On March 11, 2020 the World Health Organization classified COVID‐19, caused by Sars‐CoV‐2, as a pandemic. Although not much was known about the new virus, the first outbreaks in China and Italy showed that potentially a large number of people worldwide could fall critically ill in a short period of time. A shortage of ventilators and intensive care resources was expected in many countries, leading to concerns about restrictions of medical care and preventable deaths. In order to be prepared for (...) this challenging situation, national triage guidance has been developed or adapted from former influenza pandemic guidelines in an increasing number of countries over the past few months. In this article, we provide a comparative analysis of triage recommendations from selected national and international professional societies, including Australia/New Zealand, Belgium, Canada, Germany, Great Britain, Italy, Pakistan, South Africa, Switzerland, the United States, and the International Society of Critical Care Medicine. We describe areas of consensus, including the importance of prognosis, patient will, transparency of the decision‐making process, and psychosocial support for staff, as well as the role of justice and benefit maximization as core principles. We then probe areas of disagreement, such as the role of survival versus outcome, long‐term versus short‐term prognosis, the use of age and comorbidities as triage criteria, priority groups and potential tiebreakers such as ‘lottery’ or ‘first come, first served’. Having explored a number of tensions in current guidance, we conclude with a suggestion for framework conditions that are clear, consistent and implementable. This analysis is intended to advance the ongoing debate regarding the fair allocation of limited resources and may be relevant for future policy‐making. (shrink)

Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms (...) enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee. Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice. (shrink)

While there is a significant amount of research investigating managerial ethical judgments, a limited amount examines consumer judgments of unethical corporate behavior and its impact on the marketplace. This study examines how consumers' commitment to a company impacts not only their ethical judgment of corporate behavior but also the outcomes of that judgment. The authors test hypotheses with data from 334 consumers and find that consumers' level of commitment attenuates the level of perceived fairness. More specifically, highly committed consumers may (...) forgive companies for behaviors when perceived harm is low, but become progressively dissatisfied as the level of perceived harm increases. Results of the study point to the importance of considering ethical behavior from a consumer perspective. If corporate actions are perceived as unethical, the company stands to lose favor with their most committed customers. Considering that more time, effort and investment is required to gain a new customer as to retain an old, this study shows that engaging in behavior perceived as unethical by consumers risks alienating the most committed customers. (shrink)

_Changing the Subject_ is a classic critique of traditional psychology in which the foundations of critical and feminist psychology are laid down. Pioneering and foundational, it is still _the _groundbreaking text crucial to furthering the new psychology in both teaching and research. Now reissued with a new foreword describing the changes which have taken place over the last few years, _Changing the Subject _will continue to have a significant impact on thinking about psychology and social theory.

The “gift exchange theory” articulated by Marcel Mauss, along with his core concept of a threefold obligation, is the dominant theoretical framework used to explain the majority of gift issues in marketing. This perspective assumes that some interest always lies behind gifts, such that a gift always implies a counterpart of receiving something in return. Despite the relevance of this approach in understanding the day-to-day consumer behavior, this paper presents empirical cases where the consumer is also able to give freely, (...) that is to say without implying a counterpart or even expecting it. To explain those empirical cases, we mobilize a key teaching of the Catholic Church: the “gratuitous gift” and then introduce the concept of the “need to give.” We show that gratuitousness is a relevant concept to understand most of gifts made by consumers, and we develop the normative aspect of gratuitous gift for ethical marketers. We also show that Catholic Social Teaching offers an appropriate anthropology to understand consumer behaviors motivated by this need for gratuitousness. To conclude, we propose further avenues of research. (shrink)

The lack of gender parity in philosophy has garnered serious attention recently. Previous empirical work that aims to quantify what has come to be called “the gender gap” in philosophy focuses mainly on the absence of women in philosophy faculty and graduate programs. Our study looks at gender representation in philosophy among undergraduate students, undergraduate majors, graduate students, and faculty. Our findings are consistent with what other studies have found about women faculty in philosophy, but we were able to add (...) two pieces of new information. First, the biggest drop in the proportion of women in philosophy occurs between students enrolled in introductory philosophy classes and philosophy majors. Second, this drop is mitigated by the presence of more women philosophy faculty. (shrink)

Memory exhibits episodic superposition, an analog of the quantum superposition of physical states: Before a cue for a presented or unpresented item is administered on a memory test, the item has the simultaneous potential to occupy all members of a mutually exclusive set of episodic states, though it occupies only one of those states after the cue is administered. This phenomenon can be modeled with a nonadditive probability model called overdistribution (OD), which implements fuzzy-trace theory's distinction between verbatim and gist (...) representations. We show that it can also be modeled based on quantum probability theory. A quantum episodic memory (QEM) model is developed, which is derived from quantum probability theory but also implements the process conceptions of global matching memory models. OD and QEM have different strengths, and the current challenge is to identify contrasting empirical predictions that can be used to pit them against each other. (shrink)

While corporate social responsibility is recognized as taking on various national meanings and practices, research has not sufficiently investigated how multinational companies simultaneously achieve global CSR integration and local CSR adaptation. Building on a qualitative case study carried out at ASICS, an MNC headquartered in Japan, we show how this organizational dilemma may be solved through hybridization work, a form of institutional work performed by CSR managers in subsidiaries to combine and adapt different institutional approaches to CSR. By developing the (...) notion of hybridization work, we contribute by revealing a set of practices that contribute to institutional change within organizations and enriching the study of CSR organizational change and international business by showing how hybridization Work leads to a greater organizational integration between core and periphery, and by identifying the triggering factors for subsidiary initiative in CSR. (shrink)

Backround Education in ethics and professionalism should reflect the realities medical students encounter in the hospital and clinic. Method We performed content analyses on Case Observation and Assessments (COAs) written by third-year medical students about ethical and professional issues encountered during their internal medicine and paediatrics clinical clerkships. Results A cohort of 141 third-year medical students wrote 272 COAs. Content analyses identified 35 subcategories of ethical and professional issues within 7 major domains: decisions regarding treatment (31.4%), communication (21.4%), professional duties (...) (18.4%), justice (9.8%), student-specific issues (5.4%), quality of care (3.8%), and miscellaneous (9.8%). Conclusions Students encountered a wide variety of ethical and professional issues that can be used to guide pre-clinical and clinical education. Comparison of our findings with results from similar studies suggests that the wording of an assignment (specifying “ethical” issues, “professional” issues, or both) may influence the kinds of issues students identify in their experience-based clinical narratives. (shrink)

Will we make machines as smart, as dumb, as creative, as whiny, as human beings—or are we wasting our time trying? What makes human cognition unique and irreplaceable—if anything? With James Moor , Drew Arrowood , and Valerie Hardcastle.

In Spoils of War, a diverse group of distinguished contributors suggest that acts of aggression resulting from the racism and sexism inherent in social institutions can be viewed as a sort of "war," experienced daily by women of color.

BackgroundBiobanks are considered to be key infrastructures for research development and have generated a lot of debate about their ethical, legal and social implications. While the focus has been on human genomic research, rapid advances in human microbiome research further complicate the debate.DiscussionWe draw on two cystic fibrosis biobanks in Toronto, Canada, to illustrate our points. The biobanks have been established to facilitate sample and data sharing for research into the link between disease progression and microbial dynamics in the lungs (...) of pediatric and adult patients. We begin by providing an overview of some of the ELSI associated with human microbiome research, particularly on the implications for the broader society. We then discuss ethical considerations regarding the identifiability of samples biobanked for human microbiome research, and examine the issue of return of results and incidental findings. We argue that, for the purposes of research ethics oversight, human microbiome research samples should be treated with the same privacy considerations as human tissues samples. We also suggest that returning individual microbiome-related findings could provide a powerful clinical tool for care management, but highlight the need for a more grounded understanding of contextual factors that may be unique to human microbiome research.ConclusionsWe revisit the ELSI of biobanking and consider the impact that human microbiome research might have. Our discussion focuses on identifiability of human microbiome research samples, and return of research results and incidental findings for clinical management. (shrink)

Climate, diet, lifestyle, and environmental settings have all been shown to modulate mood, play a role in mental disorders, and even pose a mental health risk. Can climatotherapy, in its adaptive approach aiming to restore balance among the economic, social, and ecological realms of human societies, situate itself as a therapeutic avenue for the promotion of sustainable mental health?

The air pollution generated by motor vehicles and by static sources is, in certain geographic areas, a very serious problem, a problem that exists because of a failure of the marketplace. To address this marketplace failure, the State of California has mandated that by 2003, 10% of the Light-Duty Vehicle Fleet (LDV) be composed of Zero-Emission Vehicles (ZEVs). However, the policy-making process that was utilized to generate the ZEV mandate was problematic and the resulting ZEV mandate is economically unsound. Moreover, (...) an ethical analysis, based primarily upon the work of John Rawls, suggests that implementation of the California ZEV mandate is—in spite of the wide latitude that ought to be given to policy decision makers—unethical. A more ethical and economically efficient approach to the pollution caused by marketplace failure is one that relies on market incentives and thereby achieves the desired improvement in air quality by appealing both to the self-interest of motorists and to those businesses that are directly or indirectly involved with the automobile industry. Such an approach would take better advantage of the creative forces of the market and improvements in technology over time and avoid the infringements on individual liberty and fairness embodied in the ZEV mandate. (shrink)

BackgroundThe outbreak of COVID-19 has been a major interrupting event, challenging how societies and individuals deal with risk. An essential determinant of the virus’ spread is a series of individual decisions, such as wearing face masks in public space. Those decisions depend on trade-offs between costs and risks, and beliefs are key to explain these.MethodsWe elicit beliefs about the COVID-19 pandemic during lockdown in France by means of surveys asking French citizens about their belief of the infection fatality ratio for (...) COVID-19, own risk to catch the disease, risk as perceived by others, and expected prevalence rate. Those self-assessments were measured twice during lockdown: about 2 weeks after lockdown started and about 2 weeks before lockdown ended. We also measured the quality of these beliefs with respect to available evidence at the time of the surveys, allowing us to assess the calibration of beliefs based on risk-related socio-demographics. Finally, comparing own risk to expected prevalence rates in the two successive surveys provides a dynamic view of comparative optimism with respect to the disease.ResultsThe risk perceptions are rather high in absolute terms and they increased between the two surveys. We found no evidence for an impact of personal experience with COVID-19 on beliefs and lower risk perceptions of the IFR when someone in the respondent’s family has been diagnosed with a disease. Answers to survey 1 confirmed this pattern with a clear indication that respondents were optimistic about their chances to catch COVID-19. However, in survey 2, respondents revealed comparative pessimism.ConclusionThe results show that respondents overestimated the probabilities to catch or die from COVID-19, which is not unusual and does not necessarily reflect a strong deviation from rational behavior. While a rational model explains why the own risk to catch COVID-19 rose between the two surveys, it does not explain why the subjective assessment of the IFR remained stable. The comparative pessimism in survey 2 was likely due to a concomitant increase in the respondents’ perceived chances to catch the disease and a decreased expected prevalence rate. (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

Aim The aim is to understand current research into the impact of undergraduate nursing education on the development of professional values. Background Values are evident in the professional standards for nurses and the guidelines and healthcare policies of many countries. These professional values guide decisions and behaviour and are recognised as an essential component in the professions ability to provide safe and professional care. This literature review presents the current research on the impact of education on professional values in undergraduate (...) nurse education. Design An integrative review of the findings was conducted to provide insight into the current research on the professional value development in undergraduate nurses. Data sources CINAHL, PubMed and Scopus. Review methods A literature search was undertaken within defined date parameters 2010–2021 using a systematic approach. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guide PRISMA was used to guide and illustrate the process. Papers were assessed for quality using the Mixed Methods Appraisal Tool. Results Two distinct areas of inquiry were identified. (a) Changes in professional values as an outcome of undergraduate nursing education or (b) changes in professional values as an outcome of specifically designed educational content. These areas were further explored to better understand the influences of undergraduate education on students’ professional values. Conclusion There is a lack of evidence in the literature to support the premise that professional values develop in line with academic year progression; however, there is strong evidence to support the inclusion of explicit learning in undergraduate education that engages students in education specifically designed to explore and develop professional values. (shrink)

We investigated the definition, prevalence, perceived prevalence and severity of, as well as justifications for and expected responses to, academic dishonesty at the graduate level in a sample of 246 graduate students, 49 faculty, and 20 administrators. Between 2.5% and 55.1% of students self-reported engaging in academically dishonest behaviors, depending on the nature of the behavior. Students and faculty rated 40 examples of academically dishonest behaviors similarly in terms of severity, but faculty tended to underestimate the prevalence of academic dishonesty. (...) Students and faculty also reported how they would idealistically and realistically expect themselves to respond to cheating situations. Students rated 21 behaviors in terms of their likeliness to increase or decrease academically dishonest behavior. Suggestions are given for developing a climate or culture of academic integrity to address academic dishonesty. (shrink)

The significance of private standards and associated local level initiatives in agri-food value chains are increasingly recognised. However whilst issues related to compliance and impact at the smallholder or worker level have frequently been analysed, the governance implications in terms of how private standards affect national level institutions, public, private and non-governmental, have had less attention. This article applies an extended value chain framework for critical analysis of Private Standards Initiatives (PSIs) in agrifood chains, drawing on primary research on PSIs (...) operating in Kenyan horticulture (Horticulture Ethical Business Initiative and KenyaGAP). The paper explores the legislative, executive and judicial aspects of governance in these southern PSIs highlighting how different stakeholders shape debates and act with agency. It is argued that governance is exercised ‘beyond the vertical’ in that one can identify wider horizontal processes of governance, including how the scope of key debates is constructed (especially in legislative governance) but analysis of executive governance emphasises the dominant role of the lead buyers. (shrink)

In 2017 and 2018 [Name of research project] organized two transnational youth resistance art workshops. These workshops addressed online social justice issues and placed emphasis on pushing back against technology-facilitated violence and surveillance in networked spaces. Our engagement with these workshops raised three dilemmas associated with these sorts of resistive social justice art projects. This article explores these dilemmas, which include how to enable the production of digital art in a manner that is attentive to intersectional issues of digital literacy (...) and access; artistic appropriations of sexually explicit, discriminatory or hateful speech and their relation to cultural appropriation; and defamation, privacy, copyright and trademark considerations relating to artistic appropriations. In addressing these dilemmas, examples of regulatory frameworks shaping resistance opportunities and social justice initiatives are highlighted, along with suggestions for addressing these dilemmas for those who may wish to facilitate or engage in youth resistance art workshops in future. (shrink)

Despite the growing attention on the topic of abusive supervision, how abusive supervision affects individual and team creativity have not yet been thoroughly investigated. Drawn from the perspective of leader-member exchange (LMX), the current study develops a multilevel model to describe the relationships between abusive supervision and creativity at both team and individual levels, with a focus on the roles played by team-level leader-member exchange (TLMX) and LMX differentiation (DLMX). Based on data collected from 319 team members and their team (...) leaders in 71 teams, the results show that abusive supervision has a negative relationship with TLMX, a practice that is conducive to both team and individual creativity. At the team level, the negative relationship between abusive supervision and TLMX is lessened by a higher level of DLMX. In addition, the positive relationship between TLMX and team creativity is weakened by a higher level of DLMX. Theoretical and practical implications of the findings are discussed. (shrink)

Background The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics- Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. Objectives The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was (...) to describe the Cell’s functions during that period. Research design This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient’s/designated representative’s preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. Participants and research context Only our university hospital’s clinicians could request EST intervention. Ethical considerations The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. Findings/results 33 requests (patients’ mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. Discussion Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. Conclusions COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions. (shrink)

How should you live? Should you devote yourself to perfecting a single talent or try to live a balanced life? Should you lighten up and have more fun, or buckle down and try to achieve greatness? Should you try to be a better friend? Should you be self-critical or self-accepting? And how should you decide among the possibilities open to you? Should you consult experts, listen to your parents, or should you do lots of research? Should you make lists of (...) pros and cons, or go with your gut? These are not questions that can be answered in general or in the abstract. Rather, these questions are addressed to the first person point of view, to the perspective each of us occupies when we reflect on how to live without knowing exactly what we're aiming for. To answer them, this book focuses on the process of living one's life from the inside, rather than on defining goals from the outside. Drawing on traditional philosophical sources as well as literature and recent work in social psychology, this book argues that to live well, we need to develop reflective wisdom: to care about things that will sustain us and give us good experiences, to have perspective on our successes and failures, and to be moderately self-aware and cautiously optimistic about human nature. Further, we need to know when to think about our values, character, and choices, and when not to. A crucial part of wisdom, the book maintains, is being able to shift perspectives: to be self-critical; to be realistic; to examine life when reflection is appropriate, but not when we should lose ourselves in experience. (shrink)

Medical legal partnerships address individual legal needs that can create impediments to health. Little is known about outcomes from medical legal partnerships and their relationship to access to justice. This paper reports outcomes from one medical legal partnership from the perspective of the client, with specific emphasis on impact on health and concepts related to access to justice. We suggest a conceptual model for incorporating medical legal partnerships into a broader framework about access to justice.

BackgroundGiven that advances in research continuously raise new ethical issues, a multidisciplinary working group of investigators involved in biomedical research has gathered to discuss and compare ethical viewpoints in their daily practice.MethodsThe working group has drafted a Charter for Ethics in Biomedical Research that encompasses all the steps in the research process, i.e. from the initial idea to analysis and publication of the results.ResultsBased on key principles for ethically responsible research, the Charter may serve as a tool for performing research, (...) discussing research issues and training researchers.ConclusionsThe Charter should stimulate researchers to think about their responsibility for research in a progressive, caring society. (shrink)

This paper examines ethical, legal and economic dimensions of the decision facing employers regarding whether it is appropriate to monitor the electronic mail (e-mail) communications of its employees. We review the question of whether such monitoring is lawful. Recent e-mail monitoring cases are viewed as a progression from cases involving more established technologies (i.e., phone calls, internal memoranda, faxes and voice mail).The central focus of the paper is on the extent to which employer monitoring of employee e-mail presents a structure (...) of costs and benefits to the employer which are unlikely to make such a practice profitable or practical to the employer. The practice of employer monitoring to detect illicit employee behavior (e.g., fraud, harassment of fellow employees, industrial espionage) is considered. (shrink)

The Toolbox dialogue method enables members of heterogeneous groups to identify, share, and compare their perspectives on topics of common interest, such as research questions or complex problems (Hubbs et al. 2020). These interactions occur in dialogue, typically in relatively brief (eg, two-to four-hour) workshop settings, where participants jointly consider their responses to abstract and often philosophical statements that express positions on the topics. By expressing positions on topics that matter to the group, these statements structure a dialogue that enhances (...) mutual understanding in valuable ways. The method is valuable for heterogeneous groups because it enhances both self-understanding and mutual understanding. It does this by transforming dialogue participants into teachers and learners: teachers of their own perspective to others and learners of the perspectives of others and, to some extent... (shrink)

Prior research shows that reasoners' confidence is poorly calibrated (Shynkaruk & Thompson, 2006). The goal of the current experiment was to increase calibration in syllogistic reasoning by training reasoners on (a) the concept of logical necessity and (b) the idea that more than one representation of the premises may be possible. Training improved accuracy and was also effective in remedying some systematic misunderstandings about the task: those in the training condition were better at estimating their overall performance than those who (...) were untrained. However, training was less successful in helping reasoners to discriminate which items are most likely to cause them difficulties. In addition we explored other variables that may affect confidence and accuracy, such as the number of models required to represent the problem and whether or not the presented conclusion was necessitated by the premises, possible given the premises, or impossible given the premises. These variables had systematically different relationships to confidence and accuracy. Thus, we propose that confidence in reasoning judgements is analogous to confidence in memory retrievals, in that they are inferentially derived from cues that are not diagnostic in terms of accuracy. (shrink)

In an adaptive clinical trial , key trial characteristics may be altered during the course of the trial according to predefined rules in response to information that accumulates within the trial itself. In addition to having distinguishing scientific features, adaptive trials also may involve ethical considerations that differ from more traditional randomized trials. Better understanding of clinical trial experts’ views about the ethical aspects of adaptive designs could assist those planning ACTs. Our aim was to elucidate the opinions of clinical (...) trial experts regarding their beliefs about ethical aspects of ACTs. (shrink)