A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

Interest in teaching business ethics classes on college campuses has increased dramatically during the past decade. In the United States, virtually all graduate and undergraduate business programs teach business ethics in some form. While current pedagogy relies primarily on factual recounting of actual workplace incidents and actual and hypothetical case studies, calls for multidisciplinary approaches to teaching business ethics have not yet produced significant pedagogical change. We propose the use of fiction (novels, dramas, and short stories) to enrich current teaching (...) materials. This paper illustrates the tremendous power of stories which deal with ethical dilemmas in business to illuminate moral issues in ways that lead to a clearer understanding of ethical theory. The fiction cited in this paper is all drawn from American literature. It seems likely that similar sources could be found in the literature of other countries. (shrink)

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on (...) the following key issues: § 1.Providing information about research integrity § 2.Providing education, training and mentoring § 3.Strengthening a research integrity culture § 4.Facilitating open dialogue § 5.Wise incentive management § 6.Implementing quality assurance procedures § 7.Improving the work environment and work satisfaction § 8.Increasing transparency of misconduct cases § 9.Opening up research § 10.Implementing safe and effective whistle-blowing channels § 11.Protecting the alleged perpetrators § 12.Establishing a research integrity committee and appointing an ombudsperson § 13.Making explicit the applicable standards for research integrity. (shrink)

The area of services marketing is a highly crucial one for potential ethical violations. The services industry, which drives over two-thirds of our national economy, is about to experience severe changes due to increasing competition. The temptation to make ethical compromises will pose a dramatic threat to the business climate.We review conceptual approaches to the field of marketing ethics and conclude that existing models often lack an important component which affects ethical decision-making. That component includes the interorganizational variables: the primary (...) task environment, including immediate customers and suppliers to the buyer and seller; the secondary task environment, comprised of suppliers and customers to the immediate suppliers and customers, competitors, and regulatory agencies, and the macro-environment, those broader forces which impinge on the activities in the primary and secondary task environments. (shrink)

Although many studies have revealed the importance of study skills for students' first?year performance and college retention, the extent of the impact of study skills preparation on students' academic achievement is less clear. This paper explores the impact of pre?university study skills preparation on students' first?year study experiences, academic achievement and persistence. The setting for this study is a large law school in the Netherlands which attracts students from more than 100 schools for secondary education. The results show that the (...) perceived study skills preparation concerning time management and learning skills does have a positive impact on college students' first?year study behaviour and academic achievement. However, the study also shows that the impact of perceived college preparation is far less important for college retention than other factors such as satisfaction about the chosen degree programme and tutorial attendance. (shrink)

There is strong theoretical support for a relationship between various characteristics of religiousness and attitudes towards business ethics. This paper examines three frequently- studied dimensions of religiousness (fundamentalism, conservatism, and intrinsic religiousness) and their ability to predict students' willingness to behave unethically. Because prior research indicated a possible relationship between the religious affiliation of an institution and its members' ethical orientation, we studied students at universities with three different types of religious affiliation: evangelical, Catholic, and none.Results of the study lend (...) support to a negative relationship between the above-mentioned dimensions of religiousness and willingness to behave unethically. In addition, students at the Evangelical university were far less willing to engage in unethical behavior than were students at either the Catholic or the unaffiliated institutions. (shrink)

Over the past seventy-five years, the UN secretary-general has come to occupy a highly visible position in world politics. While the UN Charter describes the post merely as the “chief administrative officer” of the organization, today it is widely recognized that the secretary-general also plays a central role in political matters. What makes the role of the UN secretary-general special? Where does the office's authority come from? As part of the special issue on “The United Nations at Seventy-Five: Looking Back (...) to Look Forward,” this essay looks back at the tenures of previous UN secretaries-general and applies ideas from sociological institutionalism to argue that the UN secretary-general holds the position of a “guardian” of the UN Charter. The UN secretary-general, more than anyone else within the UN system, represents the UN overall. From this flows great responsibilities and challenges, as the UN secretary-general is often expected to step in when other parts of the UN are unable or unwilling to act, and to take the blame when things go wrong. But this special position also endows the office with a substantial degree of authority, which future holders of the office can use to shape policies and mobilize support as the UN seeks to address urgent global challenges. (shrink)

Delivering high quality genomics-informed care to patients requires accurate test results whose clinical implications are understood. While other actors, including state agencies, professional organizations, and clinicians, are involved, this article focuses on the extent to which the federal agencies that play the most prominent roles — the Centers for Medicare and Medicaid Services enforcing CLIA and the FDA — effectively ensure that these elements are met and concludes by suggesting possible ways to improve their oversight of genomic testing.

What was really going on in the Baby K case? Many people have posed that or similar questions to me when I have been introduced as the attorney for Baby K's mother. In a nutshell, the courts in Baby K ruled that a hospital is required to provide emergency medical care to an anencephalic baby at the mother's request. In this paper, I provide some insights into the factors that underlie the litigation and the legal issues decided by the courts. (...) In my view, this case involved a myriad of legal questions, religious principles, power struggles, and health care resources arguments that could arise in other contexts. (shrink)

This paper examines levels of similarity in ethical outlooks in countries where economic and sociocultural values may differ markedly. We compared students from a capitalist country, the United States, with students from Ukraine, a country experiencing dramatic ideological confusion and economic change. We tested the hypothesis that greater social and moral integration, as operationalized by a lack of alienation and by religiousness, will directly affect one's willingness to engage in unethical business practices.The sample was composed of business students in both (...) Ukraine and the United States. The survey instrument consisted of widely used scales for measuring alienation and religiousness. The measure of ethical standards was a vignette-based quasi-projective technique. (shrink)

Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to (...) graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of decision-making that confront them in daily practice.” Six major themes corresponding to questions posed to the participants included the ability to advocate for good patient care; to support and empower colleagues, patients, and families; they experienced personal and professional transformation; they valued the multimodal nature of the program; and were using their new knowledge and skills in practice. However, they also recognized that their development as moral agents was an ongoing process. Discussion: Findings support that enhancing nurse confidence in their moral agency with a multimodal educational approach that includes mentored practice in ethical decision-making, enhancing communication skills and role-play can mitigate moral distress. A majority found the program personally and professionally transformative. However, they recognized that ongoing ethics discussion involvement and supportive environments would be important in their continued development of ethical agency. Conclusion: Multimodal ethics education programs have potential to be transformative and enhance nurse confidence in their ethical decision-making. (shrink)

This article provides practical guidance for researchers who wish to enroll and collect data from pediatric research participants through online and mobile platforms, with a focus on the involvement of both children and their parents in the decision to participate.

Making Sense of Sex: Attitudes towards Sexuality in Early Jewish and Christian Literature. By William Loader. Grand Rapids, Mich.: William B. Eerdmans Publishing Co., 2013. Pp. vii + 168. $24.

Screening for prostate cancer with the prostate-specific antigen blood test is controversial, as evidence to date has not demonstrated such screening does more good than harm. While the potential benefit of PSA screening on reducing prostate cancer mortality has not been documented in randomized trials, many risks of PSA screening have been well documented. These risks include a substantially higher risk of a prostate cancer diagnosis over a screenee’s lifetime, false-positive and false-negative test results, possible complications from biopsies done in (...) response to suspicious test results, and substantial risks of side effects from subsequent prostate cancer treatments. Nevertheless, PSA screening is widespread in the United States, and many physicians in a national survey reported supporting routine PSA screening as well as getting PSA tests themselves, despite the lack of evidence. (shrink)

Some individuals and businesses have become increasingly dependent upon multiple financing sources for economic survival. Certain currently used lending policies, such as interest-only loans and revolving credit lines, may encourage borrower dependency on the lender. The paper reviews religious teachings, specifically religious safeguards on lending identified in primary Jewish sources including the Tanach and rabbinic teachings, and finds that the safeguards in place centuries ago may still be relevant for lending practices today to both protect the borrower while still providing (...) a profitable means to help borrowers. (shrink)

We have previously found that attention to internal somatic sensations during a heart beat perception task increases the misperception of external touch on a somatic signal detection task , during which healthy participants erroneously report feeling near-threshold vibrations presented to their fingertip in the absence of a stimulus. However, it has been suggested that mindful interoceptive attention should result in more accurate somatic perception, due to its non-evaluative and controlled nature. To investigate this possibility, 62 participants completed the SSDT before (...) and after a period of brief body-scan mindfulness meditation training, or a control intervention . The meditation intervention reduced tactile misperception and increased sensitivity during the SSDT. This finding suggests that the perceptual effects of interoceptive attention depend on its particular nature, and raises the possibility that body-scan meditation could reduce the misperception of physical symptoms in individuals with medically unexplained symptoms. (shrink)

In his article, “What should ChatGPT mean for bioethics?” I. Glenn Cohen explores the bioethical implications of Open AI’s chatbot ChatGPT and the use of similar Large Language Models (LLMs) (Cohen...

The concept of ‘place’, and general references to ‘geographies of …’ are making gradual incursions into nursing literature. Although the idea of place in nursing is not new, this recent spatial turn seems to be influenced by the increasing profile of the discipline of health geography, and the broadening of its scope to incorporate smaller and more intimate spatial scales. A wider emphasis within the social sciences on place from a social and cultural perspective, and a wider turn to ‘place’ (...) across disciplines are probably equally important factors. This trend is raising some interesting questions for nurses, but at the same time contributes some confusion with regard to imputed meanings of ‘place’. While it is clear that most nurse clinicians and researchers certainly understand that place of care matters to their practices and patients, many diverse uses of ‘place’ are found within nursing literature, and contemporary understandings of the term ‘place’ within nursing are not immediately clear. It is in this context that this article plans to advance the discussion of place. More specifically, the aims of this paper are threefold: to critique ‘place’ as it appears in nursing literature, to explore the use of ‘place’ within health geography, whence notions of place and ‘geographies of’ have originated and, finally, to compare and contrast the use of ‘place’ in both disciplines. This critique intends to address a deficit in the literature, in this era of growing spatialization in nursing research. The specific questions of interest here are: ‘what is “place” in nursing?’ and ‘how do concepts of place in nursing compare to concepts of place in health geography?’. (shrink)

Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. Design, Setting, Participants A survey of resident/fellow physicians and internal medicine (...) attendings at an academic medical center, May to August 2013. Measurements We used a 24-item, internet-based survey assessing physician-respondents’ demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. Main Results A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/ fellows. Only 32 percent of the respondents indicated that a surrogate’s consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate’s objection. Those who self-reported as “knowledgeable” about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VAECMO over a surrogate’s objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Conclusions Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/ critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians’ hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. (shrink)

In applying statutory safeguards, the FDA must not regulate investigational new products so stringently that a life‐saving therapy is unavailable. But the agency must also protect dying patients from exploitation by unscrupulous or overzealous researchers. The balance between individual choice and public protection has been questioned in cases involving experimental AIDS drugs and an artificial heart.

This article describes some potential uses of Bayesian estimation for time-series and panel data models by incorporating information from prior probabilities (i.e., priors) in addition to observed data. Drawing on econometrics and other literatures we illustrate the use of informative “shrinkage” or “small variance” priors (including so-called “Minnesota priors”) while extending prior work on the general cross-lagged panel model (GCLM). Using a panel dataset of national income and subjective well-being (SWB) we describe three key benefits of these priors. First, they (...) shrink parameter estimates toward zero or toward each other for time-varying parameters, which lends additional support for an income → SWB effect that is not supported with maximum likelihood (ML). This is useful because, second, these priors increase model parsimony and the stability of estimates (keeping them within more reasonable bounds) and thus improve out-of-sample predictions and interpretability, which means estimated effect should also be more trustworthy than under ML. Third, these priors allow estimating otherwise under-identified models under ML, allowing higher-order lagged effects and time-varying parameters that are otherwise impossible to estimate using observed data alone. In conclusion we note some of the responsibilities that come with the use of priors which, departing from typical commentaries on their scientific applications, we describe as involving reflection on how best to apply modeling tools to address matters of worldly concern. (shrink)

Christmas gives us that 'sweet little Jesus Boy' and Lent follows that with the 'gentle Jesus, meek and mild.' He was neither of those. In point of fact, he was the 'tough guy from Nazareth.' He was consistently abrasive, if not abusive, to his mother (Lk 2:49; Jn 2:4; Mt 12:48) and aggressively hard on males, particularly those in authority. In Mark 8 he cursed and damned Peter for failing to get Jesus' esoteric definition of Messiah correct. Nobody else understood (...) it either. Jesus had made it up himself and not adequately explained it to anybody until then. He called the religious authorities snakes, corrupt tombs, filthy chinaware, fakes, and Mosaic legalists who had forgotten God's real revelation of universal grace and salvation in the Abraham Covenant. He tore up the temple in the middle of a worship service and cursed those present for turning God's house of prayer into a den of thieves, when actually they were kind, helping out-of-town tourists obtain the proper sacrifices for the liturgical rituals. Jesus was persistently aggressive, often angry and not infrequently irrational, killing an innocent fig tree with his curse, for example. He constantly attacked the Pharisees and their proposals for renewing the spiritual vitality of the Jewish Community. He abused numerous people by healing them on the Sabbath just to make his political point against the religious leaders. He could just as well have healed them on Tuesday, if he really wanted to heal them. By healing the blind man in John 9 on the Sabbath, for example, he caused the man to be driven out of his synagogue, his family, and his community of faith; isolated and abandoned as if he were a leper. Even when he said surprising things about children, his focus was not on the children but on his disciples, using the children as tools for making an assertive teaching point. Jesus' life was one of perpetually aggressive claims for his vision of God's reign. He constantly and intentionally provoked conflict and disruption of the status quo, spiritually and politically. He refused to negotiate, compromise, palliate, or mollify his insistence upon keeping his elbow perpetually in the eye of the people in power. In all this he would not back down. The principle by which Jesus operated was absolute and that is why he did not back down, even though they killed him for this very reason. His principle was simply that the renewal of Jewish spirituality could only come from a return to the Abrahamic Covenant, which declared (Gn 12; Rm 8) that God is gracious and universally forgiving towards all humankind, unconditional to our conduct and behaviour, and radically in that it removes all fear, guilt, and shame from the equation of our relationship with God (Mi 7:18-20). He saw that the Pharisees and Scribes were absolutely wrong in assuming that the Mosaic legal system would renew the Jewish relationship with God. He was not the gentle Jesus, meek and mild. He was that tough guy from Nazareth! He had good reason and he was willing to go the distance for what he stood for, even to death on the cross. (shrink)

Although previous work has linked parent autonomy support to the development of children’s executive function skills, the role of specific autonomy-supportive behaviors has not been thoroughly investigated. We compiled data from four preschool-age samples in the Midwestern United States to examine three relevant autonomy-supportive behaviors and their associations with child EF. We coded parent autonomy-supportive behaviors from a 10-min interaction between parent and child dyads working on challenging jigsaw puzzles together. Children completed a battery of EF. Overall, child EF was (...) most consistently correlated with the offering choice subscale. Additionally, only the offering choice subscale predicted child EF while controlling for the other autonomy support subscales and child age. These results suggest that parent provision of choice is an especially relevant aspect of autonomy-supportive parenting and may be important to the development of EF in early childhood. Future research should directly measure children’s experience with choice and how it relates to emerging EF. (shrink)

Introduction - This paper is aimed at gaining more insight into the effects of camera-surveillance on behavior. This study investigates the effects of three different ways of ‘framing’ camera presence on cheating behavior and pro-social behavior. First, we explore the effect of presenting the camera as the medium through which an intimidating authority watches the participant. Second, we test the effect of presenting the camera as being a neutral, non-intimidating viewer. Third, we investigate whether a participant watching themselves via a (...) camera has an effect on their behavior. In contrast to most studies of camera surveillance, we will conduct our experiments in an indoor setting, enabling us to investigate behavior to a much greater detail. We will also explore possible moderating effects of personality traits. Methods - 86 students participated in this experiment, distributed over four conditions: three different ways of framing the camera presence, plus a control condition. Our main dependent variables were various kinds of cheating and pro-social behavior. We established the participant’s relevant personality traits in a separate session. Results - For cheating behavior, findings showed that the ‘authorative’ way of framing camera presence and the situation in which participants viewed themselves, differed significantly from a situation without camera-surveillance. We did not find significant effects of camera surveillance on pro-social behavior during the experiment. Looking at personality traits, we found an indication that people with an internal locus of control are more inclined to cheat when there is no camera present compared to people with an external locus of control. However, the effects of our manipulations were stronger. Conclusion - These results support the idea that the framing of a camera’s presence does indeed influence cheating behavior, adding to the preventive effects of camera-surveillance. Additionally, this study provides some valuable insights into the influence of camera presence on behavior in general. (shrink)

Sentences such as “The ship was sunk to collect the insurance” exhibit an unusual form of anaphora, implicit control, where neither anaphor nor antecedent is audible. The non-finite reason clause has an understood subject, PRO, that is anaphoric; here it may be understood as naming the agent of the event of the host clause. Yet since the host is a short passive, this agent is realized by no audible dependent. The putative antecedent to PRO is therefore implicit, which it normally (...) cannot be. What sorts of representations subserve the comprehension of this dependency? Here we present four self-paced reading time studies directed at this question. Previous work showed no processing cost for implicit vs. explicit control, and took this to support the view that PRO is linked syntactically to a silent argument in the passive. We challenge this conclusion by reporting that we also find no processing cost for remote implicit control, as in: “The ship was sunk. The reason was to collect the insurance.” Here the dependency crosses two independent sentences, and so cannot, we argue, be mediated by syntax. Our Experiments 1–4 examined the processing of both implicit (short passive) and explicit (active or long passive) control in both local and remote configurations. Experiments 3 and 4 added either “3 days ago” or “just in order” to the local conditions, to control for the distance between the passive and infinitival verbs, and for the predictability of the reason clause, respectively. We replicate the finding that implicit control does not impose an additional processing cost. But critically we show that remote control does not impose a processing cost either. Reading times at the reason clause were never slower when control was remote. In fact they were always faster. Thus, efficient processing of local implicit control cannot show that implicit control is mediated by syntax; nor, in turn, that there is a silent but grammatically active argument in passives. (shrink)

This article is a longitudinal analysis of the relation between gendered labour divisions and new data processing technologies at the Dutch Central Bureau of Statistics. Following social-constructivist and evolutionary economic approaches, the authors hold that the relation between technology and work organization is a two-way process. This means that technology does not only affect the relations between men and women at work, but that these relations also influence technological choices. The proportional numbers of men and women on the labour market (...) and changing conceptions of which work is deemed appropriate for women have been important factors in the strongly varying extent to which women participated in office work. They have also been important factors in determining the course of technological development. Shortages of women on the labour market have even determined search heuristics for new technological solutions in specific directions. (shrink)

From February 2020, the COVID-19 pandemic led to closures of educational institutions to reduce the spread of infectious disease. This forced the U.S. education system into a massive experiment with online education. Despite conducting online bioethics education for nearly twenty years, our bioethics program, a joint endeavor of Clarkson University and Icahn School of Medicine at Mount Sinai, was not immune to this disruption because our curriculum features intensive, one-week onsite courses. Even in the face of historic disruptions, it is (...) vital to ensure minimal interruptions to teaching and assessing students to provide effective education. This paper reviews the steps we took to successfully convert the onsite components of our curriculum to a synchronous online format, and it focuses on how we preserved instruction and assessment of practical skills that comprise these courses’ core. It also explains how we fostered interactive classroom environments. (shrink)