The authors aim to explore a better fitting leadership style that is designed for the sustainable era in believing and committing to work for cherishing resources and developing the organization toward a new sustainable direction. This study developed the questionnaire items of the Resource-Dilemma-Handling-Leadership scale, representing a new sustainable era's new leadership style, and then to compare it with the transformational leadership style in order to highlight the importance of RHDL for sustainable development. This study took companies, which (...) have more than 100 employees in Taiwan as research samples. Those companies were selected because they were socially tagged as being operating continuously for more than 20 years and identifying themselves with the operational orientation of social responsibility as their business philosophy and core values for management. A total of 532 valid questionnaires were collected, with a 90.6% valid return rate, and tested with the SEM method. Consistent with the authors' inferences from the literature, the test results suggest that CSR plays the role of full mediator between RDHL and OC. CSR itself is like a sense of responsibility, giving employees a sense of mission, to complete meaningful sustainability-relevant tasks in the organization. RDHL, compared with TL, has a better prediction power on CSR and OC. Theoretically, this study implies that the impact of leadership of the organization on OC in the aspects of sustainable development should be going through the influence of the ELB system in the form of CSR to promote the organization's internal and external organizational CSR performance, with added internal strengthening power from OC. Practically, the new RDHL concepts brought up by this study include the training and enhancement of leadership skills based on the content of the scale items being explored. The new RDHL scale contains a comprehensive description of the spirit of the new sustainable era's leadership style. Also, the future applications of RDHL ideas in the form of human resource development should help the realization of the ideally sustainability behavioral patterns of leaders and employees in the organizations. (shrink)

Fundamental problems of environmental sustainability, including climate change and fisheries management, require collective action on a scale that transcends the political and cultural boundaries of the nation-state. Rational, self-interested neoclassical economic theories of human behavior predict tragedy in the absence of third party enforcement of agreements and practical difficulties that prevent privatization. Evolutionary biology offers a theory of cooperation, but more often than not in a context of discrimination against other groups. That is, in-group boundaries are necessarily defined by those (...) excluded as members of out-groups. However, in some settings human’s exhibit behavior that is inconsistent with both rational economic and group driven cooperation of evolutionary biological theory. This paper reports the results of a non-cooperative game-theoretic exercise that models a tragedy of the commons problem in which groups of players may advance their own positions only at the expense of other groups. Students enrolled from multiple universities and assigned to different multi-university identity groups participated in experiments that repeatedly resulted in cooperative outcomes despite intergroup conflicts and expressions of group identity. We offer three possible explanations: students were cooperative because they were in an academic setting; students may have viewed their instructors as the out-group; or the emergence of a small number of influential, ethical leaders is sufficient to ensure cooperation amongst the larger groups. From our data and analysis, we draw out lessons that may help to inform approaches for institutional design and policy negotiations, particularly in climate change management. (shrink)

Decision-making regarding treatment for newborns with disabilities in resource-poor settings is a difficult process that can put parents and caregivers in conflict. Despite several guidelines that have helped to clarify some of the medical decision-making in Ghana, there is still no clear consensus on the specific moral criteria to be used. This article presents the case of a mother who expressed her wish that her child with Down syndrome should not have been resuscitated at birth. It explores the ethical (...) issues at stake in both her misgivings about the resuscitation and her unwillingness to consider surgical repair of an atrioventricular (AV) canal defect. Knowing that children born with Down syndrome are able to pursue life’s goals, should our treatment of complete AV canal defect in such children be considered morally obligatory, even in resource-poor settings like Ghana? (shrink)

BackgroundRadiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.MethodsSemi-structured (...) interviews were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.ResultsParticipants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.ConclusionsMultiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views. (shrink)

When the demand for a medical resource exceeds the supply, we have a problem of scarcity. There are many instantiations of this issue. The time of health care providers during an emergency, organs for transplantation, a bed in an intensive care unit, and a slot in a research protocol can all be scarce resources. Interest in this issue has been renewed because of recent concerns about a pandemic and shortages of vaccines. In each of these cases there is a (...) problem of distributive justice. If the resource is lifesaving, then the question is especially poignant: Who shall be saved when not all can be? This was the problem faced by Sir Dr. Colenso Ridgeon in Bernard Shaw's 'The Doctor's Dilemma', a play first performed a century ago. (shrink)

During disasters, clinicians may be forced to play dual roles, as both a provider and an allocator of scarce resources. At present, a clear framework to govern resource stewardship at the bedside is lacking. Clinicians who find themselves practicing in this ethical gap between clinical and public health ethics can experience significant moral distress. One provider describes her experience allocating an oxygen tank in the intensive care unit at a hospital in Port-au-Prince, Haiti, immediately following the 2010 earthquake. Using (...) a clinical vignette and reflective narrative she attempts to identify the factors that influenced her allocation decision, opening up the factors for commentary and debate by an ethicist. A better paradigm for the ethical care of patients during disasters is needed to better guide provider choices in the future. (shrink)

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

International migration of work force is presently a high amplitude phenomenon. Romanian people have emigrated for work around the world, being engaged both in the physically hardest jobs and in activities that require completion of specialized courses and certification in a particular field. This last category includes social workers who, following schooling and certification and even having a minimal experience in the home country, apply for jobs in the field of social assistance. These recruiters aim to distribute social workers at (...) the workplace of interest, according to certain well-defined criteria. In the present paper we describe international migration of work force, and we illustrate it by adding case studies of life experience of social workers who underwent the process of emigration to the United Kingdom. Throughout the emigration process, these workers experienced certain changes in their life principles, mentality, values, and were marked by professional dilemmas in extreme situations. (shrink)

This article is the second one in a series dealing with mental health ethics in Cuba. It reports on ethical dilemmas, resources and limitations to their resolution, and recommendations for action. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans experience dilemmas related to the interests of clients, their personal interests, and the interest of the state. These conflicts are related to power differentials among clients and professionals, professionals from various disciplines, and professionals and (...) organizational authorities. Resources to solve ethical dilemmas include government support, ethics committees, and collegial dialogue. Limitations include minimal training in ethics, lack of safe space to discuss professional disagreements, and little tolerance for criticism. Recommendations to address ethical dilemmas include better training, implementation of a code of ethics, and provision of safe space to discuss ethical dilemmas. The findings are discussed in light of the role of power in applied ethics. (shrink)

Background: Positioned at the frontlines of the battle against COVID-19 disease, nurses are at increased risk of contraction, yet as they feel obligated to provide care, they also experience ethical pressure. Research question and objectives: The study examined how Israeli nurses respond to ethical dilemmas and tension during the COVID-19 outbreak, and to what extent this is associated with their perceived risk and motivation to provide care? Research design: The study implemented a descriptive correlative study using a 53-section online questionnaire, (...) including 4 open-ended questions. Participants and research context: The questionnaire was complete by 231 registered and intern nurses after being posted on nurses’ Facebook and WhatsApp groups, and through snowball sampling. Ethical considerations: The research was pre-approved by the ethics committee of the Faculty of Social Welfare and Health Sciences at the University of Haifa, Israel. Findings: In all, 68.8% of the respondents had received some form of training about COVID-19. Respondents positioned themselves at perceived high risk levels for contracting the virus. About one-third feared going to work because of potential contraction and due to feeling inadequately protected. While 40.9% were scared to care for COVID-19 patients, 74.7% did not believe they have the right to refuse to treat certain patients. When asked about defining an age limit for providing patients with scarce resources (such as ventilation machines) in cases of insufficient supplies, respondents stated that the maximum age in such scenarios should be 84 (standard deviation (SD = 19) – yet most respondents (81.4%) believed that every patient has the right to receive optimal treatment, regardless of their age and medical background. Discussion: Correlating with their strong commitment to care, nurses did not convey intention to leave the profession despite their stress, perceived risk, and feelings of insufficient support and protection at work. The nurses did not hold a utilitarian approach to resource allocation, thereby acknowledging the value of all people and their entitlement to care, regardless of optimal outcomes. Conclusion: While experiencing significant personal risk and emotional burden, nurses conveyed strong dedication to providing care, and did not regret working in the nursing profession, yet they did seek a supportive climate for their needs and ethical concerns. (shrink)

Educators and policy makers confront challenging questions of ethics, justice, and equity on a regular basis. Should teachers retain a struggling student if it means she will most certainly drop out? Should an assignment plan favor middle-class families if it means strengthening the school system for all? These everyday dilemmas are both utterly ordinary and immensely challenging, yet there are few opportunities and resources to help educators think through the ethical issues at stake. Drawing on research and methods developed in (...) the Justice in Schools project at the Harvard Graduate School of Education,_ Dilemmas of Educational Ethics_ introduces a new interdisciplinary approach to achieving practical wisdom in education, one that honors the complexities inherent in educational decision making and encourages open discussion of the values and principles we should collectively be trying to realize in educational policy and practice. At the heart of the book are six richly described, realistic accounts of ethical dilemmas that have arisen in education in recent years, paired with responses written by noted philosophers, empirical researchers, policy makers, and practitioners, including Pedro Noguera, Howard Gardner, Mary Pattillo, Andres A. Alonso, Jamie Ahlberg, Toby N. Romer, and Michael J. Petrilli. The editors illustrate how readers can use and adapt these cases and commentaries in schools and other settings in order to reach a difficult decision, deepen their own understanding, or to build teams around shared values. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analyzed using interpretive content and thematic analysis. Three (...) key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices because psychologists described 5 distinct options. These can be conceptualized on a spectrum of varying degrees of client autonomy, ranging from “no disclosure” to “disclosure without the client’s knowledge or consent”. Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimize potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development. (shrink)

Philosophical Dilemmas: A Pro and Con Introduction to the Major Questions and Philosophers, Fourth Edition, outlines the classic arguments made by philosophers through the ages. It features sixty-three brief topical essays by author Phil Washburn organized around thirty-one fundamental philosophical questions like "Does God exist?" "Is morality relative?" and "Are we free?" Each essay takes a definite stand and promotes it vigorously, creating a sharp contrast between the two positions and giving each abstract theory a more personal and believable "voice." (...) The accessible writing style and conflicting answers encourage students to examine the different positions and to think carefully about which essay makes the stronger case. This fourth edition, a major revision, now enriches the discussion of each philosophical question by adding fifty-four brief essays--two in each chapter--on great philosophers who held conflicting viewpoints on the issues covered. Additionally, the chapters have been rearranged so that these essays and the philosophers discussed appear in approximate chronological order, from Plato and Protagoras to Wittgenstein and Searle. The text is enhanced by numerous pedagogical features including an introduction to each issue, key terms, chapter summaries, study questions after each essay, chronologies, a glossary, and an appendix on how to write an essay. A Companion Website at www.oup.com/us/washburn contains online sources and self-test questions for students and numerous instructor resources: introductions to the issues; summaries of the topical essays; summary points, PowerPoint-based slides, and test questions for the historical essays; answers to the critical questions that follow each essay; test questions on the topical essays; suggestions for class discussions; and a list of online resources. (shrink)

Sequences of numbers representing prior resource size were presented to participants in a common-pool resource dilemma. The numbers were sampled from uniform probability distributions with either a low variance (low resource uncertainty) or a high variance (high resource uncertainty). Presentations were both sequential and simultaneous. Three groups of 16 undergraduates either estimated the size of the resource when it did not represent value to them; requested an amount from the resource, identified with a (...) sum of money, when the outcome of the requests only depended on resource size; or requested from the resource (sum of money) when the outcome of the requests depended on both resource size and how much others in a group requested. In support of an individual outcome-desirability bias due to selective recall of the number sequences, after sequential presentation larger requests were observed when resource uncertainty was high than when it was low. No effects of resource uncertainty or presentation were found on the estimates of resource size. Whether or not the outcome of the requests depended on others' requests made little difference. (shrink)

Background: Healthcare professionals encounter ethical dilemmas and concerns in their practice. More research is needed to understand these ethical problems and to know how to educate professionals to respond to them. Research objective: To describe ethical dilemmas and concerns at work from the perspectives of Finnish and Dutch healthcare professionals studying at the master’s level. Research design: Exploratory, qualitative study that used the text of student online discussions of ethical dilemmas at work as data. Method: Participants’ online discussions were analyzed (...) using inductive content analysis. Participants: The sample consisted of 49 students at master’s level enrolled in professional ethics courses at universities in Finland and the Netherlands. Ethical considerations: Permission for conducting the study was granted from both universities of applied sciences. All students provided their informed consent for the use of their assignments as research data. Findings: Participants described 51 problematic work situations. Among these, 16 were found to be ethical dilemmas, and the remaining were work issues with an ethical concern and did not meet criteria of a dilemma. The most common problems resulted from concerns about quality care, safety of healthcare professionals, patients’ rights, and working with too few staff and inadequate resources. Discussion: The results indicated that participants were concerned about providing quality of care and raised numerous questions about how to provide it in challenging situations. The results show that it was difficult for students to differentiate ethical dilemmas from other ethical work concerns. Conclusion: Online discussions among healthcare providers give them an opportunity to relate ethical principles to real ethical dilemmas and problems in their work as well as to critically analyze ethical issues. We found that discussions with descriptions of ethical dilemmas and concerns by health professionals provide important information and recommendations not only for education and practice but also for health policy. (shrink)

Dilemma in Politics underlines the major faults and fissures in the academic discourses around the themes emphasising upon the prevalence of 'dichotomy' between 'what ought to be' and 'what is' in the political sphere. How do the political values get marginalized, if not compromised, in the name of ideological conflicts and alliances? This book highlights this 'dilemma' across a range of themes which explore the gaps in the practice and the praxis of politics. The essays in this volume (...) present detailed analytical perspective on issues concerning environment, women empowerment and feminist discourses, identity-based politics, and its limitations, among various other key themes. Further it analyses the concept of rights in the neoliberal democratic context, caste and class politics and its inherent dilemmas and also illustrates the gaps in the political discourses to discusses possible alternatives or solutions. With contributions by eminent political scientists working on Indian politics, this book would be an invaluable resource for scholars and researchers of political science, political philosophy, public administration, governance, public policy, political participation, democracy, and South Asia studies, as well as be of interest to bureaucrats, policymakers, and the general readers. (shrink)

This paper presents a new kind of problem in the ethics of distribution. The problem takes the form of several “calibration dilemmas,” in which intuitively reasonable aversion to small-stakes inequalities requires leading theories of distribution to recommend intuitively unreasonable aversion to large-stakes inequalities. We first lay out a series of such dilemmas for prioritarian theories. We then consider a widely endorsed family of egalitarian views and show that they are subject to even more forceful calibration dilemmas than prioritarian theories. Finally, (...) we show that our results challenge common utilitarian accounts of the badness of inequalities in resources. (shrink)

The human resources profession emphasizes the personal and interpersonal aspects of work, that make it conscious of complex ethical issues in relationships in the workplace, while finance specialists are conversant with routine compliance with regulations. Marketing professionals are under pressure to produce revenue results. Thus, this research hypothesized that human resources managers would be more disapproving of unethical conduct than both finance and marketing functional managers, and that finance managers would be more disapproving than marketing managers. When asked to evaluate (...) instances of unethical behavior in vignettes, human resources and finance managers were both significantly more disapproving than marketing managers. However, human resources managers were not significantly more disapproving than finance managers. Explanations for the results lie in the divergent antecedent conditions, objectives, perceptions of ethical problems and demands of the various functions. Alternative behavior patterns to resolve ethical dilemmas and expected consequences by the different functions also define their ethical orientations. Average responses on the disapproving side from all three functional groups are explained by two complementary trends that promote ethical awareness among all functional managers. One is the adoption of homogeneous conventions in ethical business practice. The other trend is the increase in ethical awareness specific to each of the functional professions. (shrink)

This article develops a dilemma for Buddhist Reductionism that centers on the nature of normative reasons. This dilemma suggests that Buddhist Reductionism lacks the resources to make sense of normative reasons and, furthermore, that this failure may cast doubt on the plausibility of Buddhist Reductionism as a whole.

This book presents five controversial issues that stir conflicts about moral decisions in our time. John Chirban draws upon resources of specific faith traditions. He provides case discussion and considers numerous interdisciplinary perspectives, arguing an interdependent approach for addressing these current ethical issues.

We make the case that the Prisoner’s Dilemma, notwithstanding its fame and the quantity of intellectual resources devoted to it, has largely failed to explain any phenomena of social scientific or biological interest. In the heart of the paper we examine in detail a famous purported example of Prisoner’s Dilemma empirical success, namely Axelrod’s analysis of WWI trench warfare, and argue that this success is greatly overstated. Further, we explain why this negative verdict is likely true generally and (...) not just in our case study. We also address some possible defenses of the Prisoner’s Dilemma. (shrink)

There is a tension between our need for associative control and our need for social connections. This tension creates ethical dilemmas that we can call each-we dilemmas of sociability. To resolve these dilemmas, we must prioritize either negative moral rights to dissociate or positive moral rights to social inclusion. This article shows that we must prioritize positive social rights. This has implications both for personal morality and for political theory. As persons, we must attend to each other's basic social needs. (...) As a society, we must adopt a sufficientarian approach to the regulation of social resources. (shrink)

The authors’ aim is to bring to the attention of readers the inadequacies of care for people in Hungary who are terminally ill. They believe that both objective and subjective factors cause these inadequacies. Most of these factors arise from moral dilemmas that could be eased or even solved if ethics education had a much more prominent place in the nursing curriculum. Even if nurses would not become automatically better persons morally, a much wider knowledge of medical/nursing ethics could significantly (...) improve nursing care both before and at the end of life. Although the article is also critical of the nursing care provided, it is not its purpose to make any generalizations. The study utilized selected passages from essays written by 76 practicing nurses on their personal experience of ethical dilemmas in their work environment, and a questionnaire administered to 250 students (registered nurses and health care students) studying for a college degree. This article is written by two authors who have formed an unusal alliance: a registered nurse with 29 years’ experience of bedside nursing, but who is currently a teacher of nursing ethics at a local health college, and a lawyer turned bioethicist. (shrink)

Telling the truth is one of the most respected virtues in medical history and one of the most emphasized in the code of medical ethics. Health care providers are frequently confronted with the dilemma as to whether or not to tell the truth. This dilemma deepens when both choices are critically vicious: The choice is no longer between “right and right” or “right and wrong,” it is between “wrong and wrong.” In the case presented and discussed in this (...) paper, a research team in Saudi Arabia unintentionally uncovered information regarding misattributed paternity. In such a situation and in the context of a tribal cultural system, what should the team do with this information? This case analysis demonstrates the joint application of ethical resources originating from within and outside the Saudi Arabian context. The article analyses the case based on the moral problems involved, relevant medical application, and the impact of such information in the Saudi tribal and Islamic domains. The most pertinent relevant values and secular debates on similar matters are discussed. Finally, the article aims to provide an Islamic dimension of family, fatherhood, and adultery. (shrink)

The debate over how to best guide HIV-infected mothers in resource-poor settings on infant feeding is more than two decades old. Globally, breastfeeding is responsible for approximately 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding with contaminated water) is responsible for 1.5 million child deaths per year. The largest burden of these infections and deaths occur in Sub-Saharan Africa. Using this region as an example of the burden faced more generally (...) in other resource-poor settings, we contrast the evolution of the clinical standard of care for infant feeding with HIV-infected mothers in high-income countries to the current international clinical guidelines for HIV-infected mothers and infant feeding in resource-poor settings. While the international guidelines of exclusive breastfeeding for a 6-month period seem to offer the least-worst strategy for reducing mother-to-child transmission of HIV during infancy while conferring some immunity through breastfeeding post-6 months, we argue that the impact of the policy on mothers and healthcare workers on the ground is not well understood. The harm reduction approach on the level of health policy translates into a complicated, painful moral dilemma for HIV-positive mothers and those offering them guidance on infant feeding. We argue that the underlying socio-economic disparities that continue to fuel the need for a harm reduction policy on infant feeding and the harm to women and children justify: (1) that higher priority be given to solving the infant feeding dilemma with improved data on safe feeding alternatives, and (2) support of innovative, community-driven solutions that address the particular economic and cultural challenges that continue to result in HIV-transmission to children within these communities. (shrink)

The Russo–Williamson thesis maintains that establishing a causal claim in medicine normally requires establishing both a correlation and a mechanism. In this paper, I present a dilemma for defenders of this thesis: a strong version of the thesis requires denying a plausible counterexample, but as the thesis is weakened, its defenders must give up their favoured account of the explanatory role of causal claims in medicine. I appeal to some recent work in epistemology on infallibilism to propose a way (...) out of this dilemma, where this way out requires neither denying the plausible counterexample nor giving up the favoured account. I think this shows that even apparently abstract debates in epistemology can provide resources that may help to resolve debates in the philosophy of science and medicine. (shrink)

Médecins Sans Frontières (MSF) is an independent medical humanitarian organisation working in over 70 countries. It has provided medical assistance for over 35 years to populations vulnerable through conflict, disease and inadequate health systems. Medical ethics define the starting point of the relationship between medical staff and patients. The ethics of humanitarian interventions and of research in conflict settings are much debated. However, less is known about the ethical dilemmas faced by medical humanitarian staff in their daily work. Ethical dilemmas (...) can be intensified in humanitarian contexts by insecure environments, lack of optimum care, language barriers, potentially heightened power discrepancies between care providers and patients, differing cultural values and perceptions of patients, communities and medical staff. Time constraints, stressful conditions and lack of familiarity with ethical frameworks can prevent reflection on these dilemmas, as can frustration that such reflection does not necessarily provide instant solutions. Lack of reflection, however, can be distressing for medical practitioners and can reduce the quality of care. Ethical reflection has a central role in MSF, and the organisation uses ethical frameworks to help with clinical and programmatic decisions as well as in deliberations over operational research. We illustrate and discuss some real ethical dilemmas facing MSF teams. Only by sharing and seeking guidance can MSF and similar actors make more thoughtful and appropriate decisions. Our aim in sharing these cases is to invite discussion and dialogue in the wider medical community working in crisis, conflict or with severe resource limitations. (shrink)

Recent and rapid technological developments on many fronts have created in our society some extremely difficult moral predicaments. Previous generations have not had to face the dilemmas posed by, for example, the availability of safe abortions, sperm banks and prostoglandins. They have not had to come to terms with an unchecked exploitation of natural resources heralding imminent ecological crisis, or, worst of all, with the recognition that only in this current generation have people the capacity to destroy themselves and their (...) environment. This book seeks to show how, and why, Seventh-day Adventism has addressed these moral issues, and that the ethical questions arising from these issues are especially relevant to the Adventist church and its development. Dr Pearson looks specifically at the moral decisions Adventists have made in the area of human sexuality, on such issues as contraception, abortion, the role and status of women, divorce and homosexuality, from the beginnings of the movement to 1985. He seeks to put such decision-making in perspective by providing the general social context in which it took place, and shows how Ellen White (whose charismatic leadership held the movement together in its first fifty years) has been a major source of moral authority in the Adventist church - her writings continuing to exercise authority in a contemporary society of turmoil and change. This important book, which conveys something of the general ethos of Adventism, is the first to investigate the ethics of the movement, ans so fill a notable gap in the literature. (shrink)

We consider an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.

OBJECTIVES: To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups. DESIGN: A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales. SUBJECTS: The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria. RESULTS: Ethical dilemmas experienced during the previous six months were reported by 118 occupational and (...) 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emerged for physical therapy. Different ethical themes emerged between the two groups, with the most common in occupational therapy being difficult/dangerous behaviour in patients and unprofessional staff behaviour, and for physical therapists resource limitations and treatment effectiveness. No differences were found in the ethical principles used. CONCLUSION: The ethical dilemmas reported by the therapists were primarily concerned with health care ethics, rather than the more dramatic ethics reported in much of the biomedical ethics literature. Differences were found between the two professional groups when ethical contexts and themes were compared but not when ethical principles were compared. This suggests that educators and researchers need to be aware of work settings and the interdisciplinary nature of employment as well as ethical principles held by individual therapists. (shrink)

The current problems of sub-Saharan peoples who are subject to recurrent famine and shortages of food are only one facet of a wider problem which confronts the peoples of the world. This problem, which is a vast in scale, concerns the relationship between the physical and biological resources which the world can muster and the provision of food for the adequate nutrition of its peoples. Overshadowing much of the thought about the future is the theorem propounded by Malthus almost 200 (...) years ago, namely that population, unless checked in some way, has the capacity to outstrip the productivity of the earth in supplying food. Malthus' views are examined in this 1986 book and estimates are made of the need to increase and the possibilities of increasing both the nutritional status of the world's population and the production of food and other essentials. The enormous dilemmas that face mankind, the economic arguments that, while apparently logical, pose large moral questions, and the possible role of new scientific advances are outlined. (shrink)

Management practices prevailing in business organizations receive considerable criticism for often treating the employee as one of many resources or an instrument to achieve the organization’s goals. As employee reification has so far been largely investigated in the scientific literature from the perspective of neo-Marxist approach, this article seeks to broaden the discussion by showing how social teaching of the Catholic Church can serve to solve the problem of reification. Although there is no doubt that universal norms of business ethics (...) can serve as protection of the employee dignity from the individual’s reification tendencies, moral relativism operating in postmodern life tends to call into question any universal moral norms. Therefore, this article discusses how responses to challenges posed by moral relativism can be obtained by applying methodological approaches proposed by the neo-Marxist classics Lukács, Honneth, and Catholic Social Teaching. The similarities and differences of these approaches are identified, and attention is also drawn to the possibilities and limitations of their application in business ethics practice. It is also demonstrated how understanding of human dignity and the attitude to a virtue, offered by social teaching of the Catholic Church, broadens the discussion on addressing the dangers posed by the person’s reification in organizations. (shrink)

This essay discusses the universal aspects of our present civilization created largely by the progress of science and technology. It has brought many unprecedented, direct and indirect, definitely positive achievements in the material and cultural, economic and political spheres. Unfortunately, this has been accompanied by the emergence of equally unprecedented dangers: of nuclear or chemical war, global pollution of the environment, squandering of natural resources, spreading of egoistic, hedonistic attitudes and other social and moral maladies. Concerning the ecological problems the (...) author is moderately optimistic, as he points out that the negative trends can be reversed by applying strong control and successive introduction of new pro-ecological technologies. This, however, requires not only a better understanding of these problems, but also good will and accord on behalf of the decision makers and common citizens. It is also necessary to find satisfactory models of moral and social order that would be suitable also for poor countries. (shrink)

To investigate the impact of framing on rule-breaking in social dilemmas, we incorporated a rule in a 1-shot resource game with 2 framing treatments: in one frame, we offered a give-some dilemma (i.e., a variant of a public goods game), and in the other frame, a take-some dilemma (i.e., a variant of a commons dilemma game). In each frame, all participants were part of 1 single collective sharing a common good. Each participant was initially equipped with (...) 1 of 5 different endowments of points from which they must give/were allowed to take amounts to/from the common good. The rule established outcome equality between participants by prescribing the exact amounts of what to give/take to/from the common good, which was finally divided equally among participants. Participants decided whether to cooperate and comply with the rule or to break the rule to their own advantage and to the detriment of the collective (i.e., giving lower/taking higher amounts). The results of an online experiment with 202 participants showed a significantly higher proportion of individuals breaking the rule in the take-some dilemma than in the give-some dilemma. In addition, endowment size influenced the proportion of rule-breaking behavior in the take-some dilemma. However, the average amounts of points not given/taken too much were not different between the 2 dilemma types. (shrink)

Background: Not all patients are considered equal. For patients who are considered to be “very important persons,” care can be different from that of other patients with advantages of greater access to resources, special attention from staff, and options for luxurious hospital amenities. While very important person care is common and widely accepted by healthcare administration, it has negative implications for both very important person and non-very important person patients, supports care disparities and inequities, and can create serious ethical dilemmas (...) for healthcare professionals. Very important person care can also result in negative care outcomes for its recipients. Objective: This article sought to explore the implications and ethical considerations of very important person care within the context of United States healthcare system, and integrate bioethical principles and American Nurses Association Code of Ethics for Nurses to influence recommendations for managing ethical dilemmas associated with very important person care. Method: A synthesis of the literature on very important person care was undertaken for this article. Ethical considerations: Ethical conduct was considered and respected when performing the literature review, referencing sources, and establishing authorship. Findings: According to the published literature, very important person care bares both positive and negative implications for patients, and negative implications for nurses. Nurses are the most affected by the demands from their administrators to provide special care and attention to patients in the “very important person” category and their families. Very important person care can be disruptive, disorienting, challenging, and stressful to nurses. Conclusion: While physicians and other healthcare professionals have commented on very important person care, limited work has been done in nursing. There have not been any empirical studies on very important person care. Therefore, in order to minimize the negative implications of very important person care, studies of this phenomenon are warranted. Exposing very important person care is important in the development of an ethical healthcare system. Moreover, understanding the ethical principles surrounding the concept of very important person care will empower nurses to effectively manage conflicts and ethical dilemmas that arise with very important person care. (shrink)

North American archaeologists have long defined their ethical responsibilities in terms of a commitment to scientific goals and an opposition to looting, vandalism, the commercial trade in antiquities, and other activities that threaten archaeological resources. In recent years, the clarity of these commitments has been eroded from two directions: professional archaeologists find commercial entanglements increasingly unavoidable, and a number of nonarchaeological interest groups object that they are not served by scientific exploitation of the record. I offer an analysis of issues (...) having to do with the identity of archaeology that underlie this debate and outline one strategy of response now emerging. (shrink)

This article argues that British psychogeography is an arena of conflict between two important and unresolved strands within radicalism: the use of the past to critique industrial modernity and the suppression of nostalgia. The article begins by outlining the emergence of nostalgia as a site of dilemma and creativity within political radicalism. It is shown that as nostalgia became marginalized within mainstream radicalism it became available as a provocative resource for `counter-cultural' interventions. The article then turns to how (...) the dilemma of nostalgia is negotiated within two forms of contemporary British psychogeography, the travel narratives of Iain Sinclair and the activities of revolutionary psychogeographical groups. Within Sinclair's travel books the modern landscape becomes a site of creative purgatory, a necessary violence that simultaneously anchors the writer in modernism while establishing marginal histories and spaces as expressions of cultural and social loss. In revolutionary psychogeography nostalgia is also refused and deployed. However, this process is enacted in a different way and to different ends. The development of `magico-Marxism' encapsulates the novelty but also the folk-historical inclinations of this project. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

In this article, written for the generally educated reader, I summarize my latest thinking about a dilemma that I believe current theoretical reflection faces about the proper ultimate aims of a public university. Specifically, I make the following three major points: (1) On the one hand, all dominant theories of how properly to spend public resources entail that academics should not pursue knowledge for its own sake and should rather devote their energies toward promoting some concrete public good (such (...) as citizenship, justice, autonomy or the like). (2) On the other hand, that view of the academic enterprise entails patent absurdities. (3) The dilemma is best resolved by articulating a new theory of how public resources ought to be spent, one according to which the point of the state and its public institutions ought to be to _balance_ the realization of final goods. (shrink)

Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval granted (...) by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

High technology and nursing: ethical dilemmas nurses and physicians face on high‐technology units in Norway Results from two studies of ethical dilemmas nurses and doctors experience on two high‐technology units are compared and discussed. The qualitative comparative methodology of grounded theory was used to generate theoretical frameworks grounded in the empirical realities of the units. The ethical dilemmas they faced were related to: treating the one vs. the common good; end of life questions; and resource allocations with inadequate staffing. (...) Similarities were related to intensity and urgency of nursing care and patient treatment, clear nursing ideologies based on treating humans within a framework of hope, embracing technology and scarce resources. Differences between the two study units were patient diagnosis, hierarchical structure on one unit while one had a vertical structure and decision‐making processes, and finally how nursing knowledge and autonomy were used. The two studies demonstrated that clinical, ethical and administrative interactions and decisions are highly compounded, stressful and intertwined. (shrink)

Public health interventions, particularly in low‐ and middle‐income countries (LMICs), are implemented with the never‐ending challenge of limited resources and the ever‐present challenge of choosing between interventions. While necessary, the application of ethical analysis is absent in most of such decision‐making, resulting in fewer favourable consequences. In applying ethical principles to the saving of women from the burden of cervical cancer, I argue in favour of saving statistical lives (investing in prevention) in LMICs, by mapping the principles of justice in (...) resource allocation to the prevailing circumstance. The key facts in this circumstance are that providing treatment (which is saving identified lives), involves mostly providing palliative treatment, which is associated with a high likelihood of death among the identified lives while undergoing treatment or shortly thereafter. I focus on the dilemma of having a national cancer prevention program versus the expansion of cancer treatment facilities. (shrink)

The author argues that simple constructive dilemma is a valuable argument form for reasoning under relative conditions of uncertainty. When applied to legal argument this value of simple constructive dilemma is shown in its political, strategic, rhetorical, and especially economic, uses by lawyers and judges. After considering some examples of the use of the form by trial lawyers, the author gives examples of the more interesting use of the form by appellate courts. Research into the use of simple (...) constructive dilemma by appellate courts helps us to understand how those courts distribute judicial resources. It also helps us to understand the political role of the appellate courts with respect to the doctrine of the separation of powers. Given some of the specific examples of legal reasoning used by the appellate courts presented in this article, and given the discussion of the doctrine of precedent, the article’s focus is on common law legal systems of the Anglo-American-type. (shrink)

This article examines various dilemmas (or, as I suggest, pseudo-dilemmas) that have dogged epistemology and philosophy of language since the 1940s heyday of logical empiricism. These have to do chiefly with the problem those thinkers faced in overcoming the various dichotomies imposed by their Humean insistence on maintaining a sharp distinction between logical 'truths of reason' and empirical 'matters of fact'. I trace this problem back to Kant's failure to offer any plausible, explanatorily adequate account of the process whereby 'sensuous (...) intuitions' were brought under 'concepts of understanding' through the joint (somewhat mysterious) agency of 'judgement' and 'imagination'. The argument then proceeds, via Quine's (on the face of it) radically anti-dualist critique of logical empiricism, to more recent attempts - by Davidson and McDowell - to locate the residual dualism in Quine (that of scheme and content), and thus to bring philosophy out on the far side of all these vexing dilemmas. I maintain that the problem goes much deeper and re-emerges with full force both in Davidson's coupling of a formalized (Tarskian) truth-theoretic approach with a strain of radical empiricism and likewise in McDowell's revisionist, supposedly 'naturalized', but none the less dualist reading of Kant on the twin powers of 'spontaneity' and 'receptivity'. Its ultimate source - I suggest - is the normative deficit, i.e., the lack of rational and justificatory values that has typified empiricist thinking from Hume to Quine, along with its attendant sceptical outlook as regards the existence of causal powers or the status and validity of causal explanations. My paper concludes by indicating briefly some alternative resources that might point a way beyond this longstanding impasse. (shrink)

The article addresses the gendered implications of Covid-19 in the Global South by paying attention to the intersectional pre-existing inequalities that have given rise to specific risks and vulnerabilities. It explores various aspects of the pandemic-induced ‘crisis of social reproduction’ that affects women as the main caregivers as well as addressing the drastic increase of various forms of gender-based violence. Both, in addition to growing poverty and severely limited access to resources and health services, are particularly devastating in marginalized and (...) vulnerable communities in the Global South. The article looks at specific regions and countries to illustrate wider challenges faced by LGBTQ populations, ethnic minorities, domestic workers, migrants and sex workers. Against the background of these gendered intersectional challenges, the article then moves to discuss feminist initiatives and mobilizations to deal with the crisis in specific local contexts as well as nationally, regionally and transnationally. It concludes by highlighting a number of visions, tensions and dilemmas faced by feminists in the Global South that will need to be taken into consideration in terms of transnational feminist solidarities. (shrink)

& A college development officer is offered a generous gift by a donor whose identity would embarrass the institution. Should the development officer accept? & A volunteer lies about his level of giving, but classmates believe him and match his "gift." Should donors be told the truth? & A development officer must explain to a donor the difference between naming an endowed chair and selecting the person to fill the chair. Where is the line between reasonable donor expectations and intrusion? (...) "There was a time, barely a generation ago, when most college fund raising was a placid, back-porch operation... That pattern, like so much in higher education, began to change dramatically... On the heels of all this change comes this splendid volume by Deni Elliot. The new fund-raising environment raises a host of ethical questions that were largely unknown or unrecognized by earlier generations of fund raisers... The great value of this book is that it provides some clear-eyed guidance through the ethical thicket that is modern higher education fund raising. The great charm of the book is that it provides this important service with such eloquence and good taste... Anyone involved in modern fund raising will find something of value in this book." -- G. Calvin MacKenzie, Academe "This volume provides college and university development officers and administrators practical help with recognizing difficult ethical situations and discerning the correct ethical response. It can also serve as a guide for donors who wonder what's reasonable for them to expect from fund raisers." -- Resources in Education Contributors: Allen Buchanan, James A. Donahue, Marilyn Batt Dunn, Deni Elliott, Bernard Gert, Judith M. Gooch, Bruce R. Hopkins, Frank Logan, Mary Lou Siebert, Holly Smith, and Eric B. Wentworth. (shrink)

This article presents two theorems: a generalization of Löb’s Theorem that applies to formal proof systems operating with bounded computational resources, such as formal verification software or theorem provers, and a theorem on the robust cooperation of agents that employ proofs about one another’s source code as unexploitable criteria for cooperation. The latter illustrates a capacity for outperforming classical Nash equilibria and correlated equilibria, attaining mutually cooperative program equilibrium in the Prisoner’s Dilemma while remaining unexploitable, i.e., sometimes achieving the (...) outcome, and never receiving the outcome as player 1. (shrink)

The aim of this article is to establish that current thought about the point of a publicly funded university faces a dilemma. On the one hand, influential and attractive ‘macro’-level principles about how state resources ought to be accountably used entail that academic freedom should be utilised solely for the sake of social justice or some other concrete public good. Standard theories of public morality entail that an academic’s responsibility is entirely to be ‘responsive’ or ‘relevant’ to her social (...) context in the way she teaches and researches. On the other hand, ‘micro’-level self-conceptions of teachers and researchers include the idea that it can be proper to use academic freedom in order to discover and impart knowledge that is unlikely to foster social justice, however construed. Probably most academics accept the idea that ‘knowledge for its own sake’ can often merit pursuit and transmission. In this article, I use the most space to defend the second horn of the dilemma, the micro-level perspective, by indicating just how counterintuitive the macro one is. As a foil I critically discuss a recent report by the South African Council on Higher Education, which occasions awareness of the position that the right to academic freedom is exhausted by a duty to benefit society. However, I conclude by noting prima facie defences of the first horn, pointing out that dominant accounts of institutional ethics forbid scholars from seeking knowledge for its own sake, and hence indicating the need to resolve an antinomy about the proper final ends of a state university. (shrink)