The rising use of social media, for both clinical and nonclinical purposes, obviates the need for policy to more explicitly guide physicians, and their behaviors, in this new digital environment. The current report from the AMA Council on Ethical and Judicial Affairs (CEJA) addresses a number of these issues, specifically the nature of interaction and representation between physicians and patients. However, given the nature of the focus of this report—the nonclinical use of the internet and social media—there are a number (...) of issues that deserve attention, in particular encouraging education and addressing how to approach relationships among medical professionals of varying levels of training. (shrink)

Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions. Objective To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics. Methods Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, (...) and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences. Results Data were collected from 8308 of 11 620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9). Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small. (shrink)

The pronoun ‘I’ refers to myself from the first-person perspective and a person (me) from the third person perspective. Essentially there is something common between the two perspectives taken: ‘I’ from the first person perspective refers to ‘self’; from the third person perspective refers to a ‘person’. Now ‘self’ and ‘person’ signify the same concept. ‘Self’ is a term used in context of first-person statements and ‘person’ is a term used in third person contexts. Both the terms refer to the (...) same concept but from different perspectives. Consequently the terms ‘no-person’ and ‘no-self’ will be taken as synonymous in this article. The use of ‘I’ signifies one more thing – that there exists a ‘self’ or ‘person’ that exists through time, in other words, it signifies ‘self-identity’ or ‘personal identity’. The aim of this article is to analyze the notion of ‘self’ or ‘person’ as denoted in the usage of the pronoun ‘I’. This article would examine ‘I’ as a fictitious entity in the background of the two historical theories of personal identity – David Hume’s theory and the Buddhist theory. (shrink)

Corruption in public life needs to be examined in greater detail as not only an individual lapse but also a feature of the collective that either does or does not put pressure on the individual to lapse. This paper takes a methodological holistic perspective exceeding the methodological individualistic perspective in understanding corruption. The claim is that the locus of responsibility cannot be restricted to the individual alone and the collective (if there be such an entity) be left scot-free. This claim (...) is premised on the conception that an individual’s act which is in deviation of expected and established norms cannot be faulted only at the level of the individual, and careful consideration needs to be made to assess the role of the collective in precipitating the lapse(s) in the actions of the individual. This paper argues for sharing the liability of corruption in public life between the legally responsible individual as agent and the cultural milieu in which the agent operates. At a foundational level this paper calls for a reconceptualization of individual agency and decision making from being isolated and discrete, to being construed by the collective that the individual agent is a part of. (shrink)

The advent of the intelligent robot has occupied a significant position in society over the past decades and has given rise to new issues in society. As we know, the primary aim of artificial intelligence or robotic research is not only to develop advanced programs to solve our problems but also to reproduce mental qualities in machines. The critical claim of artificial intelligence advocates is that there is no distinction between mind and machines and thus they argue that there are (...) possibilities for machine ethics, just as human ethics. Unlike computer ethics, which has traditionally focused on ethical issues surrounding human use of machines, AI or machine ethics is concerned with the behaviour of machines towards human users and perhaps other machines as well, and the ethicality of these interactions. The ultimate goal of machine ethics, according to the AI scientists, is to create a machine that itself follows an ideal ethical principle or a set of principles; that is to say, it is guided by this principle or these principles in decisions it makes about possible courses of action it could takea. Thus, machine ethics task of ensuring ethical behaviour of an artificial agent. Although, there are many philosophical issues related to artificial intelligence, but our attempt in this paper is to discuss, first, whether ethics is the sort of thing that can be computed. Second, if we are ascribing mind to machines, it gives rise to ethical issues regarding machines. And if we are not drawing the difference between mind and machines, we are not only redefining specifically human mind but also the society as a whole. Having a mind is, among other things, having the capacity to make voluntary decisions and actions. The notion of mind is central to our ethical thinking, and this is because the human mind is self-conscious, and this is a property that machines lack, as yet. (shrink)

Consumer complaining behavior (CCB) is an important stream of research and practice, as it links the domains of service failure and service recovery. CCB research, although extensive and temporally wide, exhibits a lack of concern for the underlying assumptions of scholarly inquiry. Researchers neither explicitly mention, nor consciously indicate their ontological, epistemological, and methodological assumptions. We systematically identify the extant CCB literature and map it to two well-accepted paradigmatic classifications (Burrell and Morgan 1979; Deetz Organization Science 7(2): 191–207, 1996). Normative (...) or functionalist paradigm with the assumptions of an objective external reality, a positivist epistemology, a determinist view of human nature, and nomothetic methodology emerges as the dominant CCB research paradigm. The implications of this dominance are discussed as a barometer of the future of CCB research and practice. (shrink)

While mass spectrometry (MS)‐based quantification of small molecules has been successfully used for decades, targeted MS has only recently been used by the proteomics community to investigate clinical questions such as biomarker verification and validation. Targeted MS holds the promise of a paradigm shift in the quantitative determination of proteins. Nevertheless, targeted quantitative proteomics requires improvisation in making sample processing, instruments, and data analysis more accessible. In the backdrop of the genomic era reaching its zenith, certain questions arise: is the (...) proteomic era about to come? If we are at the beginning of a new future for protein quantification, are we prepared to incorporate targeted proteomics at the benchside for basic research and at the bedside for the good of patients? Here, an overview of the knowledge required to perform targeted proteomics as well as its applications is provided. A special emphasis is placed on upcoming areas such as peptidomics, proteoform research, and mass spectrometry imaging, where the utilization of targeted proteomics is expected to bring forth new avenues. The limitations associated with the acceptance of this technique for mainstream usage are also highlighted. (shrink)

As AI technologies are rolled out into healthcare, academia, human resources, law, and a multitude of other domains, they become de-facto arbiters of truth. But truth is highly contested, with many different definitions and approaches. This article discusses the struggle for truth in AI systems and the general responses to date. It then investigates the production of truth in InstructGPT, a large language model, highlighting how data harvesting, model architectures, and social feedback mechanisms weave together disparate understandings of veracity. It (...) conceptualizes this performance as an operationalization of truth, where distinct, often-conflicting claims are smoothly synthesized and confidently presented into truth-statements. We argue that these same logics and inconsistencies play out in Instruct’s successor, ChatGPT, reiterating truth as a non-trivial problem. We suggest that enriching sociality and thickening “reality” are two promising vectors for enhancing the truth-evaluating capacities of future language models. We conclude, however, by stepping back to consider AI truth-telling as a social practice: what kind of “truth” do we as listeners desire? (shrink)

The world is witnessing a rise in speech-enabled devices serving as epistemic informants to their users. Some philosophers take the view that because the utterances produced by such machines can be phenomenologically similar to an equivalent human speech, and they may deliver the same function in terms of delivering content to their audience, such machine utterances should be conceptualized as “assertions”. This paper argues against this view and highlights the theoretical and pragmatic challenges faced by such a conceptualization which seems (...) to be based on a “functionalist” account of assertion. Instead, the paper argues that the view that some such machine utterances can be “proxy assertions”, made on behalf of the designers and/or deployers of such machines is more tenable. Existing accounts of such a view, however, need further refinement, which is provided here. The paper then discusses implications of this view for design of such machines, particularly those enabled and equipped with machine learning capabilities. (shrink)

Graphical AbstractWe can, for example, understand intimately how the human endocrine systems works, and likewise the chemical nature of compounds present in our environment; but the result of the interaction cannot be deduced from any simple combination of the two knowledge sets: it's not the interacting entities that we should be studying, but the process that creates the phenomena that we witness as a result of this interaction. This is the “biodynamic interface” to which Manish Arora, Alessandro Giuliani and (...) Paul Curtin refer in their article in this issue, and it is a conceptual structure that comes into being upon interaction of entities: a new way to study interactions in complex systems and better understand emergent phenomena. (shrink)

Opponents of male circumcision have increasingly used human rights positions to articulate their viewpoint. We characterize the meaning of the term “human rights.” We discuss these human rights arguments with special attention to the claims of rights to an open future and to bodily integrity. We offer a three-part test under which a parental decision might be considered an unacceptable violation of a child's right. The test considers the impact of the practice on society, the impact of the practice on (...) the individual, and the likelihood of adverse impact. Infant circumcision is permissible under this test. We conclude that infant circumcision may be proscribed as violating local norms, even though it does not violate human rights. (shrink)

Moving forward rapidly in the clinical research phase, uterus transplantation may be a future treatment option for women with uterine factor infertility, which accounts for three per cent of all infertility in women. This new method of treatment would allow women, who currently rely on gestational surrogacy or adoption, to gestate and birth their own genetic offspring. Since uterus transplantation carries significant risk when compared with surrogacy and adoption as well as when compared with other organ transplants, it requires greater (...) justification because its goals are quality of life, not life-saving, in their scope. It is important to address questions regarding the physical, psychosocial and ethical risks and benefits of uterus transplantation for all three parties involved—the patient, the donor and the potential child—as well as discuss the regulatory implications as research on uterus transplantations moves forward. (shrink)

In the limited literature on gender and climate change, two themes predominate – women as vulnerable or virtuous in relation to the environment. Two viewpoints become obvious: women in the South will be affected more by climate change than men in those countries and that men in the North pollute more than women. The debates are structured in specific ways in the North and the South and the discussion in the article focuses largely on examples from Sweden and India. The (...) article traces the lineage of the arguments to the women, environment and development discussions, examining how they recur in new forms in climate debates. Questioning assumptions about women's vulnerability and virtuousness, it highlights how a focus on women's vulnerability or virtuousness can deflect attention from inequalities in decision-making. By reiterating statements about poor women in the South and the pro-environmental women of the North, these assumptions reinforce North–South biases. Generalizations about women's vulnerability and virtuousness can lead to an increase in women's responsibility without corresponding rewards. There is need to contextualise debates on climate change to enable action and to respond effectively to its adverse effects in particular places. -/- . (shrink)

The power of technology to transform religions, science, and political institutions has often been presented as nothing short of revolutionary. Does technology have a similarly transformative influence on societies’ morality? Scholars have not rigorously investigated the role of technology in moral revolutions, even though existing research on technomoral change suggests that this role may be considerable. In this paper, we explore what the role of technology in moral revolutions, understood as processes of radical group-level moral change, amounts to. We do (...) so by investigating four historical episodes of radical moral change in which technology plays a noteworthy role. Our case-studies illustrate the plurality of mechanisms involved in technomoral revolutions, but also suggest general patterns of technomoral change, such as technology’s capacity to stabilize and destabilize moral systems, and to make morally salient phenomena visible or invisible. We find several leads to expand and refine conceptual tools for analysing moral change, specifically by crystallizing the notions of ‘technomoral niche construction’ and ‘moral payoff mechanisms’. Coming to terms with the role of technology in radical moral change, we argue, enriches our understanding of moral revolutions, and alerts us to the depths of which technology can change our societies in wanted and unwanted ways. (shrink)

This paper argues that the type of conscience claims made in last decade’s spate of cases involving pharmacists’ objections to filling birth control prescriptions and cases such as Ms. Means and Mercy Health Partners of Michigan, and even the Affordable Care Act and the Little Sisters of the Poor, as different as they appear to be from each other, share a common element that ties them together and makes them fundamentally different in kind from traditional claims of conscience about which (...) a practical consensus emerged in the 1980s and 1990s. This difference in kind is profoundly significant; so much so, we contend, that it puts them at odds with the normative basis for protecting conscience claims in United States health care settings in the first place, making them illegitimate. Finally, we argue that, given the illegitimacy of these contemporary claims of conscience, physicians and other health professionals must honor their well-established standing obligations to provide informed consent and refer or transfer care even if the service requested or needed is at odds with their own core moral beliefs—a requirement that is in line with the aforementioned practical consensus on traditional claims of conscience. (shrink)

The environment impacts human health in profound ways, yet few theories define the form of the relationship between human physiology and the environment. It is conjectured that such complex systems cannot interact directly, but rather their interaction requires the formation of an intermediary “interface.” This position contrasts with current epidemiological constructs of causation, which implicitly assume that two complex systems transfer information directly while remaining separate entities. Further, it is contended that dynamic, process‐based interfaces incorporate components from all the interacting (...) systems but exhibit operational independence. This property has many consequences, the foremost being that characteristics of the interface cannot be fully resolved by only studying the systems involved in the interaction. The interface itself must be the subject of inquiry. Without refocusing the attention on biodynamic interfaces, how the environment impacts health cannot be discerned. Also see the video abstract here https://youtu.be/XeyjeZeyo4o. (shrink)

Wearable self-tracking devices capture multidimensional health data and offer several advantages including new ways of facilitating research. However, they also create a conflict between individual interests of avoiding privacy harms, and collective interests of assembling and using large health data sets for public benefits. While some scholars argue for transparency and accountability mechanisms to resolve this conflict, an average user is not adequately equipped to access and process information relating to the consequences of consenting to further uses of her data. (...) As an alternative, this paper argues for fiduciary relationships, which put deliberative demands on digital health data controllers to keep the interests of their data subjects at the forefront as well as cater to the contextual nature of privacy. These deliberative requirements ensure that users can engage in collective participation and share their health data at a lower risk of privacy harms. This paper also proposes a way to balance the flexible and open-ended nature of fiduciary law with the specific nature and scope of fiduciary duties that digital health data controllers should owe to their data subjects. (shrink)

Purpose Digital transformation leverages digital technologies to change current processes and introduce new processes in any organisation’s business model, customer/user experience and operational processes. Artificial intelligence plays a significant role in achieving DT. As DT is touching each sphere of humanity, AI led DT is raising many fundamental questions. These questions raise concerns for the systems deployed, how they should behave, what risks they carry, the monitoring and evaluation control we have in hand, etc. These issues call for the need (...) to integrate ethics in AI led DT. The purpose of this study is to develop an “AI led ethical digital transformation framework”. Design/methodology/approach Based on the literature survey, various existing business ethics decision-making models were synthesised. The authors mapped essential characteristics such as intensity and the individual, organisational and opportunity factors of ethics models with the proposed AI led ethical DT. The DT framework is evaluated using a thematic analysis of 23 expert interviews with relevant AI ethics personas from industry and society. The qualitative data of the interviews and opinion data has been analysed using MAXQDA software. Findings The authors have explored how AI can drive the ethical DT framework and have identified the core constituents of developing an AI led ethical DT framework. Backed by established ethical theories, the paper presents how DT pillars are related and sequenced to ethical factors. This research provides the potential to examine theoretically sequenced ethical factors with practical DT pillars. Originality/value The study establishes deduced and induced ethical value codes based on thematic analysis to develop guidelines for the pursuit of ethical DT. The authors identify four unique induced themes, namely, corporate social responsibility, perceived value, standard benchmarking and learning willingness. The comprehensive findings of this research, supported by a robust theoretical background, have substantial implications for academic research and corporate applicability. The proposed AI led ethical DT framework is unique and can be used for integrated social, technological and economic ethical research. (shrink)

Journal of International Political Theory, Ahead of Print. Practice turn marks an important advancement in International Relations theorizing. In challenging abstract meta-theoretical debates, practice theorizing in International Relations aims to get close to the lifeworld of the actual practitioners of politics. Scholars from different positions such as constructivism, critical theory, and post-structuralism have critically interrogated the analytical framework of practices in international politics. Building upon these works, we are concerned with a question of how to examine the context of international (...) practices that unfolds in multiple ways in practitioners’ performances. Our central thesis is that a distinct pragmatic methodology offers an opportunity to keep with the practice turn and avoid the problematic foundational moves of mainstream practice theorizing. This involves foregrounding three interrelated processes in examining practices: the role of exceptions in the normal stream of performances, normative uptake of the analysts, and the semantic field that actors navigate in political performances. We argue that this methodology is predicated on its usefulness to interpret practices through reflective social-science inquiry. (shrink)

The Buddha, unlike the Upaniṣadic or Brahmanical way, has avoided the concept of the self, and it seems to be left with limited conceptual possibilities for free will and moral responsibility. Now, the question is, if the self is crucial for free will, then how can free will be conceptualized in the Buddhist ‘no-self’ (anattā) doctrine. Nevertheless, the Buddha accepts a dynamic notion of cetanā (intention/volition), and it explicitly implies that he rejects the ultimate or absolute freedom of the will, (...) but not the minimal power of free will. It seems that the Buddha’s view shifts from agent causation (independent ownership) to a causal sequence of impersonal processes (psychophysical factors). This paper claims to shed clarity on ‘whether free will is viable in the context of the anattāvāda in Buddhism.’ It mainly studies the secondary sources (even though it has also discussed the primary sources) and their interpretations of freedom of the will and how it further does argue for a compatibility approach of free will in Buddhist thought. (shrink)

Some scholars blame capitalism for the prevalence of modern slavery. However, data reveal that it is wrong to blame capitalism for a problem that long preceded it and would likely be much worse without it. We explain why this is the case.

BackgroundResuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit, meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people regarding resource allocation decisions in the NICU.MethodsThe study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were (...) 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing.ResultsThe majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival, life expectancy, and cost of treatment. In the classic ‘lifeboat’ scenario, all but two respondents were utilitarian.ConclusionsThis survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment. (shrink)

We examine the role of alignment between organizational social consciousness and the informal and formal institutions of a country in increasing female representation on boards. Using fixed-effects and Hausman Taylor regression methodology for endogenous covariate with panel data for the years 2006–2020, we find that the greater the alignment between organizational social consciousness and certain formal and informal institutions, the more progress there is toward gender representation on corporate boards in Europe. We also find that more socially conscious firms make (...) the most progress, often going beyond the minimum regulatory targets. By showing the complementarity of these factors, we address the enduring question of how the interplay of formal and informal institutions directly affects corporate behavior, thus contributing to the institutional, public policy/regulatory, and corporate governance literatures. We note the need for policymakers to go beyond mere codification of rules via quotas and simultaneously work toward raising national and organizational social consciousness levels on issues of gender equality. (shrink)

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; (...) whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward. (shrink)

In this paper we show how defeasible logic could formally account for the non-monotonic properties involved in motivational attitudes like intention and obligation. Usually, normal modal operators are used to represent such attitudes wherein classical logical consequence and the rule of necessitation comes into play, i.e., ⊢A/⊢ □A, that is from ⊢A derive ⊢ □A. This means that such formalisms are affected by the Logical Omniscience problem. We show that policy-based intentions exhibit non-monotonic behaviour which could be captured through a (...) non-monotonic system like defeasible logic. To this end we outline a defeasible logic of intention that specifies how modalities can be introduced and manipulated in a non-monotonic setting without giving rise to the problem of logical omniscience. In a similar way we show how to add deontic modalities defeasibly and how to integrate them with other motivational attitudes like beliefs and goals. Finally we show that the basic aspect of the BOID architecture is captured by this extended framework. (shrink)

This study investigates how essential retailers responded to the COVID-19 pandemic through stakeholder communications. Based on a comprehensive text analysis of the corporate websites of the 20 largest U.S. essential retailers during the first 19 months of the crisis, we categorize the public health measures communicated by these retailers and assess how these retailers adapted their messaging to address the concerns of different stakeholders over time. This analysis allowed us to create a framework for understanding the flow of retailer/stakeholder communication (...) during a health crisis, highlighting the important role businesses can play in alleviating stakeholder concerns when public health is on the line. We discuss the implications of our findings for retailers and public policy, aiming to enhance preparedness and response for future health emergencies. (shrink)

We demonstrate that the key components of cognitive architectures (declarative and procedural memory) and their key capabilities (learning, memory retrieval, probability judgment, and utility estimation) can be implemented as algebraic operations on vectors and tensors in a high‐dimensional space using a distributional semantics model. High‐dimensional vector spaces underlie the success of modern machine learning techniques based on deep learning. However, while neural networks have an impressive ability to process data to find patterns, they do not typically model high‐level cognition, and (...) it is often unclear how they work. Symbolic cognitive architectures can capture the complexities of high‐level cognition and provide human‐readable, explainable models, but scale poorly to naturalistic, non‐symbolic, or big data. Vector‐symbolic architectures, where symbols are represented as vectors, bridge the gap between the two approaches. We posit that cognitive architectures, if implemented in a vector‐space model, represent a useful, explanatory model of the internal representations of otherwise opaque neural architectures. Our proposed model, Holographic Declarative Memory (HDM), is a vector‐space model based on distributional semantics. HDM accounts for primacy and recency effects in free recall, the fan effect in recognition, probability judgments, and human performance on an iterated decision task. HDM provides a flexible, scalable alternative to symbolic cognitive architectures at a level of description that bridges symbolic, quantum, and neural models of cognition. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Impatience to EmpathyStephanie Pierce and Kavita Shah AroraWe gave J.H. a label the first time we met her, as many often do—“Uncooperative.” She was a patient with autism and intellectual delay who had presented to the emergency department (ED) with vaginal bleeding. After receiving the gynecology consult request from the emergency medicine physicians, we were already mentally formulating our recommendations based on the information they told us over (...) the phone. “Does not cooperate with exam,” “no acute surgical intervention is currently warranted,” and “recommend outpatient follow–up.”When we arrived in her room, she was sitting in the hospital bed surrounded by a protective shield of caregivers from her group home. We introduced ourselves as the gynecology team but it was obvious that J.H. could not communicate verbally. Upon speaking with her caregivers we learned that she had Cowden syndrome, a genetic disease that confers significantly increased risks for several types of cancer including endometrial, thyroid, and breast cancers. J.H. had also been having heavy vaginal bleeding, which was difficult for her caregivers to manage, and this was the reason she was brought into the emergency department. After attempting to gain as much information as we could from the caregivers, we started to perform an abdominal exam, which made J.H. extremely agitated. We quickly stopped the exam and the caregivers helped to calm J.H. We remember our mixture of emotions—bewilderment at the agitation and commotion in the exam room full of people, frustration at not being able to complete our exam fully, and annoyance that this “difficult patient” was taking up our limited time between surgical cases. Thankfully, these knee–jerk reactions were quickly replaced by feelings of concern for the patient and the realization of how frightening an experience this must be for her—being in a strange place with white walls and unfamiliar people, unable to communicate her thoughts.J.H.’s mother, her surrogate decision–maker, was not at the hospital that day but the caregivers told us that she had expressed a strong desire for her daughter to have a prophylactic hysterectomy due to her lifetime risk for developing uterine cancer as well as a permanent solution to the bleeding concerns. What had initially started as a simple ED consult was now turning into a complex question. The ethical and legal dilemma was obvious—whether to perform a major surgery that would irreversibly sterilize a patient who could not consent on her own behalf in order to minimize the potential risk of cancer later in life. While medical management could improve the bleeding and potentially reduce the risk of cancer, frequent exams would be necessary [End Page 19] to ensure that the medication was working and that premalignant changes were not occurring in J.H.’s uterus. However, based on our experience in the emergency department, J.H. would need anesthesia for such exams and it was doubtful the medications would completely normalize her elevated risk of uterine malignancy. We knew that in order to address this question, we would need to see J.H. again along with her mother to have a frank discussion about the risks and benefits of such a decision, and so we made plans to see her in our outpatient clinic.Several days later, J.H., her mother, and the group home caregivers arrived in the office. Anticipating a complex discussion, we had requested a representative from the hospital ethics committee to join us at the visit. We didn’t know what to expect meeting J.H.’s mother for the first time but as we sat in the room talking, it was obvious that she was truly trying to act in her daughter’s best interest. Similarly, it was touching to watch the faces of the caregivers from the group home as they nodded in solidarity with J.H.’s mother, also clearly wanting what was best for her and supporting her mother in this difficult decision. J.H., meanwhile, seemed content to sit silently with us during the discussion, surrounded as she was by people who cared deeply for her well–being.After extensive partnership with the ethics consultants... (shrink)

The power of technology to transform religions, science, and political institutions has often been presented as nothing short of revolutionary. Does technology have a similarly transformative influence on societies’ morality? Scholars have not rigorously investigated the role of technology in moral revolutions, even though existing research on technomoral change suggests that this role may be considerable. In this paper, we explore what the role of technology in moral revolutions, understood as processes of radical group-level moral change, amounts to. We do (...) so by investigating four historical episodes of radical moral change in which technology plays a noteworthy role. Our case-studies illustrate the plurality of mechanisms involved in technomoral revolutions, but also suggest general patterns of technomoral change, such as technology’s capacity to stabilize and destabilize moral systems, and to make morally salient phenomena visible or invisible. We find several leads to expand and refine conceptual tools for analysing moral change, specifically by crystallizing the notions of ‘technomoral niche construction’ and ‘moral payoff mechanisms’. Coming to terms with the role of technology in radical moral change, we argue, enriches our understanding of moral revolutions, and alerts us to the depths of which technology can change our societies in wanted and unwanted ways. (shrink)

Despite research establishing emojis as sites of critical racial discourse, there is a paucity of literature examining their importance in the increasingly popular context of mobile payments. This is particularly important as new forms of social payment platforms such as Venmo bridge the seamlessness of mobile payments with the vibrant communicative practices of social networks. As such, they provide a unique medium to examine how emojis are used within the context of digital consumption, and by extension, self-representation. This study analyzes (...) approximately 325 million public transactions on the U.S. payment platform Venmo to understand whether emoji usage in mobile payments is more hedonic or utilitarian. We then explore how race is represented across emoji usage on Venmo via tone-modified emojis, a subset of emojis whereby users can choose a skin tone. We found that while emojis in general are used for more hedonic purposes than utilitarian ones, darker tone-modified emojis indicate a proportionately higher use in hedonic consumption as compared to lighter tone-modified emojis, and also show a higher representation of utilitarian categories in transactions. Thematic analysis revealed that subsets with darker tone-modified emojis have a greater lexical variety and engage in more playful uses of emoji in mobile payments. (shrink)

This paper explores ethical concerns arising in healthcare integration. We argue that integration is necessary imperative for meeting contemporary and future healthcare challenges, a far stronger evidence base for the conditions of its effectiveness is required. In particular, given the increasing emphasis at the policy level for the entire healthcare infrastructure to become better integrated, our analysis of the ethical challenges that follow from the logic of integration itself is timely and important and has hitherto received insufficient attention. We evaluated (...) an educational intervention which aims to improve child health outcomes by making transitions between primary to secondary care more efficient, ensuring children and parents are better supported throughout. The programme provided skills for trainee paediatricians and general practitioners (GPs) in co-designing integrated clinical services. The key ethical challenges of integrated care that arose from a clinical perspective are: professional identity and autonomy in an integrated working environment; the concomitant extent of professional responsibility in such an environment; and the urgent need for more evidence to be produced on which strategies for integrating at scale can be based. From our analysis we suggest a tentative way forward, viewed from a normative position broadly situated at the intersection of deontology and care ethics. We adopt this position because the primary clinical ethical issues in the context of integrated care concern: how to ensure that all duties of care to individual patients are met in a newly orientated working environment where clinical responsibility may be ambiguous; and the need to orientate care around the patient by foregrounding their autonomous preferences and ensuring good patient clinician relationships in clinical decision-making. (shrink)

Although COVID-19 pandemic has re-orientated humans to be more physically healthy and hygienic, it has also persuaded humans to create affiliations and experience a sense of belongingness through social networks and digital technologies. However, amidst these changes, experiences of COVID-19 patients and their perception of the outside world's attitudes toward them appears to be less attended in literature which formed the basis for the current study's objectives. Using qualitative methodology, the present study explored the experiences, perceptions and attitudes of patients (...) and their care-givers' toward COVID-19. The thematic analysis emerged with four major themes. Psychological Experiences of People was generated prominently with sub-themes indicating the perceived experiences like fear of spreading diseases to others, and the need for psychological counseling. Attitude of others toward patients and caregivers revealed that family members and relatives played a major positive role on the patient's mental health, however, the neighbor's stigmatized attitude led to several undesired behaviors. Social Connectedness was another major theme derived from the study. Altruistic volunteers, a sub-theme of Social connectedness have indicated that amidst these negative factors, one can spread social harmony by motivating and supporting the victims with basic needs, financial support, hope and social empathy. Opinions of participants for digital technology through technological aids and preventive measures emphasized an overall positive attitude as it helped the society, in general to maintain social connections as well to curb the rate of COVID-19 cases. (shrink)

he importance of gender equality and of women’s work in relation to the environment is regarded as a crucial question for development in “third‐world” rural societies. “Development” and a certain standard of welfare make these issues appear to be less urgent in a wealthier country such as Sweden. In this article, I trace some of the contradictions and connections in the ways in which gender equality is conceptualized in women’s struggles vis‐à‐vis environmental issues in rural areas in Sweden and India. (...) The article throws light on two important insights: First, in Sweden, where gender equality has been actively pursued as the bedrock of modern societal organizing, the space to organize as women in relation to environmental issues was fraught with ambiguity. Second, development discourses about equality and empowerment of oppressed third‐world women not only bear on how gender equality is conceptualized and practiced in the global South but also shape the space for gender equality in the North. Analyzing the two cases in relation to each other reveals the travel of ideas and conversations across distant geographical spaces. While ideas about the independent, empowered woman are used to deny agency to women’s collectives in India, gendered discrimination has taken different forms in Sweden, making it more difficult to contest. Understanding how this takes place opens an opportunity for interruption in an order and a space that appears to have become narrower under the umbrella of development, welfare, and growth. It brings into question the category of development in a southern but particularly so in a northern context, where the North, and especially Sweden, is taken as a referent for questions of development and gender equality. -/- . (shrink)

We focus on alternative innovation pathways for addressing agricultural sustainability challenges in Odisha, India. The first pathway that we term as industrial, is focused on breeding new seed varieties in modern laboratories and test fields, ostensibly for climate resilience. It is driven by public scientific institutions and private corporations. The second pathway that we call agroecological, is grounded in saving and sharing of diverse local varieties, largely by Indigenous (Adivasi) smallholders and their allies in civil society. Using the pathways’ descriptions (...) as bases, we present perspectives of different professional groups who appraise how effectively each pathway addresses a range of sustainability issues. While all participants appraise the agroecological pathway to be clearly better performing for addressing agricultural biodiversity and cultural uses of rice, appraisals for issues of the economy, seed accessibility, stress tolerance, and nutrition diverged from each other. An overall picture in support of one pathway did not emerge. Embracing such ambiguities and uncertainties associated with appraisals, we argue for balancing political support between diverse pathways. Greater support for structurally marginalised agroecological pathways may be crucial to meet sustainability goals. This support can include the restitution of lands and other socio-ecological resources for marginalised pathways as well as guaranteeing autonomy of Adivasi (Indigenous) communities among whom the pathways thrive. (shrink)

What does it mean to study places in ‘crisis’ and how does that affect the research done on the ‘rural’? To be considered to be in crisis is not really new as any literature review of rural studies indicates. And yet, we live now in a new context, with new challenges for ‘rural’ research, in particular that of sustainability. Sustainability is the new policy focus and is increasingly reflected in research on rural Europe. Although scholars are beginning to theorize on (...) what is sustainable in and for rural areas, our intention is to take this further. We theorize on what the focus on crisis and, increasingly on sustainability, means for the research we do and the knowledge we produce on rural Europe. Our aim is to bring attention to the politics of past and present knowledge production on the rural to be able to imagine just and sustainable futures. In an analysis of literature primarily from Sweden and the UK, we argue that two construals, that of a rural crisis and that of rural–urban polarization, have set the tone for rural studies and may have overshadowed a more plural approach. We outline what might be needed from rural research to meet future challenges and what the notion of sustainability, with its emphasis on the entanglements of the social, economic and environmental, might mean for the future of rural research. (shrink)

This study investigates the impact of firms’ legacy institutional imprints on its engagement in corporate misconduct. We discover that a closed economic regime’s protectionist policies inscribe imprints in the form of opaque organizational routines and cause incumbent firms to develop competitive limitations. Utilizing the theoretical principles of the organizational imprinting theory, this research attests to the endurance of corruptive routines and argues that the degree of closed economy imprints increases firms’ engagement in income-increasing earnings management in the post-liberalization period. Furthermore, (...) we find that the impact of imprints is weakened by firms’ choices on international exposure and internal innovation. By utilizing the historical data on Indian economic policies from 1956 to 1991 and analyzing a sample of 18,432 firm-year observations for 2,396 listed Indian manufacturing firms from 1997 to 2007, we find support for our hypotheses. (shrink)

Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by (...) trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk–benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents’ unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents’ ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted. (shrink)

Feminist decolonial scholars have called for disengaging from the current system built on a hierarchical logic of race and gender central to modern, colonial thinking. They have looked to worlds outside the modern system to lead us out of current unjust practices harming both humans and the environment. Although policymaking may be seen as the stronghold of the current political agenda and of the structures that have led to the climate crisis, we argue that climate policies too, are also crucial (...) for rethinking and transforming societies. Our examination of climate adaptation policies in Sweden and the literature from Europe shows how policy documents ignore and unknow the oppressive intersections of gender and power despite the knowledge that exists on these issues in the public domain. Drawing on the tools of agnotology, we examine how this is achieved by strategies of ‘denial, dismissal, diversion and displacement.’ Building on feminist post and decolonial scholarship, we make explicit the gendered and racial hierarchies and dichotomies underpinning these policy documents. At the same time, we bring attention to the nuances in the policy documents we study and look for the openings that might be used to bring about transformation by making these hierarchies explicit and calling them into question. We argue that a transformation is possible through a feminist post and decolonial intervention, even in policymaking otherwise ignorant of culture, values and the colonial histories that have produced contemporary society. (shrink)

This special issue contributes to a grounded understanding about 'sustainability' in a range of rural contexts and in so doing sheds light on accompanying tensions and implications for the future of rural areas in Europe. It also brings attention to how the rural might be changing as a result of this new focus on sustainability. The 17 contributions bring to light crucial dimensions of sustainability: (1) the imperative of wellbeing, belonging and care; (2) dimensions of power and identity; (3) the (...) apprehension of time and space - in other words, sustainability as a process and always in transition; (4) social and spatial justice; and (5) the question of knowledge production on the rural and on sustainability. (shrink)