these issues should be addressed through policy interventions at both the national and global levels. (shrink)

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how (...) the 'medical consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver. (shrink)

ZusammenfassungDer Begriff „Ethik“ wurde vor kurzem sowohl in die zahnmedizinische Musterberufsordnung 2014 als auch in den aktuellen „Nationalen Kompetenzbasierten Lernzielkatalog Zahnmedizin“ aufgenommen. Die hier vorgelegte Studie widmet sich der Frage, welche Bedeutung dies für die zahnmedizinische Profession und die Gesellschaft hat. Zu diesem Zweck werden die gesellschaftlichen Prozesse erörtert, die durch den autonom handhabbaren Handlungsspielraum der zahnmedizinischen Profession bedingt sind. Die sozialwissenschaftlichen Diskursfelder Profession, Vertrauen, Bildung, Expertise, Handlungspraxis und Sanktion werden hierzu in ihrer Anschlussfähigkeit zueinander und als struktureller Bedeutungsrahmen professionsethisch (...) reflektierten Handelns aufgearbeitet. Basis des professionellen Handlungsspielraums ist ein gesellschaftlicher Vertrauensvorschuss, der dem professionell Handelnden seitens der Gesellschaft und seitens des einzelnen Patienten entgegengebracht wird. Die Studie kommt zu dem Ergebnis, dass das jahrzehntelange Fehlen einer institutionell etablierten Vermittlung der ethischen Grundlagen des zahnmedizinischen Handelns ein schweres Versäumnis darstellt, da junge Zahnärzte nicht angeleitet werden, ihre fachliche Expertise in Bezug auf die zu lösenden Problemstellungen permanent zu reflektieren. Dieses Defizit ist nunmehr benannt worden. Eine institutionell getragene Struktur zur Bearbeitung ethischer Fragen im Rahmen der Zahnheilkunde ist hiernach zu fordern und sollte nunmehr dringend implementiert und umgesetzt werden. (shrink)

Business ethics in Africa, as a field of research, practice, and teaching, has grown rapidly over the last two decades or so, covering a wide variety of topical issues, including corporate social responsibility, governance, and social entrepreneurship. Building on this progress, and to further advance the field, this special issue addresses four broad areas that cover important, under-researched or newly emerging phenomena in Africa: culture, ethics and leadership; business, society and institutions; corruption, anti-corruption and governance; and philanthropy, social (...) entrepreneurship and impact investing. In addition to advancing research by addressing some of the imbalances and gaps in the extant literature, this special issue draws attention to indigenous African theories, models and firms. Some challenges facing business ethics, as a field of practice and teaching in Africa, are also highlighted. The paper concludes with a summary of the eight articles in this special issue. (shrink)

Clinical ethics committees (CECs) have been developing in many countries since the 1980s, more recently in the transitional countries in Eastern Europe. With their increasing profile they are now faced with a range of questions and challenges regarding their position within the health care organizations in which they are situated: Should CECs be independent bodies with a critical role towards institutional management, or should they be an integral part of the hospital organization? In this paper, we discuss the (...) organizational context in which CECs function in Europe focusing on five aspects. We conclude that in Europe clinical ethics committees need to maintain a critical independence while generating acceptance of the CEC and its potential benefit to both individuals and the organization. CECs, perhaps particularly in transitional countries, must counter the charge of “alibi ethics”. CECs must define their contribution to in-house quality management in their respective health care organization, clarifying how ethical reflection on various levels serves the hospital and patient care in general. This last challenge is made more difficult by lack of consensus about appropriate quality outcomes for CECs internationally. These are daunting challenges, but the fact that CECs continue to develop suggests that we should make the effort to overcome them. We believe there is a need for further research that specifically addresses some of the institutional challenges facing CECs. (shrink)

Organizational ethics and institutional theories are extended by recovering Weberian and Pre-Weberian theorizing that emphasized the joining of ethics and institutional theories. Understanding how ethics and institutional systems influence each other can advance our understanding of the nature and causes of structural organizational ethics issues and help guide potential reforms. We consider the interplay of these elements during the recession of 2008–2009, highlighting how structural ethics problems may have to be addressed at (...) the institutional levels and not solely the individual or organizational levels. (shrink)

There is little doubt that Corporate Social Responsibility (CSR) is now a global concept and a prominent feature of international business, with its practice localised and differing across countries. Despite the growing body of research focussing on CSR in developing countries, there is dearth research on CSR institutionalisation in African countries. Drawing on institutional theory (IT), this article examines the focus and form of CSR practice of companies in Kenya. It is evident from our findings that the nature and (...) orientation of CSR differ across companies with operations only in Kenya and those headquartered abroad or with international operations. Significantly, firm-related drivers such as public relations and performance, as well as global institutional pressures explain the focus and form of CSR in Kenya. This article concludes that for the institutionalisation of CSR in Kenya, attention must be paid to conditions that stifle CSR uptake such as lack of government regulations, and the government's capacity and commitment to enforce regulation. The establishment of functional CSR institutions and a vibrant civil society that advance civil regulation ought to be encouraged. (shrink)